Legislative Hearing on: Discussion Draft: the “BEACON Act”; H.R.6444, the “Blast Overpressure Research and Mitigation Task Force Act”; H.R.6526, the “Clarity on Care Options Act”; Discussion Draft: the “Data Driven Suicide Prevention Act”; H.R. 2283, the “RECOVER Act”; Discussion Draft: the “Health Desert Reform Act”; H.R. 2426, the “Veterans Mental Health and Addiction Therapy Quality of Care Act”; H.R 6652: the “US Vets of the FAS Act”; H.R. 4509, the “NOPAIN for Veterans Act”; H.R. 5999, To amend title 38, United States Code, to direct the Secretary of Veterans Affairs to furnish an opioid antagonist to a veteran without requiring a prescription or copayment; H.R. 6001, the “Veterans with ALS Reporting Act”; Discussion Draft: the “Whole Health for Veterans Act.”

1[House Hearing, 119 Congress]2[From the U.S. Government Publishing Office]34                          LEGISLATIVE HEARING56=======================================================================78                                HEARING910                               before the1112                         SUBCOMMITTEE ON HEALTH1314                                 of the1516                     COMMITTEE ON VETERANS' AFFAIRS1718                     U.S. HOUSE OF REPRESENTATIVES1920                    ONE HUNDRED NINETEENTH CONGRESS2122                             SECOND SESSION23                               __________2425                       TUESDAY, JANUARY 13, 202626                               __________2728                           Serial No. 119-4229                               __________3031       Printed for the use of the Committee on Veterans' Affairs3233               [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]3435                    Available via http://govinfo.gov3637                               ______3839                 U.S. GOVERNMENT PUBLISHING OFFICE404163-300                    WASHINGTON : 20264243                     COMMITTEE ON VETERANS' AFFAIRS4445                     MIKE BOST, Illinois, Chairman4647AUMUA AMATA COLEMAN RADEWAGEN,       MARK TAKANO, California, Ranking48    American Samoa, Vice-Chairwoman      Member49JACK BERGMAN, Michigan               JULIA BROWNLEY, California50NANCY MACE, South Carolina           CHRIS PAPPAS, New Hampshire51MARIANNETTE MILLER-MEEKS, Iowa       SHEILA CHERFILUS-MCCORMICK,52GREGORY F. MURPHY, North Carolina        Florida53DERRICK VAN ORDEN, Wisconsin         MORGAN MCGARVEY, Kentucky54MORGAN LUTTRELL, Texas               DELIA RAMIREZ, Illinois55JUAN CISCOMANI, Arizona              NIKKI BUDZINSKI, Illinois56KEITH SELF, Texas                    TIMOTHY M. KENNEDY, New York57JEN KIGGANS, Virginia                MAXINE DEXTER, Oregon58ABE HAMADEH, Arizona                 HERB CONAWAY, New Jersey59KIMBERLYN KING-HINDS, Northern       KELLY MORRISON, Minnesota60    Mariana Islands61TOM BARRETT, Michigan6263                       Jon Clark, Staff Director64                  Matt Reel, Democratic Staff Director6566                         SUBCOMMITTEE ON HEALTH6768               MARIANNETTE MILLER-MEEKS, Iowa, Chairwoman6970JACK BERGMAN, Michigan               JULIA BROWNLEY, California,71GREGORY F. MURPHY, North Carolina        Ranking Member72DERRICK VAN ORDEN, Wisconsin         SHEILA CHERFILUS-MCCORMICK,73JEN KIGGANS, Virginia                    Florida74ABE HAMADEH, Arizona                 MAXINE DEXTER, Oregon75KIMBERLYN KING-HINDS, Northern       HERB CONAWAY, New Jersey76    Mariana Islands                  KELLY MORRISON, Minnesota7778Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public79hearing records of the Committee on Veterans' Affairs are also80published in electronic form. The printed hearing record remains the81official version. Because electronic submissions are used to prepare82both printed and electronic versions of the hearing record, the process83of converting between various electronic formats may introduce84unintentional errors or omissions. Such occurrences are inherent in the85current publication process and should diminish as the process is86further refined.8788                         C  O  N  T  E  N  T  S8990                              ----------9192                       TUESDAY, JANUARY 13, 20269394                                                                   Page9596                           OPENING STATEMENTS9798The Honorable Mariannette Miller-Meeks, Chairwoman...............     199The Honorable Julia Brownley, Ranking Member.....................     3100101                         SPEAKING FROM THE DAIS102103The Honorable Kimberlyn King-Hinds, U.S. House of104  Representatives, (MP-01).......................................     4105The Honorable Greg Landsman, U.S. House of Representatives, (OH-106  01)............................................................     5107The Honorable Pat Fallon, U.S. House of Representatives, (TX-04).     6108The Honorable Chris Deluzio, U.S. House of Representatives, (PA-109  17)............................................................     7110The Honorable Ryan Mackenzie, U.S. House of Representatives, (PA-111  07)............................................................     8112The Honorable Jack Bergman, U.S. House of Representatives, (MI-113  01)............................................................     9114115                               WITNESSES116117                                Panel I118119Dr. Mark Koeniger, Acting Assistant Under Secretary for Health120  for Patient Care Services, U.S. Department of Veterans Affairs.    10121122        Accompanied by:123124    Dr. Maria Llorente, Acting Assistant Under Secretary for125        Health for Integrated Veteran Care, U.S. Department of126        Veterans Affairs127128                                Panel II129130H.E. Charles Rudolph Paul, Ambassador Extraordinary &131  Plenipotentiary, Embassy of the Republic of the Marshall132  Islands........................................................    20133134Mr. James Whaley, Chief Executive Officer, Mission Roll Call.....    21135136Ms. Elizabeth McCoy, Associate Director, Government Affairs,137  Wounded Warrior Project........................................    22138139Ms. K. Conwell Smith, Deputy Chief, Military & Veterans Policy,140  American Psychological Association.............................    24141142                                APPENDIX143144                    Prepared Statements Of Witnesses145146Dr. Mark Koeniger Prepared Statement.............................    39147H.E. Charles Rudolph Paul Prepared Statement.....................    80148Mr. James Whaley Prepared Statement..............................    81149Ms. Elizabeth McCoy Prepared Statement...........................    82150Ms. K. Conwell Smith Prepared Statement..........................    89151152                       Statements For The Record153154Veterans of Foreign Wars of the United States Prepared Statement.    93155Easterseals Prepared Statement...................................    98156157                          APPENDIX--continued158159American Federation of Government Employees, AFL-CIO Prepared160  Statement......................................................   100161ALS Association Prepared Statement...............................   102162ALS United Prepared Statement....................................   103163The Honorable Jason Crow, U.S. House of Representatives, (CO-06)164  Prepared Statement.............................................   105165Dennis Boothe Prepared Statement.................................   107166Endeavors Prepared Statement.....................................   110167Fleet Reserve Association Prepared Statement.....................   111168Jewish War Veterans Prepared Statement...........................   115169Association of VA Nurse Anesthesiologists, Association of VA170  Psychologist Leaders, Association of VA Social Workers,171  National Association of VA Physicians and Dentists, Nurses172  Organization of Veterans Affairs, and Veterans Healthcare173  Policy Institute Prepared Statement............................   116174Cohen Veterans Network, Inc. Prepared Statement..................   121175Aspire Health Partners Prepared Statement........................   123176Berry Law Prepared Statement.....................................   125177Easterseals DC/MD/VA Prepared Statement..........................   152178Voices for Non-Opioid Choices Prepared Statement.................   153179Centerstone Prepared Statement...................................   156180The Up Center Prepared Statement.................................   157181Air Force Sergeants Association Prepared Statement...............   158182Tragedy Assistance Program for Survivors Prepared Statement......   159183VoteVets Prepared Statement......................................   161184Embassy of the Federated States of Micronesia Prepared Statement.   163185186                          LEGISLATIVE HEARING187188                              ----------189190                       TUESDAY, JANUARY 13, 2026191192                    Subcommittee on Health,193                    Committee on Veterans' Affairs,194                             U.S. House of Representatives,195                                                    Washington, DC.196    The subcommittee met, pursuant to notice, at 2:15 p.m., in197room 360, Cannon House Office Building, Hon. Mariannette198Miller-Meeks [chairwoman of the subcommittee] presiding.199    Present: Representatives Miller-Meeks, Bergman, Kiggans,200Hamadeh, King-Hinds, Brownley, Cherfilus-McCormick, Dexter,201Conaway, and Morrison.202203   OPENING STATEMENT OF MARIANNETTE MILLER-MEEKS, CHAIRWOMAN204205    Ms. Miller-Meeks. Come to order. The chair may declare a206recess at any point.207    I would like to welcome all the members and witnesses to208today's hearing. Today we will discuss 12 bills designed to209improve the lives of our Nation's veterans and the systems they210rely on for healthcare and health-related matters. I am looking211forward to a very productive discussion on each of these bills,212including the many that are focused on improving access to213mental healthcare.214    Speaking of productive, I would just like to acknowledge215that Ranking Member Brownley has decided to retire after this216term. I envy her, but I also want to say that she has been217longer on the Veterans Health Committee or the Veterans'218Affairs Committee longer than I have. This is my sixth year on219the committee and her dedication to our veterans and her input220has been invaluable. Thank you so much, Ranking Member Brownley221    Ms. Brownley. Thank you. Thank you. Thank you. Thank you.222    Ms. Miller-Meeks. Some of the bills that we will discuss223today is the Recognizing in Recognizing Community Organizations224for Veteran Engagement and Recovery (RECOVER) Act introduced by225Chairman Bost, which would help fund programs targeted toward226reducing nutrition and mental healthcare. Many veterans in227areas with limited access to care still face barriers when228seeking mental health services, especially in rural and remote229parts of the country. Provider shortages and capacity230constraints, for example, are but some of those many obstacles.231We know that in all of these rural areas or even urban areas232that telemedicine is beneficial, but still it can create233problems and challenges if you do not have provider access.234    The RECOVER Act would require the U.S. Department of235Veterans Affairs (VA) to carry out a 3-year pilot program under236which nonprofit outpatient medical health providers serving237veterans, who, for reasons outlined in the bill, may be more238likely to discontinue care, would be eligible for grant awards.239This bill would use existing resources more effectively while240working with providers to do more. As I said, telemedicine241works well in this area, so it still is an option. I am242thankful to Chairman Bost for his thoughtful legislation on243this matter to bridge the gap in care.244    The Veterans Mental Health and Addiction Therapy Quality of245Care Act introduced by Representative Fallon would require VA246to commission an independent study examining quality, access,247and outcomes for mental health and addiction treatment provided248both inside and outside the VA. This bill would ensure that we249continue to provide veterans with the best possible care to250meet their needs. I am proud to support it.251    The Veterans TBI Breakthrough Exploration of Adaptive Care252Opportunities Nationwide (BEACON) Act, introduced by General253Bergman, would direct VA to support research and clinical254trials focused on chronic mild traumatic brain injury, or mild255TBI. This would include nonpharmaceutical and community-based256rehabilitation approaches and independent research. Many257veterans experience long-term and sometimes debilitating258conditions because of mTBI. Despite the prevalence of these259injuries, work remains in research, treatment options, and260standard of care. This bill would lay the groundwork for future261decisions guided by evidence rather than assumptions. I thank262General Bergman for making sure the VA delivers care that263reflects the realities we are facing.264    I would also like to thank Representatives Mackenzie and265Jackson for their work on legislation addressing brain injury266and mental health issues affecting veterans. The Veterans267Healthcare Dessert--Desert Reform Act--you can tell I have not268had lunch yet; no, I am only kidding--the Veterans Health269Desert Reform Act of 2025, a bill I introduced, would direct VA270to pilot partnership with non-VA hospitals in an area where271care is lacking. This would allow veterans to receive care272equivalent to community care, and I have seen this in my own273district.274    Too many veterans living in rural areas across our Nation275face the challenge of living in a healthcare desert, an area276without a VA facility of any type within a realistically277accessible distance. In a health desert, basic care is278difficult to maintain and even the most routine care presents a279significant burden for veterans. My bill would fill geographic280gaps in access, again recognizing the importance of281telemedicine, ensuring that when VA facilities are not282realistically accessible, veterans can still access care closer283to home. This issue is a top priority for me and my bill is a284commonsense expansion of our veterans' access to healthcare. I285look forward to continuing this discussion and working on this286matter.287    The Clarity on Cares Option Act introduced by Ms. Kiggans288will would require VA to create and maintain a searchable289directory of providers who accept the Civilian Health and290Mental Program of the Department of Veterans Affairs, Civilian291Health and Medical Program of the Department of Veterans292Affairs (CHAMPVA). This would help ensure that beneficiaries293make informed choices about their care. Often, CHAMPVA294beneficiaries struggle to identify which healthcare providers295will accept their coverage. This leads to delays and confusion296for families already navigating a complex system, as we heard297in an earlier hearing. CHAMPVA is an important healthcare298program for dependents and survivors of our Nation's veterans.299I appreciate Ms. Kiggans' continued efforts to make that300coverage more usable in practice for families.301    I also want to thank Ms. King-Hinds for her diligence in302assuring that Freely Associated States (FAS) veterans are not303ignored. Her work on this matter is appreciated.304    This morning we are also joined by several of our305colleagues who will speak in support of their bills. We306appreciate their dedication to serving our Nation's veterans.307In accordance with committee rules, I ask unanimous consent308that the following members be permitted to participate in309today's committee hearing: Representative Pat Fallon,310Representative Ryan Mackenzie, Representative Greg Landsman,311and Representative Chris Deluzio. Without objection, so312ordered.313    I now yield to Ranking Member Brownley for any opening314remarks she may have.315316      OPENING STATEMENT OF JULIA BROWNLEY, RANKING MEMBER317318    Ms. Brownley. Thank you, Madam Chair, and thank you to our319witnesses today for providing your testimony on the legislation320we are considering.321    I am excited that we are considering several of my322Democratic colleagues' bills on today's agenda. I know the323sponsors of these bills will be on the first panel to speak324about the importance of those bills, so I will try to keep my325remarks brief. I appreciate my colleagues, Congressman Landsman326and Congressman Conaway, for introducing bills to build on VA's327work to protect veterans from the risk of opioid overdose.328    I am also glad we will consider Congressman Crow's329legislation to further our understanding of Amyotrophic Lateral330Sclerosis (ALS) and the causes of veterans' increased risk of331the disease.332    Finally, I look forward to considering Congressman333Deluzio's bill to ensure veterans are not overly burdened by334copays for participating in VA Whole Health Services.335    However, I must express some serious concerns about several336of the Republican-sponsored bills on today's agenda. The337RECOVER Act, the BEACON Act, the Health Desert Reform Act, and338the Data Driven Suicide Prevention Act share a common theme:339they all siphon money from existing VA programs and redirect it340to outside organizations and providers to do the very same341things VA is already doing, but with fewer guardrails and fewer342requirements to ensure quality of care. Taken together, these343bills represent a concerted effort to circumvent VA's direct344care program and research enterprise and create no-strings-345attached handouts of VA funding to private companies. Not only346is this wasteful and duplicative, but it could lead to a347further fracturing of continuity of care for are veterans.348    Worse still, the grant programs that would be created by349the RECOVER Act and the BEACON Act lack meaningful mechanisms350of oversight for VA to ensure that veterans are receiving the351quality care and evidence-based standards of care through these352grant programs.353    I am on record acknowledging that there will always be a354place for community care in geographic regions and in355specialties where VA cannot directly provide needed care.356However, there is a difference between participating in the357community care network and creating competing and duplicative358programs through which private providers can be paid to deliver359care with minimal requirements for veteran cultural competency,360care coordination, and communication with VA, all the while361avoiding rigorous oversight of care outcomes. This is what will362happen if the RECOVER Act and the BEACON Act and the Health363Desert Reform Act are allowed to become law.364    If private providers wish to provide care to veterans, they365should ensure they can meet the VA Community Care Network366requirements and enroll in that instead. I do not believe we367should be creating carve-outs or grant programs that would368allow private providers to avoid the requirements of the VA369Maintaining Internal Systems and Strengthening Integrated370Outside Networks (MISSION) Act and still financially benefit371from VA funding.372    I would note that many organizations who have gone on the373record supporting these bills already participate in VA's374Community Care Network and some are already receiving grants375from VA's Staff Sergeant Parker Gordon Fox Suicide Prevention376Grant Program. It seems to me that creating new grant programs377for which these organizations are uniquely eligible under the378RECOVER Act and the BEACON Act does nothing but enable these379organizations to double or triple dip and receive380reimbursements for community care in addition to the new grant381funding. That does not seem fiscally responsible to me.382    I will continue to oppose legislation that does nothing to383ensure veterans receive quality care and instead simply siphons384money from VA straight into the pockets of private entities385without any guardrails. I am looking forward to hearing from386our witnesses today and to some productive rounds of questions.387    With that, I yield back, Chairwoman Miller-Meeks.388    Ms. Miller-Meeks. We will limit the time to 3 minutes per389bill to ensure we can move in a timely manner. General Bergman,390if you are not ready to go, I am going to recognize Ms. King-391Hinds. You are up unless you are not ready and I will go to Ms.392King-Hinds.393    Okay. Ms. King-Hinds, you are recognized for 3 minutes to394speak on your discussion draft of your bill.395396               STATEMENT OF KIMBERLYN KING-HINDS397398    Ms. King-Hinds. Thank you, Chairwoman Miller-Meeks, and399thank you to the ranking member and to my colleagues for the400opportunity to speak today. I am proud to discuss my bill, H.R.4016652, a bill that is about honoring a commitment Congress made402just 2 years ago through the Compact of Free Association (COFA)403Amendments Act and ensuring that the Department of Veterans404Affairs follows through on that promise.405    FAS citizens serve in the U.S. military at among the406highest rates per capita. However, the brave FAS citizens who407have chosen to return home after their service face408disproportionate challenges to receiving their full benefits,409including access to medical care when residing in their Pacific410Islands. When the COFA Act was enacted, it recognized a411longstanding obligation to veterans and families from the412Freely Associated States. The United States agreed to expand413access to care and to ensure that those veterans will no longer414be left behind because of geography or administrative415discretion. Despite that clear intent, implementation has416remained stalled and too many veterans are still waiting for417those commitments to translate into real, reliable care.418    H.R. 6652 is necessary because the promise alone is not419enough. This bill makes clear that VA must fully deliver on420what they agreed to under the COFA Act. It ensures that421essential components of care are not treated as optional, but422as required parts of the services veterans receive.423    This bill does not require anything extraordinary. It424ensures access to telehealth, mail order pharmacy services, and425makes beneficiary travel more accessible. This legislation426provides clarity, consistency, and accountability so that427veterans and their families can depend on the care they were428promised rather than navigating uncertainty or delays.429    Our veterans upheld their end of the bargain through their430service to this country. Congress acted through COFA and now it431is time for VA to make good on that agreement. I look forward432to working with my colleagues in the Department of VA to ensure433this promise is fully and finally kept.434    I yield my time.435    Ms. Miller-Meeks. Thank you, Representative King-Hinds.436    The chair now recognizes General Bergman for 3 minutes for437any comments he may have on his bill.438    General Bergman yields.439    The chair will now recognize off-committee members to speak440for 3 minutes on behalf of their legislation. The chair441recognizes Representative Landsman for 3 minutes.442443                   STATEMENT OF GREG LANDSMAN444445    Mr. Landsman. Thank you, Madam Chair. Thank you to all the446members, Ranking Member, for having me in today's legislative447hearing and allowing me to talk about my bill, H.R. 4590, the448NOPAIN for Veterans Act. I also want to thank our co-leads,449Representatives Van Orden, Pappas, Bergman, Sewell, and450Hamadeh, for partnering with me on this important issue.451    The opioid epidemic is a--it is a disaster, right, you452know, across the board. It has really hit our veterans and you453all know that. This is a really frustrating situation because454there are all these U.S. Food and Drug Administration (FDA)-455approved nonopioid pain treatments for veterans, for everybody.456The VA will not provide those to veterans even though the FDA457has approved them and they work and veterans are asking for458pain relief that will not ruin their lives. The VA is saying459no, no, no, it is going to require an act of Congress to update460what we can provide to veterans.461    As such, we are trying to get this bill onto the floor or,462you know, onto the docket and pass. There is a companion bill463in the Senate. We can get this done. It will make a big464difference for veterans who are asking for, looking for465nonopioid, you know, based pain relief.466    You know, the statistics are staggering, but you all know467just how problematic, you know, this addiction can be. Our468veterans are going through all kinds of--you know, dealing with469all kinds of issues that require some pain management. Again,470this just would allow the VA to provide veterans with what471Medicare folks and other folks in the private sector or with472private insurance get, which is a slew of nonopioid-related or473nonopioid-based pain relief.474    Hopefully, we can get this on the floor or on the docket. I475appreciate your efforts in letting me speak here and encourage476everyone to vote for it, encourage their colleagues and folks477in the Senate to do the same so we can get this passed.478    Thank you. I yield back.479    Ms. Miller-Meeks. The gentleman yields.480    The chair now recognizes Representative Fallon for 3481minutes to speak on his bill.482483                    STATEMENT OF PAT FALLON484485    Mr. Fallon. Thank you, Madam Chair, for the opportunity to486discuss our bill, H.R. 2426, the Veterans Mental Health and487Addiction Therapy Quality Care Act. This bill is an important488step in ensuring that our veterans are receiving the best489possible care across all treatment settings and to identify490gaps and, for that matter, best practices that could inform491future policy.492    Today, approximately 18 veterans die of suicide daily. It493is 18 too many. This is not an abstract number. These are real494men and women who served our Nation. Not only they return home495and they continue fighting battles, and all too well--or all496too often, unfortunately, they fight those alone. This bill497arises from a longstanding concern about how to best serve498veterans' mental health and addiction care needs, particularly499in light of the mixed delivery systems and persistent suicide500and treatment access challenges.501    Over the last decade, Congress has worked in a bipartisan502way to expand access to care, including through community care503programs that allow veterans to seek treatment outside the VA.504That effort was necessary and well intentioned. However, access505alone is not enough. Quality matters and outcomes matter. Lives506matter depend on it.507    H.R. 2426 addresses an important fundamental question: are508we truly delivering the highest quality mental health and509addiction care to our veterans, regardless of where that care510is provided? What we still lack is an independent, objective511assessment of how mental health and addiction therapy delivered512by VA providers compares with care delivered by non-VA513providers. Competition is a good thing. This bill directs that514such a study be undertaken by the Department of the VA, and it515will do two things primarily. One, assess the quality of care516across a broad set of modalities, including telehealth,517inpatient, outpatient, intensive outpatient, and residential518treatments. Second, perhaps most importantly, the Department519must make the findings of that report public.520    If the outcomes of this study show strengths, we should, of521course, build on them. If they reveal gaps in community care,522we should fix them because we must fix them. If it reveals523exceptional care in any facet, we need to replicate that524success everywhere.525    Here is the bottom line. Suicide rates are unacceptably526high. Doing nothing is not acceptable. Our veterans and their527families are being devastated by suicide and we have the528ability and the obligation to demand accountability and work529toward improvements.530    I want to thank my colleagues on both sides of the aisle531who have supported this legislation, specifically our532Democratic co-lead, Representative Sanford Bishop. I would also533like to thank the veterans advocates who continue to rightfully534push us to do better.535    This is not a partisan issue. It is a national536responsibility. I urge this esteemed subcommittee to give H.R.5372426 thoughtful consideration and swift action. Our veterans538have already given us so much and given so much to this539Republic. We owe them the care that is worthy of that540sacrifice.541    Thank you, Madam Chair. I yield back.542    Ms. Miller-Meeks. The gentleman yields.543    The chair now recognizes Representative Deluzio for 3544minutes for any comments he may have on his bill.545546                   STATEMENT OF CHRIS DELUZIO547548    Mr. Deluzio. Thank you, Chairwoman Miller-Meeks, Ranking549Member Brownley. It is great to be back in front of the Health550Subcommittee. Thank you for having me and considering my bill,551H.R. 6848, the Whole Health for Veterans Act.552    This bill will help more of my fellow veterans improve553their health and well-being through access to the VA's Whole554Health program. I know the subcommittee members know that VA555Whole Health, it is a comprehensive program. It helps veterans556build a personal health plan that works for them as directed by557their care team. It does things like teach veterans to treat558their health proactively, provides resources and oversight for559things like strength and mobility training, and is tailor made560to help each veteran meet their own unique goals. When veterans561are more actively involved in their own care, it improves562healthcare outcomes and in turns can lower healthcare cost.563    I have seen this in action in VA Pittsburgh. I have heard564from veterans who are part of this program and they talk about565how it saved them from surgery or other interventions that566could be much more costly and invasive in their lives. I think567it is something for us to build on. I think it is common sense568that we can make this program available to all veterans.569    Unfortunately, last October, copays were introduced,570charging Veterans Health Administration (VHA) priority groups 6571through 8 veterans $15 per visit. Around that time I heard from572a constituent, a veteran who loves this VA Whole Health program573and the care he gets there, but talked about how he would be574unable to participate due to the cost now for the program.575    My bill addresses this to fix the problem by codifying an576already existing prohibition on copays for priority groups 1577through 5 veterans and then caps the monthly copayments for578other priority groups at $30 a month. Veterans who want to579improve their health and work with their care team I think580should be able to do it without paying a fortune. VA healthcare581ought to be the best in the world.582    As I understand it, VA has provided some feedback on the583bill. I looked at it. I think there are issues that we can edit584and incorporate and update on this bill and work through. I am585excited to work with the subcommittee. I invite support from586both parties here, Madam Chair.587    I yield back.588    Ms. Miller-Meeks. The gentleman yields.589    The chair now recognizes Representative Mackenzie to speak590for 3 minutes on his bill.591592                  STATEMENT OF RYAN MACKENZIE593594    Mr. Mackenzie. Thank you, Madam Chair. It is a pleasure to595join the House Committee on Veterans' Affairs. Before I begin,596I would like to extend my thanks to all of our veterans for597their service to our country.598    Veteran suicide remains an urgent challenge facing our599country. Despite years of effort, the overall rate has remained600stubbornly high. Too often we learn after the fact that many of601the warning signs were missed. One of the most troubling602realities is that more than half of our veterans who died by603suicide were not engaged with VA healthcare in the years before604their death. That tells you something important, that605traditional episodic screening, often based on self-reporting,606is not enough to identify risk early and consistently.607    That is why I am introducing the Data Driven Suicide608Prevention and Outreach Act of 2025. The bill directs the VA to609establish a time-limited competitive grant program to support610the development of predictive models that can identify risk611factors before the crisis point. They can do that by612responsibly integrating benefits data, service records, and613clinical information.614    By leveraging new technologies, we have the potential to615revolutionize how we treat and monitor the crisis of veteran616suicide, providing more opportunities for timely intervention617that will ultimately save lives. Importantly, this bill does618not replace clinicians, nor does it create a black box619algorithm. Instead, it empowers decision-makers and builds on620the VA's knowledge of what works. Initiatives like the Recovery621Engagement and Coordination for Health-Veterans Enhanced622Treatment (REACH VET) program have shown that predictive623analytics can help flag veterans at elevated risk and prompt624earlier outreach and care engagement.625    What this legislation does differently is encourage626innovation with guardrails. Grants are limited to organizations627with demonstrated expertise in healthcare Artificial628Intelligence (AI), data security, and clinical deployment.629Models must be explainable, interoperable, and clinically630actionable. They must comply with VA cybersecurity standards631and any findings must be shared with the VA for systemwide632evaluation.633    We also intentionally prioritize areas with elevated634suicide risks and high crisis volumes with the suicide hotline.635Also, we look at where there are long mental health wait lines636and we can help prevent duplication of efforts or a missed637opportunity to intervene.638    Artificial intelligence holds promise, but it is still new639and carries real risks which we want to recognize and this bill640takes a balanced and measured approach with a pilot program.641Stakeholders have emphasized that these predictive schools can642be helpful. I have seen it in my local community where health643networks utilize AI running in the background. Again, it644becomes a force multiplier where doctors can then go out and645actually treat more of these situations that deserve their646attention and should be prioritized.647    I would like to thank the chair for recognizing us and648allowing me to be able to be with the committee today and649appreciate the consideration of this important legislation.650    Thank you. I yield back.651    Ms. Miller-Meeks. Thank you, Representative Mackenzie.652    As is our practice, we will forego a round of questioning653for the members. For those off-committee members, you may654remain to ask questions later if you desire.655    Our first panel is already at the table. Excuse me. The656chair now recognizes General Bergman to speak for 3 minutes on657his bill.658659                   STATEMENT OF JACK BERGMAN660661    Mr. Bergman. Yes. Thank you, Chairwoman. There seemed to be662a slight disconnect here when I walked in. I did not think I663was going to be speaking on this. We will get our staffs664together to make sure that we know when the timing is right.665Thanks for the opportunity. This is a discussion draft of the--666what we have titled the BEACON Act, and it is Veterans TBI667Breakthrough Exploration of Adaptive Care Opportunities668Nationwide Act.669    The bill would direct the Secretary of the VA to carry out670programs awarding grants to eligible entities to study and671conduct randomized control trials with respect to the672neurorehabilitation treatments for chronic mild traumatic brain673injury. Additionally, grants would be available to design those674treatments as well as measure the effectiveness of already675funded treatments. Nonprofits, academic institutions, and676healthcare providers with expertise in neurorehabilitative677therapies would be eligible.678    In the analysis of this, the randomized control trials679measure the effectiveness of a new intervention or treatment680and have been recognized as the gold standard for effectiveness681research. The bill would dedicate resources to a prevalent682issue, like lost TBIs that occur each year as mild TBIs or683concussions.684    This is not about, as we hear so many times, privatizing685the VA. This is enabling the Veterans Administration through686grant process to enable other scientific entities to do more687breakthrough therapies that are going to not only help688veterans, but also others that suffer from mild TBI.689    With that, I yield back.690    Ms. Miller-Meeks. Thank you, General Bergman.691    Joining us today from the Department of Veterans Affairs692are Dr. Mark Koeniger, VA's acting assistant undersecretary for693Health for Patient Care Services. He is accompanied by Dr.694Llorente, VA's acting assistant under secretary for Health for695Integrated Veteran Care.696    Dr. Koeniger, you are now recognized for 5 minutes to697present the Department's testimony.698699                   STATEMENT OF MARK KOENIGER700701    Dr. Koeniger. Good afternoon, Chairwoman Miller-Meeks,702Ranking Member Brownley, and members of the subcommittee. Thank703you for the opportunity to testify today on several bills that704would impact VA healthcare programs and services.705    As a family practice physician, I understand the importance706of comprehensive patient-centered care and the trust that707veterans place in us. My nearly 37 years in uniform have708strengthened my commitment to delivering the highest quality709care. I had the privilege of commanding the largest U.S.710military hospital in Iraq during 2009 to 2010, an experience711that underscored the value of coordinated, timely care in712saving lives. Today, as acting assistant undersecretary for713Health for Patient Care Services, I oversee 16 national program714offices that support a wide range of clinical professions and715care settings, including geriatrics, rehabilitation, and whole716health. These experiences guide my work as we strive to717strengthen VA healthcare for all who have served.718    I am joined by Dr. Maria Llorente, acting assistant719undersecretary for Health for Integrated Veteran Care.720    Before we begin, I would like to apologize for the delay in721providing testimony to this committee. VA is working on process722improvements internally as well as externally to make sure this723is prevented in the future. While I will briefly highlight VA's724position on several bills, my full written testimony provides725detailed views on all 12 bills under consideration.726    Turning to the substance of the legislation, several of the727bills on the agenda would require VA to establish new grant728programs. VA has concerns with these bills as grants may not be729the most appropriate means of providing the intended support.730Grants are one way, but not the only way for providing731financial assistance to nongovernmental agencies. VA would732welcome the opportunity to discuss these bills further with the733committee and to determine if a different structure might be734more appropriate.735    First, regarding the RECOVER Act, VA strongly supports736efforts to expand access to veteran-centric, evidence-based737mental health. While we have concerns with certain provisions738in the bill, we greatly value the committee's leadership in739this issue and welcome the opportunity to work together on740approaches that strengthen care coordination and deliver the741greatest impact for veterans.742    Second, VA supports the Veterans Mental Health and743Addiction Therapy Quality of Care Act, subject to amendments744and the availability of appropriations. This bill is consistent745with VA's current efforts to compare the quality of VA and non-746VA mental health and addiction therapy care.747    Third, although VA appreciates the intent of the NOPAIN for748Veterans Act, this bill would undermine VA's well-established749evidence-based formulary process which ensures medications are750safe, effective, and economical.751    Fourth, regarding H.R. 5999, VA supports expanding access752to opioid antagonists subject to amendments and appropriations.753While naloxone is already widely available at no cost to754enrolled veterans, eliminating prescription requirements could755increase risks of waste and fraud.756    Fifth, regarding the Veterans with ALS Reporting Act, the757VA supports the intent, but some provisions may duplicate758existing efforts. We welcome the opportunity to collaborate on759strategies that advance research and care without diverting760resources from patients.761    Similarly, the Veterans Health Desert Reform Act762underscores the importance of improving access for rural763veterans, a goal VA strongly supports. However, the bill as764written appears to create no new authority to further this765goal.766    Finally, VA appreciates the committee's focus on innovation767through research and technology, including proposals related to768traumatic brain injury and suicide prevention. These are769critical areas where VA invests heavily.770    In closing, VA remains steadfast in its commitment to771delivering world-class healthcare to veterans. We share the772committee's goals of improving access, quality, and outcomes,773and we look forward to working with you to refine these774proposals so they strengthen care without unintended775consequences.776    We are happy to answer any questions you may have.777778    [The Prepared Statement Of Mark Koeniger Appears In The779Appendix]780781    Ms. Miller-Meeks. Thank you, Dr. Koeniger.782    As is my usual practice, I will reserve my time until after783all members have had a chance to ask their questions.784    I now recognize Ranking Member Brownley for 5 minutes for785any questions she may have.786    Ms. Brownley. Thank you, Madam Chair. I think I wanted to787direct this question to Dr. Llorente. As I cited in my opening788comments, and VA cited as well, significant concerns with the789RECOVER Act. Among other things, your written testimony points790out that grantees would be able to receive financial support791from VA in the form of grant funds, still be able to bill the792VA for services under the existing VA Community Care Program,793and also be able to bill veterans' other healthcare insurance.794I cannot see how this makes sense to me. Well, three795opportunities to perhaps triple dip with the VA.796    VA already has a community care network. Why is it797important to adhere to the community care eligibility and798authorization process that was established under the MISSION799Act?800    Dr. Llorente. As you pointed out, the Community Care801Program does have a series of requirements to make sure that802the providers who are delivering services to veterans have the803needed credentials, have the privileges, and offer the quality804of care that we expect they will deliver. That is, in fact, one805of the concerns that we do have with the bill as written. It806does not really specify requirements and, as written, a807community provider could potentially get one of these grants808and offer services through one of these grants that might not809be eligible, might not meet the requirements under the810Community Care Program. It is why we really do welcome an811opportunity to work with Congress to revise the language so812that we can address some of these concerns.813    Ms. Brownley. Thank you for that. To follow up on another814bill, VA already administers the Staff Sergeant Parker Gordon815Fox Suicide Prevention Grant Program, which is intended to816address the upstream factors that contribute to suicide risk,817such as housing and employment instability and lack of social818support and engagement. We also have the Veterans Comprehensive819Prevention, Access to Care, and Treatment (COMPACT) Act, which820allows VA to cover emergency treatment for veterans821experiencing acute suicidal crises. Both the Fox Grant Program822and the COMPACT Act program serve veterans regardless of823whether they are enrolled in or otherwise connected to VA824healthcare.825    Given that, does VA think it needs the grant program that826would be created under the RECOVER Act, or would it be827duplicative?828    Dr. Llorente. As was described by Dr. Koeninger, one of the829questions that we have is whether a grant process or a grant830program is the most effective mechanism to expand access to831especially mental health and suicide prevention care for832veterans. VA is always looking for opportunities to expand833access to those types of services because we recognize that834there are areas of the country where it may be more difficult835to access those types of services.836    Again, we would really like to work with the committee,837first, to determine what is the most effective mechanism to be838able to conduct a pilot program so that we can be cost-839effective. At the same time, if there is an opportunity to840expand services, we take that opportunity.841    Ms. Brownley. Thank you for that. Probably the last842question that I have time for, Dr. Koeninger, is there any843statutory or practical barrier to VA, either through its844existing research infrastructure or through its academic845affiliates program, being able to research, develop, and846implement novel or alternative treatments for TBI?847    Dr. Koeniger. Ma'am, I will have to take that question back848to look in to make sure that there are no or are statutory849requirements. I just do not have that information offhand, but850I can get back to the committee.851    Ms. Brownley. Okay. Let us see. I think I do not have time852for this, so I will yield back.853    Ms. Miller-Meeks. Thank you, Ranking Member Brownley.854    The chair now recognizes Representative Hamadeh for any855questions he may have.856    Mr. Hamadeh. Thank you, Chairwoman. President Trump has857made veterans his priority again. He has expanded community858care, slashed bureaucratic red tape, and put the veteran, not859the bureaucracy, first. I am with him all the way.860    Now the Veterans Assuring Critical Care Expansions to861Support Servicemembers (ACCESS) Act and my Coordinating and862Aligning Records to Improve and Normalize Governance for Our863Veterans Health (CARING) Act are built on the same foundation.864Veterans deserve seamless access to care, whether it is inside865the VA or in the community. Dr. Koeniger, can you explain to me866step by step, how are you implementing the President's867directive to ensure medical records actually follow the868patient?869    Dr. Koeniger. I am going to defer to my colleague, Dr.870Llorente.871    Dr. Llorente. The medical records are really bidirectional.872When we refer veterans to community providers, we first have to873provide them with some sort of consultation or referral. In874some cases that referral will include information about875laboratories, diagnostic imaging, so that the community876provider understands what is being asked when the veteran is877referred.878    Similarly, once the community provider completes their879evaluation, their treatment recommendations, they send those880records back to the VA. At the present time, unfortunately,881there are several different ways in which those records come to882the VA. One of the things that we are in the process of doing883through the Request for Proposals (RFP) that is currently in884solicitation, that has been published, is to be able to885streamline those efforts where the Third Party Administrators886(TPA) that received the award will create essentially a portal887where the medical records from the community providers will now888be centralized in order to be able to streamline that process.889    Mr. Hamadeh. Has this been attempted before?890    Dr. Llorente. To the best of my knowledge, no, but I am891happy to take that back and get additional information.892    Mr. Hamadeh. How long until the RFP is selected?893    Dr. Llorente. We are expecting to make the awards, I894believe in March. There is a 90-day review period and I think895the awards--the solicitation closes at the end of this month.896    Mr. Hamadeh. How long will it take to be implemented?897    Dr. Llorente. It will take approximately a year.898    Mr. Hamadeh. You know, that is the biggest concern that899when I go back to my district, there are a lot of veterans, you900know, they lose their medical records, the VA does, the901community care. I really encourage the Department to really902prioritize this because this is a constant theme I hear.903    Can you assure us after this is implemented, hopefully when904you have the right RFP that you select, that the veteran is not905going to be waiting weeks for community providers' records to906actually reach the VA.907    Dr. Llorente. You have my assurance that that is--the908absolute goal, is that we are going to be receiving these909records and then being able to upload them into the veteran's910electronic health record. The specific mechanics are not911currently in place, unfortunately, that is about the extent of912what I can say right now.913    Mr. Hamadeh. Do you anticipate this actually cutting it,914time, significantly?915    Dr. Llorente. Yes.916    Mr. Hamadeh. Arizona has many rural communities that are917miles from the nearest VA facility. President Trump understands918that the veteran in rural Arizona matters just as much as the919one here in Washington, DC. Now, the Veterans Health Desert920Reform Act we are considering today addresses this head-on. How921is the VA proactively identifying these medical deserts right922now?923    Dr. Koeniger. The VA has certain processes in place that--924within the Office of Rural Health. That office has been up and925running for quite some time now. They have identified a lot of926areas in--where veterans have to travel extended periods to get927to healthcare. They have--again, through the Office of Rural928Health, we are engaging with those veterans on a regular basis.929    Mr. Hamadeh. Do you wait for the veteran to bring this930issue to you or are you being proactive about it?931    Dr. Koeniger. No, the office is proactive in terms of932outreach to veterans.933    Mr. Hamadeh. I yield back.934    Ms. Miller-Meeks. The gentleman yields.935    The chair now recognizes Dr. Conaway for 5 minutes for any936questions he may have.937    Mr. Conaway. Thank you, Madam Chair, and thanks to Ranking938Member Brownley for bringing us here today to discuss these939important pieces of legislation.940    I want to discuss a particular vulnerability that veterans941have with respect to their use of opioids. Many people in the942service have chronic pain from service-related injuries and943other trauma. People with chronic pain, as I am sure you are944aware, are at higher risk of opioid reliance. Some 289,000 vets945have used opioids in the short term and there are 162,000946veterans who are on long-term opioid use as of data in 2023.947Thank you.948    Would you describe, and the standard of care is that,949particularly for people on long-term opioid use, that naloxone950be available as a preventative for death related to opioid use.951Would you describe the current process by which a veteran who952has VA benefits can receive naloxone, this standard of care953treatment to prevent preventable opioid-related deaths?954    Dr. Koeniger. Right now a veteran can walk up to a pharmacy955and if they are high risk, there are standing orders with the956pharmacy, so they can ask the pharmacist and the pharmacist957uses those standing orders to provide the veteran with the958naloxone. Again, the naloxone is provided free of charge to959veterans. We also distribute naloxone through health fairs and960other means.961    Mr. Conaway. That is very good. They can get the962prescriptions--they can get their naloxone in the various forms963without a prescription. Also, I guess in pill form because it964does have uses in helping people that have alcohol dependence965as a problem and preventing--or helping people to relieve966themselves or at least get beyond alcohol dependence. It is967free access. It mirrors a lot. You would say, the VA system is968mirroring what many states have done in this area by providing969easier access to this life-saving chemotherapeutic?970    Dr. Koeniger. Yes, sir.971    Mr. Conaway. Moving on, discussing another piece of972legislation on the list today. Can you--I understand there is a973current process through which providers and patients can submit974formal requests for new drugs to be included in the VA National975Formulary. Can you briefly explain what that process is and how976long it takes on average for requested drugs to be added to the977formulary?978    Dr. Koeniger. Veterans, of course, we have medications that979are on the formulary and that are not. All FDA approved980medications, veterans have access to all of them. If it is not981on the formulary, a veteran can go to their provider, ask the982provider for a prescription, and generally within 96 hours will983get the medicine.984    Mr. Conaway. Now, my understanding is that the U.S.985Department of Defense (DOD) formulary and the TRICARE formulary986is broader than what is available to veterans receiving VA987care. One of the pieces of legislation seeks to ensure that the988veteran who relies on VA care for their healthcare, that they989have the same easy access to drugs that are already approved in990other Federal formularies. Your thoughts on that?991    Dr. Koeniger. I am not aware of the specifics of what DOD992has on their formulary. I would have to get back to you with993specifics.994    Mr. Conaway. Okay, thank you. That ends my questions. Thank995you both.996    Ms. Miller-Meeks. The gentleman yields.997    The chair now recognizes Representative King-Hinds for 5998minutes for any questions she may have.999    Ms. King-Hinds. Thank you, Madam Chairwoman. Fun little1000fact, the Northern Mariana Islands is a part of the Greater1001Micronesia. The folks from the COFA states, the Republic of the1002Marshall Islands, the Federated States of Micronesia, Palau,1003you know, we are all Micronesians. One of the commitments that1004I made was that I was going to be their champion here in1005Congress because they do not have representation, although they1006have served this country. I thank you for the opportunity to1007have this conversation today regarding my bill.1008    Dr. Koeniger, you, in your testimony, you referenced the1009unique legal consideration involved in extending VA benefits to1010veterans from the Freely Associated States. You specifically1011mentioned that the Department continues to support a phased1012implementation approach to ensure durable access to care and1013continuity of services, particularly in geographically isolated1014and high-risk environments. I guess I want to understand that1015statement a little bit more and I wanted a clarification on1016what specific legal questions the VA is still working through.1017    Dr. Koeniger. Ma'am, I am going to defer to Dr. Llorente on1018that question.1019    Dr. Llorente. To provide some examples, let us talk about1020the medications. There are certain medications that can be1021transported based on Department of Transportation regulations1022and laws. Then there are others that are considered hazardous1023and cannot be transported or cannot be easily transported.1024There are certain medications that require certain types of1025refrigeration. Those would be logistically complicated to be1026able to send via mail order to, as you described, very--you1027know, in some cases, some fairly isolated areas over a broad1028geographic distance. I am not saying that it is impossible to1029do some of these things, but we would need to be able to figure1030out how to do it. That is on our side.1031    On the FAS side, we would also need to understand what are1032their regulations, what are their restrictions, if they have1033any, with respect to the use of medications? Are there some1034medications that they do not allow? That is just an example of1035the types of things that would have to be worked out in1036agreements.1037    Similarly on the provider side. We have the authority for1038U.S. providers to deliver services, for example, via1039telehealth, but those providers do not necessarily right now1040have licenses, if you will, to practice medicine in the1041Federated States. It is something that would have to be worked1042out in the agreement.1043    These are just a couple of the examples of just the types1044of logistical issues that would need to be worked out. We1045welcome the opportunity not only to work with Congress, but to1046work with our interagency partners in order to see what we can1047do with respect to the options that would be available to1048deliver the services.1049    Ms. King-Hinds. Are those regulatory changes that are1050required or are there specific laws which prohibits these1051agreements from being negotiated? How does that interplay with1052regards to what the commitments that we have made with the COFA1053agreement that was passed 2 years ago?1054    Dr. Llorente. I would respectfully request that you allow1055me to take that back for the record because I do not know the1056answer to your question.1057    Ms. King-Hinds. Okay. Well, thank you for that.1058    My other question is, you know, one of the issues that were1059raised with regards to this legislation is the cost, right, and1060what has been done basically to kind of more fully vet what1061that looks like. Whenever cost comes up, it kind of aggravates1062me because we did not talk about costs when, you know, folks1063from the FAS signed up and served our country. Right? Where are1064we at with that?1065    Dr. Llorente. Yes, so we have been working at trying to1066examine and evaluate what some of the potential costs would be1067based on the types of services that would be offered, the types1068of medications that are likely to be needed, and then the1069beneficiary travel component to try to come up with an1070estimate. The cost estimates also would necessarily be a result1071of what the actual utilization turns out to be. That is not1072something that we know right at this point in time. It is1073something that we are working on to try to see if we would not1074be able to obtain an estimate and a projection.1075    Ms. King-Hinds. All right, thank you. I am out of time. I1076yield back.1077    Ms. Miller-Meeks. Thank you very much, Representative King-1078Hinds.1079    The chair now recognizes Representative Cherfilus-McCormick1080for 5 minutes for any questions she may have.1081    Ms. Cherfilus-McCormick. Thank you so much. Thank you for1082our witnesses who are here.1083    I have so many questions. Florida's district is--Florida1084has some of the top numbers of our veterans who we serve. I1085hear a lot from them that one of the issues they have, not just1086the distance and how long it takes them, I have some people who1087tell me it takes them a day to actually get to the VA, and so1088distance is a huge issue. Also I hear from them that cultural1089competency is also when they have to go outside. What are some1090of the safeguards that you have in place?1091    We know our veterans are facing specific needs and they1092have had specific harms that are unique to their situations,1093especially when it is service-related. Are there any safeguards1094in place to make sure that they are getting similar or care1095that the VA would give them?1096    Dr. Llorente. When we talk about cultural competency, it is1097important to define which culture we are talking about. In the1098VA, of course, we first and foremost start with veteran culture1099because the needs, the experiences, and the health outcomes of1100veterans are quite different than what one typically would see1101in a civilian population. There is a strong component of1102cultural competency with respect to the military culture,1103veteran health outcomes. The Sergeant First Class Heath1104Robinson Honoring our Promise to Address Comprehensive Toxics1105(PACT) Act recently mandated toxic exposure training for every1106VA provider, just as an example. I think that there is very,1107very strong training for the VA with respect to the veteran1108culture.1109    There are--those same types of trainings are afforded on1110some external websites that the VA uses. The one that is most1111used by our community providers is called TRAIN. There, too, we1112offer training to community on cultural competency for military1113culture and for veteran culture.1114    Beyond that, of course, one could think of being a woman as1115a subtype of culture. Being a woman veteran is also very, very1116unique. It is one of the reasons why VA has established not1117only the Women's Health Program and women's health clinics in1118our VAs, but also providers that have specific training to be1119women's healthcare primary providers.1120    Ms. Cherfilus-McCormick. I wanted to pause on that because1121that is getting to the root of the issue that we have been1122finding is that there is so much uniqueness when it comes to1123our veterans, not just from the military culture, but then when1124we are looking at individuals, such as women, which are growing1125populations, and the concern really comes in because the1126training right now is voluntary. There is no real1127standardization when it comes to the community-based care that1128they are receiving.1129    We submitted an amendment that would introduce that kind of1130standardization where anybody who is actually helping or1131servicing our veterans were trained the same way, so they can1132recognize burn pits or they can recognize whatever they have1133gone through, which would save our veterans a lot of time as1134they are trying to decipher what issues they have. Do you have1135anything in place that would be mandatory or do you believe1136that any kind of mandatory standardization when it comes to1137community care would actually be more advantageous to our1138veterans?1139    Dr. Llorente. Thank you. That is a wonderful question. To1140the best of my knowledge, we do not have anything in place1141right now that is mandatory. It does not mean that there have1142not been many conversations and discussions about that topic. I1143think that the biggest challenge is if we started creating a1144whole host of mandatory requirements, would that then limit1145and/or restrict the availability of those community providers?1146    Ms. Cherfilus-McCormick. Now, in other areas, because I1147know there is continuing education for our healthcare1148professionals all the time, have we seen any burdens before? I1149do not see any other continuing education when we actually look1150at priorities, right? The priority is to make sure our veterans1151are taken care of and to make sure if our veterans are1152presenting any kind of issue that the VA can pick up, that1153community care can pick it up just as fast, and they are not1154going through a system for years where the VA could have found1155it. Have you seen that before, that the actual training has1156caused less accessibility?1157    Dr. Llorente. I would have to take that back for the record1158in order to be able to provide you with that answer.1159    Ms. Cherfilus-McCormick. Thank you. I yield back.1160    Ms. Miller-Meeks. The gentlewoman yields.1161    The chair now recognizes General Bergman for 5 minutes for1162any questions he may have.1163    Mr. Bergman. Thank you, Madam Chair.1164    Dr. Koeniger, one of the biggest challenges with mild1165chronic TBI, traumatic brain injury, is that it can be hard to1166recognize and is often masked by other conditions. From the1167VA's perspective, what are the consequences of underdiagnosis1168or misdiagnosis for veterans?1169    Dr. Koeniger. Well, certainly the consequences of1170underdiagnosing or misdiagnosing any medical problem would have1171a negative impact on the veteran. Whether it is mild TBI or any1172other medical condition, VA providers strive hard not to1173underdiagnose or misdiagnose.1174    Mr. Bergman. Yes. You know, you are a medical professional.1175The idea, I am sure from your perspective, is you want to get1176it right as best you can the first time.1177    Dr. Koeniger. Absolutely.1178    Mr. Bergman. You know, I mean, that is the oath you have,1179you know, sworn to uphold, and I thank you for that. You know,1180on a different note here, but still along the same lines, Dr.1181Koeniger, many veterans struggling with mental health1182challenges never enter the VA system before engaging in self-1183destructive behaviors like suicide. They just do not--they are1184not in the system. How do we, you know, calculate the numbers?1185    As such, the true scope of need is likely far greater than1186existing data would reflect. Reducing suicide risk requires1187meeting veterans where they are within their communities. The1188expectation, especially in districts like mine where it is1189rural and remote, I mean, hours of drive from any kind of1190clinician. This underscores the need for flexible, accessible1191care that engages veterans the moment they first seek help. If1192implemented, and I am being specific here, how could the1193RECOVER Act, sponsored--you know, introduced by Chairman Bost,1194change the way veterans experience mental healthcare at the1195moment they first raise their hand for help?1196    Dr. Koeniger. Sir, I am going to actually defer to Dr.1197Llorente.1198    Dr. Llorente. We welcome the opportunity to be able to1199identify mechanisms in which to expand just the type of access1200that you described. I think one of the advantages in the1201language as written is that the providers would be encouraging1202veterans to enroll and engage with the VA to receive VA1203healthcare services in addition to any services offered in the1204community. However, we do have some significant concerns as1205written and would like to work with the committee to best1206address those concerns.1207    Mr. Bergman. Well, and I appreciate that. You know, the1208MISSION Act became the Veterans Access, Choice, and1209Accountability (CHOICE) Act and then, you know, became1210community--you know, all of those things that have morphed over1211time here over the last decade. Unfortunately, still we are in1212some ways as a committee struggling with dealing with the1213Veterans Administration to shape the environment for the1214ability to, first of all, get the first step of diagnosing the1215issue, which means contact with the veterans. I appreciate your1216willingness to take a look at different ways to make that1217initial contact because, you know, there is not a one size fits1218all, especially in those rural and remote areas.1219    With that, Madam Chair, I yield back.1220    Ms. Miller-Meeks. The gentleman yields.1221    The chair now recognizes herself for 5 minutes for any1222questions she may have.1223    Dr. Koeniger, if the pilot in my Health Deserts bill proves1224effective, how could it reshape access to care for veterans1225living in healthcare deserts nationwide and, in fact,1226worldwide?1227    Dr. Koeniger. Ma'am, it is--we are--the VA is always in1228support of trying to engage veterans in health deserts or, you1229know, in very rural areas. Again, the Office of Rural Health1230has done a lot of work in those areas to identify and, again,1231define, you know, what a rural area is. Then reach out to the1232vets who live in those rural areas and try and get them, first,1233enrolled in the VA and then figure out how to best work with1234them so that they can have access on a regular basis, whether1235it be through things like ride sharing or telehealth or1236services like that.1237    Ms. Miller-Meeks. Dr. Llorente, just in response to a1238comment from my colleague about standardization and mandatory1239training for individuals, whether they are within the VA1240providers, whether they are in the VA system or in a community1241care system, is it mandatory that a veteran go to community1242care or is that something they request?1243    Dr. Llorente. It is, first of all, they have to meet the1244eligibility criteria for community care. Then second, we offer1245them the choice. It is the veteran's preference. If they want1246to go to community care and are eligible, then, you know, we1247will do everything that we can to facilitate. If they prefer to1248receive care from the VA, then we will honor their preference.1249    Ms. Miller-Meeks. Thank you. I just wanted to emphasize1250that point, that it is voluntary and the choice of the veteran1251where they receive that care.1252    Dr. Koeniger, why is it important to explore care delivery1253models that leverage existing non-VA health systems in health1254deserts?1255    Dr. Koeniger. I think what the VA wants to do is to make1256sure that it provides the absolute best care to veterans as1257possible. As Dr. Llorente just said, you know, we need to1258consider all aspects of care, whether it is in the VA or1259outside of the VA and make sure that veterans have access to1260the best care.1261    Ms. Miller-Meeks. Thank you. As a veteran married to a1262veteran, could not agree more. I yield back.1263    On behalf of the subcommittee, I want to thank you all for1264your testimony and for joining us here today. You are now1265excused and we will wait for a moment for the second panel to1266come to the witness table.1267    I welcome everyone and thank them for their participation1268today.1269    On our second panel, we have Hon. Charles Rudolph Paul,1270Ambassador to the United States of the Embassy of the Republic1271of the Marshall Islands; Mr. James Whaley, chief executive1272officer for Mission Roll Call; Ms. Elizabeth McCoy, associate1273director of government affairs, Wounded Warrior Project; Ms. K.1274Conwell Smith, deputy chief of military and veterans policy at1275the American Psychological Association (APA). Thank you once1276again for attending today.1277    Ambassador Paul, you are now recognized for 5 minutes.12781279               STATEMENT OF CHARLES RUDOLPH PAUL12801281    Mr. Paul. Madam Chairwoman, ranking member, members of the1282subcommittee, thank you for the opportunity to testify on1283veterans' healthcare issues affecting the Republic of the1284Marshall Islands and the other Freely Associated States.1285    The Republic of the Marshall Islands is in the closest1286relationship that the United States can have with any sovereign1287country. Under the Compacts of Free Association, which is1288enacted into U.S. law, the three Freely Associated States1289permit the United States to exercise a core element of our1290sovereignty, strategic denial of access of other nations across1291the region spanning from Hawaii to Asia. In the Marshall1292Islands, we also host a critical U.S. military installation1293that the Joint Chiefs of Staff describe as the world's premiere1294range for missile testing and space operations support.1295    The United States also actively recruits in the Marshall1296Islands as if we are a U.S. State or territory. Our citizens1297enlist at some of the highest per capita rates of any U.S.1298jurisdiction. They serve honorably, deploy globally, and retire1299as U.S. veterans. Yet today, many of these veterans are1300effectively unable to return home because they cannot access1301the healthcare they earned through their service.1302    The issue was central during negotiations of the Compact of1303Free Associations Amendments Act of 2024. Congress clearly1304intended that veterans' healthcare be made available in the1305Freely Associated States. That intent was reinforced in last1306year's Continuing Resolution and the National Defense1307Authorization Act.1308    However, despite clear, repeated statutory direction1309authority, the Department of Veterans Affairs has not acted to1310implement this commitment on the ground. As a result, veterans1311must choose between remaining in the United States or returning1312home without access to VA healthcare. The Republic of the1313Marshall Islands strongly supports congressional action to1314resolve this gap and ensure the Compact Act commitment is1315fulfilled.1316    The issue is deeply personal at the highest levels of our1317government. The Minister of Foreign Affairs and Trade of the of1318the Republic of the Marshall Islands, Hon. Kalani Kaneko, is1319himself a retired U.S. Army veteran who honorably served 201320years, qualifying for full retirement. For more than a decade,1321he served as an Army recruiter and personally recruited1322approximately 200 Marshallese men and women to the United1323States Armed Forces, individuals who trusted the United States1324and answered its call to service.1325    This issue is also personal to me. My younger brother1326medically retired from the United States Army after 13 years of1327service, including three combat tours in Iraq. He now lives in1328the Marshall Islands and cannot access the healthcare he would1329receive if he remained in the United States. My nephew is1330currently serving on Active Duty. He wants to return home after1331his service but worries whether he will be able to receive the1332care if he does. No veteran's decision to return home should1333depend on whether they can access basic medical care.1334    Importantly, I am not requesting new benefits. Section1335209(a)(4) of the Compact Amendments Act explicitly directs the1336Secretary of Veterans Affairs to negotiate agreements to ensure1337the provision of veterans health services in the Freely1338Associated States. Congress has spoken clearly. The authority1339exists. The obligation is explicit.1340    This is also a national security issue. Veterans living in1341the Marshall Islands strengthen local capacity, reinforce trust1342in the Republic of Marshall Islands (RMI)-U.S. relationship,1343and serve as a stabilizing force in a strategically sensitive1344region. The Republic of the Marshall Islands stands ready to1345work constructively with Congress, the Department of Veteran1346Affairs, and the Administration to implement what the Compact1347Act already promises. Our veterans honored their commitment to1348the United States. Implementing veterans' healthcare in the1349Freely Associated States is not an expansion of benefits. It is1350the fulfillment of a solemn obligation.1351    Thank you and I look forward to your questions.13521353    [The Prepared Statement Of Charles Rudolph Paul Appears In1354The Appendix]13551356    Ms. Miller-Meeks. Thank you, Ambassador Paul.1357    Mr. Whaley, you are now recognized for 5 minutes for your1358testimony.13591360                   STATEMENT OF JAMES WHALEY13611362    Mr. Whaley. Good afternoon, Chairwoman Miller-Meeks,1363Ranking Member Brownley, and members of the Health Committee,1364distinguished guests. Thank you for the opportunity to testify1365today on behalf of Mission Roll Call and the veteran community.1366    Our mission is straightforward. We collect data from1367veterans and we make sure that that information helps inform1368decisions made in Washington. We use polling and direct1369engagement to bring real, unfiltered veteran perspectives to1370policymakers and the public. Amplifying this data on behalf of1371veterans and their families allows us to advocate for1372meaningful change that improves the lives of those who have1373served.1374    The legislation under consideration today seeks to address1375and improve the lives of multiple generations of veterans1376addressing traumatic brain injury, suicide prevention, access1377to care in remote and rural areas, mental health, opioid1378addiction, and more. Mission Roll Call's survey data shows a1379strong need within the veteran community to address these1380issues in ways that place veterans first and delivers care when1381and how a veteran will benefit most.1382    One area where this need is especially clear is suicide1383prevention and mental healthcare delivered outside of VA1384facilities. In Mission Roll Call's national suicide prevention1385polling in July 2025, nearly 80 percent of veterans told us1386that preventing suicide requires clinical treatment and1387community-based support working together, not in isolation.1388More than 90 percent said it is extremely or very important to1389include community-based organizations and prevention efforts,1390and an equally strong majority emphasized the importance of1391training, coordination, and accountability.1392    The RECOVER Act reflects those priorities by strengthening1393evidence-based mental health capacity in the community,1394ensuring providers are trained to understand veterans' risks,1395and requiring outcome reporting so Congress and the VA can1396assess what is actually working. To veterans this is about a1397system that meets veterans where they are, especially when1398timely access to care can be the difference between stability1399and crisis.1400    While suicide prevention only brings veterans into mental1401health systems, many of the underlying drivers of risk begin1402earlier and go untreated. Mission Roll Call's survey data shows1403that over 95 percent of veterans say it is extremely or very1404important to have access to specialized TBI care, including1405care delivered outside the VA. Yet among veterans seeking care1406for TBI-related symptoms, 73 percent report that assessing1407appropriate treatment is somewhat or very difficult.1408    The BEACON Act responds directly to that gap by creating a1409structured evidence-based framework for evaluating innovative1410approaches for veterans with chronic TBI. Veterans are asking1411the VA to test promising therapies responsibly, publishing1412results, and expand access where evidence supports it. From the1413veterans' perspective, the BEACON Act is about restoring1414function, reducing downstream mental health risk, and giving1415clinicians better tools to intervene before injuries compound1416into lifelong disability.1417    In addition, Mission Roll Call supports efforts to1418modernize veteran care by expanding evidence-based options1419while holding the system accountable for outcomes. The NOPAIN1420for Veterans Act moves VA toward broader use of effective1421nonopioid pain management therapies, while the Veterans Mental1422Health and Addiction Therapy Quality of Care Act ensures1423Congress and the VA have reliable independent data on how1424mental health and addiction care performs across VA and1425community programs. These measures reflect what veterans1426consistently ask for in our surveys: care that is grounded in1427evidence, reduces risk, and is evaluated based on real world1428results.1429    Mission Roll Call has always advocated that geography1430should not determine where a veteran--if a veteran receives1431timely care, and supports legislation that addresses access1432gaps for veterans who live far from VA facilities or outside1433the Continental United States. The Veterans Health Desert1434Reform Act and the U.S. Vets of the Freely Associated States1435Act recognize this reality and seek to leverage community1436providers, telehealth, and mail order pharmacy service to close1437those gaps.1438    We believe good policy starts with listening to the veteran1439community and ends with accountability. Veterans overwhelmingly1440seek better access to care in a manner that supports their life1441and family, rules that can be easily understood, and outcomes1442that can be measured and improved. The legislation before you1443reflects meaningful progress toward those goals and we1444appreciate the subcommittee's continued focus on practical1445solutions that make the veteran and family central to the1446provision of care. Thank you, Chairwoman.14471448    [The Prepared Statement Of James Whaley Appears In The1449Appendix]14501451    Ms. Miller-Meeks. Thank you, Mr. Whaley.1452    Ms. McCoy, you are now recognized for 5 minutes.14531454                  STATEMENT OF ELIZABETH MCCOY14551456    Ms. McCoy. Chairwoman Miller-Meeks, Ranking Member1457Brownley, and members of the subcommittee thank you for the1458opportunity to testify. Today's agenda includes many bills that1459are aligned with Wounded Warrior Project's mission to honor and1460empower warriors, and I am pleased to speak on several that1461would have a heightened impact on the post 9-11 wounded, ill,1462and injured veterans that we serve. My remarks today focus on1463the link between mental health and brain health and why1464investment in brain health is essential.1465    Military-related traumatic brain injury, a signature wound1466of post 9-11 service, can significantly increase neurological1467conditions that influence physical and psychological1468functioning, such as chronic pain, depression, and anxiety. To1469that end, a traumatic brain injury can both directly and1470indirectly elevate suicide risk. These realities underscore the1471need for continued investment and innovation. Scientific1472advancements have demonstrated that brain health must be1473treated as a long--lifelong whole health priority both during1474and after military service, just as we have learned with mental1475health. Yet much about brain function remains unknown,1476reinforcing the need for bold investment in research and1477advancement to improve outcomes.1478    To address these challenges, we must move toward a1479strategic framework that integrates three pillars: prevention,1480treatment, and innovation. First, prevention and early1481identification of brain injuries are critical. Servicemembers1482in training and combat can be exposed to blast overpressure and1483repetitive head impacts that accumulate over time. We encourage1484alignment of life cycle data and standards from the Department1485of War to the Department of Veterans Affairs, shared baselines,1486common measures, and longitudinal tracking so that no veteran1487falls through the cracks during their transition.1488    Legislation such as H.R. 6444, the Blast Overpressure1489Research and Mitigation Task Force Act, strengthens blast1490exposure research and seeks to translate evidence into1491standardized screening and safeguards while assuring1492assessments migrate with the veteran from their time in uniform1493to civilian life. For these reasons, we are pleased to support1494this legislation.1495    Second, personalized outcome-driven treatment is essential1496because brain injury manifests differently for every veteran.1497Precision approaches, tailored neurorehabilitation,1498nonpharmacologic therapies, and integrated mental health1499support offer pathways to measurable improvements in cognition,1500mood, and functioning.1501    We support H.R. 6993, the BEACON Act, which would seed1502innovation and clinical evaluation across nonprofits, academia,1503and community partners. We encourage streamlined funding so1504pilots add capacity rather than divert existing mental health1505resources.1506    Third, proactive suicide prevention should take brain1507health into account. Predictive analytics can help clinicians1508identify veterans at higher risk and engage them earlier with1509safety planning, follow up, and tailored treatment. Technology1510should not be used as a shortcut. Innovation should enhance1511proven strategies, not replace them. To that end, Wounded1512Warrior Project supports the Discussion Draft Data Driven1513Suicide Prevention and Outreach Act of 2025.1514    Veterans have earned care that is consistent. While public1515and private collaboration is essential to ensuring veterans1516receive the highest quality of care, VA should remain as the1517coordinator of programs and grant funding. Where shortages1518persist, especially in rural areas, we support piloting1519practical access solutions that meet veterans where they live,1520making sure data flows back to VA and measures outcomes. We are1521pleased to support the Discussion Draft Veterans Health Desert1522Reform Act of 2025.1523    The legislation included in today's hearing moves beyond1524incremental fixes and strives toward a bold, integrated vision1525for brain health that supports the servicemember to veteran1526life cycle. Wounded Warrior Project stands ready to partner1527with the subcommittee, VA, the Department of War, and community1528innovators to identify and prevent injury of the brain, create1529personalized outcome-driven treatment, and build proactive1530suicide prevention programs that take brain health into1531consideration.1532    Thank you for your leadership and for the opportunity to1533testify this afternoon.15341535    [The Prepared Statement Of Elizabeth McCoy Appears In The1536Appendix]15371538    Ms. Miller-Meeks. Thank you, Ms. McCoy.1539    Ms. Conwell Smith, you are now recognized for 5 minutes for1540your testimony.15411542                 STATEMENT OF K. CONWELL SMITH15431544    Ms. Smith. Chairwoman Miller-Meeks, Ranking Member1545Brownley, and distinguished members of the subcommittee, thank1546you for the opportunity to testify. I am Conwell Smith, the1547deputy chief for military and veterans policy for the American1548Psychological Association.1549    APA is the Nation's largest scientific and professional1550organization representing psychology with more than 190,0001551members and affiliates. Today, more than 7,000 psychologists1552work in the VA, though that number has declined by nearly 3001553since 2024. APA is proud of VA psychology's role in decades of1554mental health clinical and research advancements. My testimony1555focuses on ensuring that the legislation under consideration1556upholds the highest standards of veteran care, regardless of1557where care is delivered.1558    Several bills create new delivery models, programs and1559access points operating outside the VA's Direct Care and1560Community Care program. APA's concerns that building parallel1561systems risks further fragmenting care, separating veterans1562from coordinated treatment teams, and weakening benefits of the1563VA's integrated care model. Two bills in particular, the1564RECOVER Act and the Draft Health Desert Reform Act, are well-1565intentioned efforts to expand access, but we fear risk1566unintentionally reducing the quality of veteran healthcare1567without stronger safeguards.1568    APA recognizes the need to supplement VHA care. However,1569veterans should have the same expectations of quality and1570safety whether they are treated inside or outside the VA. To1571that end, our recommendations are as follows.1572    Number one, APA strongly supports requiring key training1573for all community providers, including those providing care1574through separate VA-funded grant programs. The RECOVER Act1575provides 60 million in grants to mental health facilities1576serving veterans, but does not require clinicians to meet the1577training standards expected of VA providers. Notably, suicide1578prevention training is not mandated even though the bill1579targets areas with high veteran suicide risk. Veterans deserve1580clinicians who understand military culture, common service-1581related conditions, and VA medical clinical expectations.1582    Number two, APA leads with psychological science and1583emphatically recommends the use of treatments scientifically1584proven to be effective for the assessment and treatment of1585mental health disorders. The RECOVER Act does not require1586provider training in evidence-based practices, leaving a1587significant gap in provider readiness to treat conditions1588disproportionately impacting veterans, such as post traumatic1589stress, depression, and substance use disorders.1590    Additionally, the BEACON Act risks weakening longstanding1591VA leadership in traumatic brain injury research and treatment1592by creating a parallel research pathway outside existing1593rigorous VA processes. The VA's evidence-driven system has1594contributed to some of the most impactful TBI advances. Any new1595framework should reinforce, not bypass, that scientific rigor.1596    Number three, APA supports requiring facility accreditation1597and strong quality assurance for any grantee providing mental1598health services to veterans. The RECOVER Act does not require1599accreditation by the Joint Commission or the Commission on1600Accreditation of Rehabilitation Facilities, diverging from1601accepted VA standards. Moreover, legislation should require1602standards for demonstrating improved clinical outcomes. Without1603outcome measures and enforcement, neither Congress nor the VA1604can assess impacts on veterans, positive or negative.1605    Number four, effective mental healthcare relies on1606coordinated care supported by shared health records. Removing1607the VA as the coordinator of care and creating increased1608fragmentation of services could worsen continuity of care1609challenges that veterans already experience. APA recommends1610requiring all community providers to participate in timely1611medical record exchange with the VA. This ensures clinicians1612have the full health history needed to provide safe and1613consistent care.1614    Number five, APA supports efforts to give veterans the1615information they need to make informed decisions about their1616care. We are encouraged by the creation of a publicly available1617directory for CHAMPVA healthcare providers as required in the1618Clarity on Care Options Act.1619    We also support the intent of the Veterans Mental Health1620and Addiction Therapy Quality of Care Act. However, the bill1621falls short in enabling meaningful comparisons and quality1622assessments.1623    It is an honor to represent the American Psychological1624Association and advocate for the essential work psychologists1625do for our veterans and military. As the spouse of a disabled1626Army veteran, who is with me here today and who receives his1627care through the Hampton VA Medical Center, ensuring high-1628quality care across all settings is deeply personal to me.1629    Distinguished members of the subcommittee, we know that1630each of you are earnest in your commitment to improve veteran1631healthcare access and quality. The VA remains a national leader1632and we stand ready to work with you on these legislative1633endeavors. Thank you.16341635    [The Prepared Statement Of K. Conwell Smith Appears In The1636Appendix]16371638    Ms. Miller-Meeks. Thank you, Ms. Conwell Smith. Thank to1639all of our witnesses for their thoughtful input.1640    Ranking Member Brownley, you are now recognized for 51641minutes for any questions you may have.1642    Ms. Brownley. Thank you, Madam Chair.1643    Thank you, Ms. Smith, for your testimony. Ms. Smith, as1644written, the BEACON Act would be paid for by diverting funding1645from existing VA mental healthcare programs and from VA's1646National Center for Post-Traumatic Stress Disorder (PTSD). Can1647you expand on how diverting these funds will impact VA's1648ability to provide clinical care and continue to conduct1649research through programs?1650    Ms. Smith. Thank you for that meaningful question. The VA's1651National Center for PTSD is a recognized leader across all of1652our healthcare system. I think the concern is that sidestepping1653scientific rigor of the VA and the gains made in PTSD and TBI1654research could potentially cost much more than money. It could1655cost clinical advancements. I think working how--figuring out1656how different entities work in tandem, but maintaining very1657high level of standards and not defunding the VA is a critical1658approach.1659    Ms. Brownley. Thank you. Thank you for that. You know, I1660asked this question of the second panel, but I was curious to1661know if you are aware of any statutory or practical barriers to1662VA either through its existing research infrastructure or1663academic affiliations programs.1664    Ms. Smith. I am not.1665    Ms. Brownley. Thank you. I also noted in my opening1666statement that I have concerns about the weak oversight1667mechanisms of the grant program that would be created by the1668RECOVER Act. Ms. Smith, I would like to get your take on1669whether the RECOVER Act is robust enough from a clinical1670perspective. From your read of the bill, would it expand1671existing services or improve quality of care for veterans?1672    Ms. Smith. I think as far as expanding services, my read of1673the bill is that it does not necessarily do so. It allows1674grantees to bill the VA and other insurers and also receive a1675$1.5 million grant with no require to treat higher numbers of1676veterans.1677    On the quality front, unlike VA facilities, the bill does1678not impose accreditation requirements, peer review processes,1679or evidence-based treatments or training in those evidence-1680based treatments. I believe that it requires one provider to be1681trained in cultural competency. Obviously, APA feels very1682strongly that all providers of mental and behavioral healthcare1683should receive core competencies training.1684    Ms. Brownley. Thank you. Are there any requirements in the1685bill that would ensure grantees engage in care coordination of1686the VA, returning medical records, or making sure veterans1687receive follow-up care from VA?1688    Ms. Smith. I do not believe that the bill mentions1689transmitting records to the VA. Of course, there is not a1690requirement to join the community care program where oversight1691exist. You know, there was a recent U.S. Government1692Accountability Office (GAO) report that demonstrated that 331693percent of VA referrals to behavioral health in the existing1694community care program were missing the initial visit record.1695This is a very serious problem and I really appreciate that1696members of the committee were addressing the importance of1697shared record exchange to quality of care.1698    Ms. Brownley. Thank you. Another question. Is there any way1699that Congress would know whether the RECOVER Act grantees are1700following evidence-based practices in the provision of care for1701veterans?1702    Ms. Smith. I do not believe, without a requirement, I do1703not believe that there would be an ability to know. I think1704oversight and accountability require processes that I am not1705familiar with regard to this bill.1706    Ms. Brownley. What kind of clinical outcomes would you1707expect to see reported following the provision of care by a1708RECOVER Act grantee versus similar care delivered by the VA?1709    Ms. Smith. Well, we are encouraged that the bill does1710mention clinical outcomes, but it is a vague word without,1711again, requirements and a building structure. Without evidence1712of grantee level effectiveness, how can Congress or the VA know1713what the positive and negative impacts are on veterans? We do1714not know that those care outcomes would be related to symptom1715improvement, for example. I think we could look to the1716congressional report on the Fox grants to demonstrate that if1717you do not have requirements and you do not have enforcement,1718there might be little there to be able to evaluate a program's1719effectiveness.1720    Ms. Brownley. Thank you for that and I will yield back. I1721will just say that, you know, I certainly respect the1722intentions of this bill, but I just feel like it needs more1723accountability, more guardrails to ensure evidence based1724practices and quality of care.1725    I yield back.1726    Ms. Miller-Meeks. Thank you, Ranking Member Brownley.1727    The chair now recognizes Representative King-Hinds for 51728minutes for any questions she may have.1729    Ms. King-Hinds. Thank you, Madam Chair.1730    First of all, Mr. Whaley, great to see you again. It was1731great meeting you the other day when we had the BEACON Act1732press conference.1733    Mr. Whaley. Yes, ma'am.1734    Ms. King-Hinds. Honorable Charles Uwakwe. A lot of my1735questions are going to be focused on conversations about the1736RMI and my legislation that expands the--not expands, but1737actually upholds the current statutory requirements to extend1738VA benefits to our Freely Associated States citizens. Let us1739just start off by having you describe what are the most unique1740challenges that our vets face in the Freely Associated States1741and how many of them are actually returning home.1742    Mr. Paul. Well, thank you. Thank you very much,1743Congresswoman, for that.1744    Some of the unique challenges that our vets are1745experiencing living in the Marshall Islands, basically, as1746outlined in my statement, healthcare, I mean, a lot of them did1747not identify that they are veterans when they get healthcare1748because there is no benefit for them to do so. Also there are1749different types of, like, healthcare needs that the Islands are1750just not equipped to provide because we do not have wars or1751combat zones near anywhere around our islands. There are1752certain things like PTSD, things of that nature----1753    Ms. King-Hinds. Okay.1754    Mr. Paul.--that we are seeing.1755    Ms. King-Hinds. That is kind of what I wanted to get into1756in terms of the types of actual physical conditions, whether it1757be PTSD or any type of visible injury. Right?1758    Mr. Paul. Right. Yes. Like, visible injuries, things like,1759you know, lost limbs from being Active Duty, but also mental, a1760lot of mental issues and mental health issues where a lot of1761folks that, you know, commit suicide in veterans. Just a couple1762months ago, a veteran jumped off a ship, and there is really no1763treatment facility for--we have one psychiatrist in the1764Marshall Islands for the whole country. The veterans are not1765getting the care that they deserve.1766    Ms. King-Hinds. You heard the conversation, the dialog that1767I had with the VA in the previous panel and, you know, you1768heard the challenges that they race with regards to the1769transportation of medication and whatnot. Right? The shipping1770issue and the different statutes that are required to be1771negotiated. I think it would be helpful for the panel to kind1772of hear what your healthcare system sound--what it is actually,1773what is there, because when you hear that description, it makes1774it seem as if you have zero healthcare facility and no1775medication is currently being shipped in. I mean, in your1776testimony, you pointed out that there is actual Department of1777Defense presence there, which I assume, you know, there is1778regular goods and commodities that are being brought in through1779DOD. Can you just speak on that with the very little time that1780we have?1781    Mr. Paul. Sure. Thank you so much.1782    Yes, so we have dispensaries and hospitals that are being1783built by compact funds for over the past 35 years. We have1784doctors that are trained and licensed from the United States in1785the Marshall Islands. In fact, if I may speak to about1786September 2024, we started engaging the VA to discuss--do1787environmental scans and what the facilities are in the Marshall1788Islands. I believe about January, February 2025, we are this1789close to starting negotiating an agreement. That was about less1790than 6 months going back and forth. We would hold monthly1791meetings with the VA. You know, we are this close to executing1792an agreement that would resolve a lot of the issues that were1793brought up today, so. I believe we can get there, we will keep1794talking and try to come up with an agreement so we can provide1795the healthcare that is needed.1796    Ms. King-Hinds. Okay. Thank you for your time.1797    I yield back the remainder of my time.1798    Mr. Paul. Thank you.1799    Ms. Miller-Meeks. Thank you. The gentlewoman yields back.1800    The chair now recognizes Dr. Dexter for 5 minutes from for1801any questions she may have.1802    Ms. Dexter. Thank you, Chair Miller-Meeks, and thank you to1803our ranking member for her service here. It is going to be very1804sad without you here on our subcommittee and a year we have.1805    Ms. Smith, thank you so much for coming and I very much1806appreciate that your statement reflects your organization's1807commitment to high-quality, outcomes-driven, and accessible1808healthcare for our veterans. As you said, for our veterans,1809those things are often best possible when veterans have access1810to clinicians and facilities that are accredited and fully1811trained and really culturally competent.1812    I also just want to shout out the outcome transparency and1813accountability that you referenced because it is really1814crucial. I am a physician, was honored to practice in a VA. It1815is crucial for making sure that what we think is science-based1816is actually driving better outcomes for our patients. Thank you1817for calling that out.1818    Last thing I wanted to highlight is your statement about1819medical record exchange. Having provided care in a VA as well1820as a community care provider, I cannot list how many times we1821led to redundant care or subjected people to recurrent,1822repeated, unnecessary treatments because we did not realize1823they had already been given somewhere else.1824    I want to ask some questions related to the Health Desert1825Reform Act, which I will reiterate as very well intentioned. We1826have to be able to provide community care to our veterans when1827they do not have access to a VA that can give timely care. That1828is absolutely. This is not a political issue. This is a1829priority issue that I think we all share here.1830    The section of the bill on oversight, I will just note, is1831less than a page long and it includes rather vague requirements1832that the VA Secretary track access, cost, quality, and veteran1833satisfaction for each hospital that enters into an agreement1834under the bill. Ms. Smith, do you have confidence that this1835requirement will be sufficient to ensure the care delivered by1836those hospitals is of equivalent or superior quality to the1837care delivered by a VA facility?1838    Ms. Smith. As it is currently written, I do not feel like1839there is the structure to give me that confidence. Am I1840encouraged that it could be? Certainly. I just think as it is1841written right now, no. I would have to say no.1842    Ms. Dexter. I share that concern. Under this bill, there1843appears to be very few parameters placed on pilot program1844eligibility. It does not stipulate that for-profit or private1845equity-backed hospitals cannot take advantage of the program1846nor does it require that a hospital be located in an area with1847a demonstrated wait time or drive time issue. In your opinion,1848what risks does this pose in terms of possible exploitation,1849overutilization, or unnecessary duplication of services?1850    Ms. Smith. APA has long been concerned that unfettered1851growth in the community realm without accountability could have1852a negative impact on the integrated care system of the VA. We1853do share that concern. I think there, again, I do think that1854there are structures even in the community care program that1855provide more oversight that could be applied in this case.1856    Ms. Dexter. I just want to highlight an issue that I have1857raised in this committee that the VA budget, unfortunately, is1858a zero-sum game. If we take it from VA facilities to provide1859this care, it does not come back. This bill includes no cap on1860the amount of funding that can be used to furnish care through1861the arrangements that it authorizes. That means it is entirely1862possible that we could siphon large amounts of funding away1863from the VA where we know our veterans get the highest quality1864and best satisfaction. This has been documented, and for1865uncertain quality and it may or may not be necessary. Is that1866your concern as well?1867    Ms. Smith. It is our concern. You know, we are down 3001868psychologists over just this past year and we know that the1869demand for mental health treatment within the VA is1870skyrocketing. I think that, you know, using funds to also1871invest in the VA's ability to meet the demand by staffing is a1872really important piece of the puzzle. If money is going from1873one place to the other, how can we reinvest there as well?1874    Ms. Dexter. With my last few seconds, I just want to1875underline that because I have heard that even physicians who1876have long been practicing, at least in our Portland VA, that1877they cannot get their patients in for appointments because the1878staff who help coordinate or get them in for those appointments1879have been dismissed. It feels like right now we should be1880underlining the commitment to making sure veterans have access1881to the VA facilities that we have already funded.1882    Thank you. With that, I yield back.1883    Ms. Miller-Meeks. Thank you. The gentlelady yields.1884    The chair now recognizes General Bergman for 5 minutes for1885any questions he may have.1886    Mr. Bergman. Thank you, Madam Chair. Mr. Whaley, good to1887see you again.1888    Mr. Whaley. Good to see you, sir.1889    Mr. Bergman. Just like a couple of days when we are out on1890the lawn or over, you know, presenting on what you all do, and1891you do it very well.1892    Mr. Whaley. Thank you.1893    Mr. Bergman. In talking with veterans in my district and1894across the country, it is clear that mild chronic TBI is far1895more common than is often recognized, frequently missed and1896undiagnosed. This prevalence seems to exceed what the VA's1897current clinical footprint alone would suggest. With only five1898polytrauma centers nationwide, the current system simply does1899not have the capacity to meet the full scope of need. The1900question, why is additional targeted funding necessary? What1901kinds of community partners, nonprofits, or academic centers1902are best positioned to extend that care and innovation beyond1903the VA's walls?1904    Mr. Whaley. Thank you, sir, for that question. We listen to1905veterans, we take their opinions in an unbiased, unfiltered1906way, and then we share it, of course, with all of you and with1907the media as well as our fellow veterans. It is clear when we1908speak to them that they want to be able to have the ability to1909get treatment early on in this process before it exaggerates,1910before it grows, before it affects their job, before it affects1911their family. It is a spiraling effect, right? When one thing1912goes bad, then the next and then the next, and before we know1913it, we are on a slippery slope to a bad place.1914    When we can get to this early and get treated and get the1915access to healthcare in a proper way, then we can mitigate1916that. We can slow it down. We can get them the assets and the1917technology and the medication in some cases that they need.1918    When I think about organizations that are doing great work1919here, I think about the Avalon Action Alliance, which has a1920number of facilities and partners across the country that right1921now are doing that, God's work for helping veterans with TBI,1922sometimes very mild, sometimes very severe. They are doing it1923in a way that is very costly to them and not sustainable long1924term for them to do without getting support.1925    I think it is important for us to realize that this is a1926national issue, just not a veteran issue, and that if we cannot1927solve TBI for those that have served our country, then we are1928not going to be able to solve TBI for our citizens. I think it1929is important to invest in this. I think it is important to make1930sure we have the assets to do that. We bring the best and1931brightest organizations to take a look at this.1932    Obviously, we need guardrails. Right? I mean, there has to1933be checks and balances to make sure that this is done in the1934right way. I applaud the efforts of those on this committee and1935all of you for your work.1936    I think everybody has the best intentions here and we want1937the very best for our veterans and their families. I say their1938families because if you have one veteran that has this problem,1939it affects his spouse, it affects the children. When we think1940about it, there is 18 million veterans in our country. When you1941think about those dependents, you are now talking about 30 or194240 million Americans that this impacts. Right now we are only1943having access through the VA to half of those veterans. This is1944a big problem. Thank you.1945    Mr. Bergman. Yes, thank you. I noticed that at Mission Roll1946Call and I took a photo of the backdrop. It said, ``The key1947word takeaway is listening.'' In any conversation or any1948dialog, at least one entity has to be listening. Thank you for1949being a listener.1950    Ms. McCoy, if this research leads to clear evidence of what1951works, how could that improve day-to-day care for veterans1952living with TBI?1953    Ms. McCoy. Thank you for that question, sir. I would like1954to echo many of Mr. Whaley's points here, that it really is our1955belief that innovation can come from anywhere. We are committed1956to efforts that reduce suicide risk among veterans living with1957long-term effects of brain injury, and that is a population1958that we serve regularly.1959    I believe that all of these efforts collaboratively can be1960streamlined, as you point, under the Fox grant. Ultimately, it1961is going to improve alignment, avoid duplication of care, and1962really improve medical outcomes for veterans.1963    Mr. Bergman. Thank you. You know, this is not--we talk1964about in weapons system, fire and forget. What we are trying to1965do here is not a fire and forget. We just throw something out,1966create the beacon. You know, whatever it is we are trying to1967do, the therapy, it is not a fire and forget. We got to keep1968working it because things are going to change.1969    With that, Madam Chair, I yield back.1970    Ms. Miller-Meeks. Thank you, General Bergman.1971    The chair now recognizes Dr. Morrison for 5 minutes for any1972questions she may have.1973    Ms. Morrison. Thank you, Madam Chair and Ranking Member1974Brownley. I reiterate Dr. Dexter's comments. Thank you for your1975service and for your mentorship. You will be dearly missed.1976Thanks to each of the witnesses testifying before the committee1977today, grateful for your presence.1978    In Minnesota, I represent Minnesota's Third District and we1979are very proud of the Minneapolis VA. It goes above and beyond1980for veterans in our State. While certainly a testament to the1981leadership and community in Minnesota, this recognition is also1982a timely reminder of how critical healthcare workers are to the1983success of VA. Intentionally tackling this burnout underscores1984how important investing in the VA workforce is and our ability1985to deliver on the promise that we have made to our veterans.1986    Having myself been one of the 70-plus percent of American1987doctors who has completed part of their medical training at a1988VA hospital, it also leads me to think about the unique1989challenges that veterans face when it comes to mental health,1990substance use disorder, and overdose risk. As our country1991struggles with the opioid crisis nationwide, my heart breaks1992for our veterans that research has repeatedly shown to be at1993higher risk of death from overdose, further complicated by1994chronic pain, service-related injuries, or other service-1995related trauma.1996    A major part of what compelled me to serve in Congress was1997my firsthand experience as a doctor seeing how difficult1998navigating our healthcare system can be. Helping veterans face1999unique challenges and elevated risk requires intentional work2000to break down those barriers.2001    Now, as a member of this committee, I am honored to have2002the opportunity to lead policies that will help meet veterans2003where they are. That is why I am proud to have joined with2004another experienced doctor, Congressman Conaway, to introduce2005H.R. 5999, the Veteran Opioid Emergency Treatment Act. This2006bill would reduce the barriers veterans face to accessing2007naloxone, a life-saving medication that can rapidly reverse an2008opioid overdose. Medication that would be life-saving in such2009critical moments should not be out of reach to veterans as a2010result of cost or difficulty scheduling appointments. I am2011grateful for the bill's inclusion in today's hearing and I look2012forward to continuing to work with Dr. Conaway and my2013colleagues as the bill moves through the committee.2014    Ms. Smith, could you elaborate on the importance of a2015consistent systemwide approach to ensuring timely access to2016naloxone? Why is this access and consistency of particular2017importance for veterans?2018    Ms. Smith. Well, thank you for the question. Recognizing2019the conditions that disproportionately impact veterans is part2020of how we approach treating them. We are recognizing that there2021is definitely a sensitivity to substance use disorder and we2022must do all that we can to prevent unnecessary veteran death.2023    Ms. Morrison. Thank you. In your testimony you highlight2024the importance of training an exceptional healthcare workforce.2025How does investing in VA providers protect the quality of care2026that veterans receive?2027    Ms. Smith. Well, you mentioned already in your comments2028about being part of the 70 percent who receive their training2029in the VA. I have the pleasure of working with VA psychologists2030who are just tremendous public servants, but they also spend2031time training the next generation of mental health providers. I2032think a lot of times it is lost that the VA is not only2033important to our veterans, which is first and foremost, it is2034important to each and every one of us because they really are2035training the healthcare workforce.2036    If I can add, because you mentioned burnout earlier, we are2037finding more and more psychologists' clinical time is being2038taken up to--you know, their entire day is filled with clinical2039scheduling and it is not leaving the time for clinical--for2040training supervision. That concerns us because I do think that2041there are training programs at certain VA facilities that are2042dying on the vine only because they do not have the time and2043the people to foster the training.2044    Ms. Morrison. Thank you so much. Madam Chair, I yield back.2045    Ms. Miller-Meeks. The gentlelady yields.2046    The chair now recognizes Representative Kiggans for 52047minutes for any questions she may have.2048    Ms. Kiggans. Thank you, Madam Chair, for just conducting2049the hearing today to talk about important pieces of legislation2050that will improve access to care for our veterans throughout2051the VA. Included in the hearing today is my legislation, the2052Clarity on Care Option Act.2053    CHAMPVA is vital for caregivers and dependents of2054permanently disabled veterans. It ensures they can continue to2055support the veteran in their lives and still receive the2056healthcare services they require. To support our veteran2057caregivers in finding providers more easily I introduced the2058Clarity on Care Options Act, which directs the VA's Community2059Care Network to create a public-facing list of all providers2060who are in-network for CHAMPVA enrollees. It is important for2061patients, for providers. There is a lot of confusion and the2062more we talk about all the other great issues we talked about2063today from mental healthcare, how we are addressing addictions,2064continuity of care issues, all the things we are working on, I2065need my veterans out there to know, to have kind of a directory2066so that they can find where the community care partners are.2067That is just what my bill does, is just establish this2068directory. We have so many and some of the great places our2069veterans live, like Hampton Roads, and just I think it would be2070a great addition to complimenting care. I just had a couple2071questions.2072    First to Ms. McCoy. What barriers do you see eligible2073families most commonly facing when they are enrolling in2074CHAMPVA? What barriers do they face after having access to the2075program?2076    Ms. McCoy. Thank you so much for your question,2077Representative Kiggans. Surviving families and caregivers often2078face heightened mental health risks and require consistent and2079comprehensive support. We are in support of this bill and fully2080encourage efforts to expand information on how to access2081essential healthcare information. We believe that a national2082registry provides a powerful tool for these beneficiaries to2083secure the care and support that they deserve.2084    Ms. Kiggans. Great. Thank you. Are there specific2085populations such as surviving spouses, caregivers, or2086dependents with disabilities, who face disproportionate2087challenges accessing CHAMPVA?2088    Ms. McCoy. Absolutely.2089    Ms. Kiggans. Which would you say or what are some of the2090more challenged groups?2091    Ms. McCoy. To my understanding, survivors and dependents.2092    Ms. Kiggans. I would agree with that, too. Again for Ms.2093McCoy, what are the most common reasons CHAMPVA claims are2094delayed or denied?2095    Ms. McCoy. Truthfully, I would have to come back to you on2096that answer.2097    Ms. Kiggans. I think a lot of times our veterans probably2098access just either Google searching or, you know, look, even2099hearing from friends. They make appointments and they are seen2100and then they find out after the fact that those were not in2101the network, which is what this bill is hoping to prevent.2102    Last question for Ms. McCoy, what factors contribute to2103delays in enrollment and what steps could reduce those delays?2104    Ms. McCoy. At this point, I would say perhaps the Veterans2105Integrated Service Network (VISN) restructure, although yet it2106has not been implemented. We do not know what those changes2107will look like, but I am hopeful that we will see positive2108outcomes with the VISN restructuring.2109    Ms. Kiggans. Good. I hope so, too. Again, I think just a2110directory and really I would like to see an overhaul of even2111just logging onto the VA system. Sometimes, you know, as a2112veteran, married to a veteran, and even daughter of veterans,2113just for me personally logging on, that log on process can be2114simplified. Even finding GI Bill, you know, health benefits, VA2115home loan, there is all the benefits that are there, but I just2116need my veterans to be able to access and understand that.2117Hopefully, this CHAMPVA piece will at least provide a little2118bit of clarity for our community care partners.2119    I have a quick question then for Ms. Conwell Smith, and2120welcome. I know you are from my hometown in my district. Have2121you heard from psychologists that service CHAMPVA that are2122having trouble just servicing our beneficiaries? What is the2123most common issue that psychologists are running into?2124    Ms. Smith. I have not heard this directly, but we can2125certainly go back to our membership and gather more information2126about this. I think that you highlighted challenges of2127navigation of any veteran and their family, and I think those2128of us that are in veterans families know those, oh, too well.2129    Ms. Kiggans. Yes, very much so. I know just psychologists2130are important care partners for us and there is a shortage of2131mental healthcare providers and we often speak of mental2132health, but thinking of the people who provide the mental2133health, we need to do more of that and making sure that the2134providers know, too. Then the patients have a directory, but2135there is clarity kind of on both sides. That is what we hope to2136accomplish with this bill.2137    Thank you so much and I yield back.2138    Ms. Miller-Meeks. The gentlelady yields.2139    I now recognize myself for 5 minutes to ask questions.2140    This is a question both for Mr. Whaley and Ms. McCoy and2141then Ms. Conwell Smith. I realize that you are not clinicians2142per se, but as I have listened to the testimony, the questions2143today, and the bills before us, I am thinking about the blast2144injury, mild TBI, so, i.e., a wave, shockwave, but not an2145actual concussion, and how difficult that is and we do not test2146for that. Would there be some validity to either an algorithm-2147based test and/or screening prior to discharge from the2148military for those individuals who during their training,2149although they may not be in combat, but during their training2150may have exposure to a blast neurotrauma and not a TBI or2151concussion in the typical diagnosed fashion?2152    Mr. Whaley. Thank you for that insight and question. We2153could not agree more. We have talked to a number of veterans,2154either in our roundtables or in our polling, and found out2155that--and find out on a systemic basis that many times someone2156does not know they have had a TBI until a number of things have2157happened. By then you are kind of picking up the pieces versus2158getting----2159    Ms. Miller-Meeks. Yes. I realize the brain activity and2160connections may be very different than what you see in a TBI.2161    Mr. Whaley. Right.2162    Ms. Miller-Meeks. I do not have a lot of time because I2163want to ask other questions. Ms. McCoy.2164    Ms. McCoy. Thank you for your question. I think it directly2165leads into H.R. 6444, which is the establishment of the task2166force, where we are able to begin to accumulate and/or leverage2167currently collected data on the DOD side of the House and allow2168that full migration of information to accompany the2169servicemember as they move into veteran status.2170    Again, to your point, we know that blast overpressure has2171been kind of linked to cumulative neurological effects. How2172those build in each veteran and servicemember over time are so2173distinct that at this point, you know, we do not know what we2174do not know. Investment in research and innovation is just key.2175I think this task force will be an important infrastructural2176step to that goal.2177    Ms. Miller-Meeks. Thank you. How could the pilot, and some2178of these bills that we presented today are discussion bills, so2179I appreciate all the input from all of our members and our2180witnesses, how could the pilot in the Health Deserts bill2181reduce travel burdens or delays for care and veterans?2182    I can assure you in Iowa, especially northwest Iowa, but2183even in my district, veterans may have to travel 2 hours to go2184to a VA facility clinic, which has lesser services. In many2185states, including Texas, a very populated State, that drive can2186be over that. If you are talking about a visit for coordinated2187care or whatever type of care you want, that could be a 5-hour2188travel time just back and forth without including the physician2189visit. Ms. McCoy.2190    Ms. McCoy. Thank you very much. I appreciate and agree with2191your point. I think that this is filling a crucial need. I2192mean, you think about a veteran that is maybe going to a2193hospital where certain providers or certain care modalities are2194covered under the community care network and others may not. An2195initial appointment may be covered, but a scan or, you know,2196some sort of Magnetic Resonance Imaging (MRI) may not be2197covered. That fragmentation of care has to be incredibly2198frustrating. It is inefficient and ultimately it is a barrier2199to care. A streamlined contractual agreement can produce2200positive outcomes for veterans.2201    Ms. Miller-Meeks. Thank you. Ms. Conwell Smith, and as a2202physician and a veteran, I appreciate your focus on clinical2203outcomes. Do you consider it a favorable clinical outcome for220417 percent of veterans to still die by suicide? Has the VA been2205successful? Is that a good clinical outcome measure?2206    Ms. Smith. I would go back, thank you for the question, I2207would go back to the advances and progress within the VA when2208it comes to mental health treatment and effective treatments2209for mental health disorders, which I think have been2210extraordinary.2211    Ms. Kiggans. Thank you.2212    Ms. Smith. We do not want one veteran suicide.2213    Ms. Kiggans. Neither do we, but that certainly is a2214clinical outcome and we have not move that needle. I think2215looking at approaches that deliver care to veterans, whether it2216is through telemedicine, community care, VA care, an algorithm-2217based care, new research, I think it is important. All of us on2218this committee want to make sure that, number one, PTSD,2219veteran suicide, that TBI veterans are getting the care that2220they need.2221    Then last, let me just say, Ambassador Paul, I do not have2222a question for you, but I just wanted to thank you for coming,2223for testifying today and coming this long way to make sure2224veterans in your area in the Marianas Islands and the FAS are--2225that their needs are met as well, too. I did not want you to2226leave without my personal thank you.2227    I thank the witnesses for being here today. Just in2228closing, I think we are looking at some bills, discussion2229drafts. I appreciate all of the input.2230    Then Ranking Member Brownley, do you have any closing2231remarks you would like to give?2232    Ms. Brownley. I do not think so, but I think, you know,2233there have been a lot of good bills here today and that, you2234know, certainly require serious consideration. I think we have2235had a good discussion on many of these bills and ways in which2236they can be improved upon so that we can move them forward.2237    I yield.2238    Ms. Miller-Meeks. Thank you, Ranking Member Brownley.2239    On behalf of the subcommittee, I want to again thank all of2240our witnesses and members, including the VA who is on the first2241panel, Dr. Koeniger and Dr. Llorente, for being here today. I2242look forward to working with you to address the issues facing2243our veterans and also the suggestions that we have had from our2244witnesses and our members today. The complete written2245statements of today's witnesses will be entered into the2246hearing record.2247    I ask unanimous consent that all members have 5 legislative2248days to revise and extend their remarks and include extraneous2249materials. Hearing no objection, so ordered.2250    This hearing is now adjourned. Please, this room is being2251used immediately after this, so when the meeting is adjourned,2252please exit the hearing room. Thank you.2253    [Whereupon, at 4:19 p.m., the subcommittee was adjourned.]22542255=======================================================================22562257                         A  P  P  E  N  D  I  X22582259=======================================================================22602261                    Prepared Statements of Witnesses22622263                              ----------22642265                  Prepared Statement of Mark Koeniger22662267[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]22682269               Prepared Statement of Charles Rudolph Paul22702271    Chairman, Ranking Member, and Members of the Subcommittee,2272    Thank you for the opportunity to testify on the U.S. Vets of the2273FAS Act, H.R. 6652, sponsored by Delegate King-Hinds and four other2274Members of the House, including Delegate Radewagen.2275    The Marshall Islands and the other FAS, Freely Associated States,2276were formerly administered by the United States as parts of a2277territory, but now are in the closest of possible relationships between2278sovereign nations with the U.S. We are the only three nations in free2279association with the U.S. Our associations are enshrined in compacts2280enacted into U.S. law.2281    Under these associations, we let the U.S. exercise a fundamental2282aspect of our sovereignty: Determining whether other nations can access2283an area the size of the 48 contiguous United States from Hawaii to2284Asia.2285    Our nations also host U.S. military bases. In my Marshall Islands,2286the Joint Chiefs of Staff say that the facility is the world's premiere2287range for testing ICBMs and military space operations support. Because2288of our location and the strategic rights that we let the U.S. exercise,2289our democracies are targets of aggressive efforts to weaken our2290alliances.2291    The U.S. military, additionally, recruits in the Freely Associated2292States as if we were U.S. States. It enlists our citizens at rates that2293are higher than the enlistment of U.S. citizens in most U.S. States.2294    Sadly, however, our U.S. military veterans are effectively2295compelled to remain in the U.S. after their service because they cannot2296receive the same healthcare if they return home.2297    This was a major issue in the renegotiation of our free2298association, which culminated in the enactment of the Compact of Free2299Association Amendments Act of 2024. The law was intended to resolve the2300issue. By agreement, it included provisions to have this healthcare2301available in our islands--as this Congress emphasized in November's2302Continuing Resolution and December's National Defense Authorization2303Act.2304    The Department of Veterans Affairs, however, has not acted to make2305the care available. It has acted contrary to what we negotiated, and2306Congress has said is the intent of the law.2307    The Government of the Marshall Islands, therefore, strongly2308supports the enactment of legislation to ensure that our veterans can2309receive the care if they return home.2310    This issue is personal at the highest levels of our government. The2311Minister of Foreign Affairs and Trade of the Republic of the Marshall2312Islands, Hon. Kalani R. Kaneko, is himself a retired United States Army2313veteran who honorably served for 20 years, qualifying him for full2314retirement under U.S. military service. During his military career, he2315served as an Army recruiter for more than a decade, actively recruiting2316across the Marshall Islands. Through that service, he recruited2317approximately 200 Marshallese men and women into the United States2318Armed Forces--individuals who answered the call because they trusted2319the United States, believed in the partnership between our nations, and2320were willing to serve wherever they were sent. Minister Kaneko has2321dedicated his life in service to the United States and its mission.2322Today, I respectfully ask the United States to stand by Minister2323Kaneko, and by the patriotic men and women he recruited, by ensuring2324access to the veterans' health care they have earned.2325    This issue is also personal to me.2326    My younger brother medically retired after 13 years of service in2327the United States Army, including three combat tours in Iraq. He2328retired due to injuries sustained during deployment. Today, he lives in2329the Marshall Islands,--and does not have access to health care he would2330have if he had not returned home.2331    My nephew is currently serving on active duty in the United States2332Army. He wants to return to the Marshall Islands 1 day to live, to2333raise a family, and to serve his community after he retires from2334military service. But he worries about whether he will be able to2335access health care if he comes home. That concern should not be the2336deciding factor in whether a U.S. veteran can go home after their2337service.2338    Importantly, access to veterans' health care in the Marshall2339Islands is not a new request, nor is it discretionary. It is explicitly2340contemplated in U.S. law and in treaty obligations.2341    Section 209(a)(4)(A) of the Compact of Free Association Amendments2342Act of 2024 directs the United States to enter into agreements to2343ensure the provision of veterans' services in the Freely Associated2344States. Congress made clear that geography should not exclude veterans2345residing in the Marshall Islands, the Federated States of Micronesia,2346or the Republic of Palau from the care they have earned.2347    That Compact obligation works in tandem with Section 1724(f) of2348title 38, United States Code, which authorizes the Department of2349Veterans Affairs to furnish hospital care and medical services outside2350the United States pursuant to agreements with foreign governments.2351Together, these provisions establish both clear authority and clear2352congressional intent.2353    The Freely Associated States are unique. We are the only sovereign2354countries in the world where the United States is permitted--by2355international agreement--to conduct active, routine military recruiting2356nationwide, without restriction as if our nations were U.S.2357territories. If the United States can actively recruit in the islands2358as if we were U.S. territories, it is reasonable--and just--that it2359provides care in the islands as if we were U.S. territories.2360    This is not only a moral obligation. It is a national security2361issue for both of our countries.2362    Veterans living in the Marshall Islands are a stabilizing force.2363Their presence strengthens local institutions, reinforces trust in the2364RMI-U.S. relationship, solidifies a vital international relationship,2365and serves as a deterrent to malign influences that seek to undermine2366this partnership.2367    Veterans who return home bring critical skills acquired through2368military service--engineering, logistics, health care, leadership,2369disaster response, and technical trades--that directly support national2370capacity-building in the Marshall Islands.2371    From a practical standpoint, the current gap in care creates an2372excessive hardship for veterans if they come home. They must fly2373thousands of miles for routine appointments or prescriptions--at huge2374personal expense and often delaying care. Telehealth services, mail-2375order pharmacy delivery, and travel support are practical, cost-2376effective solutions.2377    The Republic of the Marshall Islands stands ready to work2378constructively with Congress, the Department of Veterans Affairs, and2379the Administration to implement what the Compact Act of 2024 already2380promises.2381    Our veterans kept their commitment to the United States. 2024's2382Compact Amendments reflects the United States' commitment to them.2383Implementing equal veterans' health care in the Freely Associated2384States is not an expansion of benefits--it is fulfillment of an2385obligation.2386    Thank you. I look forward to your questions.23872388                   Prepared Statement of James Whaley23892390    Good afternoon, Chairwoman Miller-Meeks, Ranking Member Brownley,2391and Members of the Health Subcommittee.2392    Thank you for the opportunity to testify today on behalf of Mission2393Roll Call and the veteran community. Our mission is straightforward: we2394collect data from veterans, and we make sure that data helps inform2395decisions made in Washington. We use polling and direct engagement to2396bring real, unfiltered veteran perspectives to policymakers and the2397public. Amplifying this data on behalf of veterans and their families2398allows us to advocate for meaningful change that improves the lives of2399those who have served.2400    The legislation under consideration today seeks to address issues2401and improve the lives of multiple generations of veterans, addressing2402traumatic brain injury, suicide prevention, access to care in remote or2403rural areas, mental health, opioid addiction, and more. Mission Roll2404Call's survey data shows a strong need within the veteran community to2405address these issues in ways that place veterans first and delivers2406care when and how a veteran will benefit most.2407    One area where that need is especially clear is suicide prevention2408and mental health care delivered outside of VA facilities. In Mission2409Roll Call's national suicide prevention polling in July 2025, nearly 802410percent of veterans told us that preventing suicide requires clinical2411treatment and community-based support working together, not in2412isolation. More than 90 percent said it is extremely or very important2413to include community-based organizations in prevention efforts, and an2414equally strong majority emphasized the importance of training,2415coordination, and accountability.2416    The RECOVER Act reflects those priorities by strengthening2417evidence-based mental health capacity in the community, ensuring2418providers are trained to understand veteran risk, and requiring outcome2419reporting so Congress and the VA can assess what is actually working.2420To veterans, this is about a system that meets veterans where they are,2421especially when timely access to care can be the difference between2422stability and crisis.2423    While suicide prevention often brings veterans into the mental2424health system, many of the underlying drivers of risk begin earlier and2425go untreated. Mission Roll Call's survey data shows that over 952426percent of veterans say it is extremely or very important to have2427access to specialized TBI care, including care delivered outside the2428VA. Yet, among veterans seeking care for TBI-related symptoms, 732429percent report that accessing appropriate treatment is somewhat or very2430difficult.2431    The BEACON Act responds directly to that gap by creating a2432structured, evidence-based framework for evaluating innovative2433neurorehabilitation approaches for veterans with chronic TBI, including2434rigorous outcome measurement and independent evaluation. Veterans are2435asking the VA to test promising therapies responsibly, publish results,2436and expand access when evidence supports it. From the veteran2437perspective, the BEACON Act is about restoring function, reducing2438downstream mental health risk, and giving clinicians better tools to2439intervene before injuries compound into lifelong disability.2440    In addition, Mission Roll Call supports efforts to modernize2441veteran care by expanding evidence-based options while holding the2442system accountable for outcomes. The NOPAIN for Veterans Act moves VA2443toward broader use of effective non-opioid pain management therapies,2444while the Veterans Mental Health and Addiction Therapy Quality of Care2445Act ensures Congress and the VA have reliable, independent data on how2446mental health and addiction care performs across VA and community2447settings. These measures reflect what veterans consistently ask for in2448our surveys: care that is grounded in evidence, reduces risk, and is2449evaluated based on real-world results rather than assumptions.2450    Mission Roll Call has always advocated that geography should not2451determine whether a veteran receives timely care, and supports2452legislation that addresses access gaps for veterans who live far from2453VA facilities or outside the continental United States. The Veterans2454Health Desert Reform Act and the U.S. Vets of the Freely Associated2455States Act recognize this reality and seek to leverage community2456providers, telehealth, and mail-order pharmacy services to close those2457gaps.2458    We believe good policy starts with listening to the veteran2459community and ends with accountability. Veterans overwhelmingly seek2460better access to care in a manner that supports their life and family,2461rules they can easily understand, and outcomes that can be measured and2462improved. The legislation before you reflects meaningful progress2463toward those goals, and we appreciate the Subcommittee's continued2464focus on practical solutions that make the veteran and their family2465central to the provision of care.2466    Mission Roll Call has submitted a Statement for the Record that2467provides additional detail and supporting veteran data on these issues.2468    Chairman, Ranking Member, and Members of the Subcommittee, thank2469you, and I look forward to your questions.24702471                 Prepared Statement of Elizabeth McCoy24722473    Chairman Miller-Meeks, Ranking Member Brownley, and distinguished2474members of the House Committee on Veterans' Affairs, Subcommittee on2475Health - thank you for the opportunity to submit Wounded Warrior2476Project's views on pending legislation.2477    Wounded Warrior Project (WWP) was founded to connect, serve, and2478empower our Nation's wounded, ill, and injured veterans, Service2479members, and their families and caregivers. We are fulfilling this2480mission by providing life-changing programs and services to more than2481255,000 registered post-9/11 warriors and 60,000 of their family2482support members, continually engaging with those we serve, and2483capturing an informed assessment of the challenges this community2484faces. Rooted in this experience, we are pleased to provide our2485perspective on pending legislation that would likely have a direct2486impact on many we serve.24872488H.R. 2283: Recognizing Community Organizations for Veteran Engagement2489and Recovery Act (RECOVER) Act24902491    In response to WWP's most recent Warrior Survey, 76 percent of2492warriors reported having (or experiencing) post-traumatic stress2493disorder (PTSD), with nearly half presenting moderate to severe2494symptoms. PTSD, anxiety, and depression have continually ranked among2495the top mental health issues among warriors. Mental health and suicide2496prevention continue to be top priorities for WWP, and we support an2497approach that integrates both government as well as non-profit and2498private organizations to help increase access to timely mental health2499care that addresses these health challenges.2500    The RECOVER Act would authorize grant funding for non-profit2501organizations that provide evidence-based mental health treatment2502services to veterans in outpatient facilities. Funding would aim to2503ensure that programs serve all interested veterans with care, at no2504cost. Communities that are medically underserved, have large veteran2505populations, or have large numbers of veterans at high risk of suicide2506would be key recipients. Grantees would be required to educate care2507recipients about eligibility for Department of Veterans Affairs (VA)2508healthcare and encourage enrollment.2509    While WWP appreciates the need to keep VA as a coordinator of2510unfragmented clinical care, we believe that it should embrace grants to2511direct care programs. According to VA's 2024 National Veteran Suicide2512Prevention Annual Report, an average of 17.6 veterans died by suicide2513each day in 2022, and less than half (40 percent) of those had used VHA2514services in the 2-years prior to their death. These grants may help2515connect those unconnected veterans to available and VA supported mental2516health resources within their communities. Additionally, this approach2517is particularly important given the unfortunate reality that there is2518some skepticism toward VA within parts of the veteran community and2519best reflects a commitment with putting veteran's needs first.2520    These figures indicate that a vast majority of veterans who die by2521suicide are not receiving mental health treatment from VA. Whether due2522to appointment hours, bad prior experiences, perceived stigma, or the2523thought that receiving care may take away an opportunity from someone2524who needs it more, many still choose not to pursue mental health care2525at VA or forego seeking help entirely. Mental health treatment works,2526but every individual has unique needs, and there is no one-size-fits-2527all solution.2528    In this context, we must do everything we can to ensure that there2529is no wrong door to seeking mental health care, even if the first step2530is taken in the community. This approach has been embraced within the2531Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program (SSG2532Fox SPGP), which has been a cornerstone of VA's community-based suicide2533prevention strategy since its launch. While ``Fox Grants'' can be used2534to provide baseline mental health screenings among many other upstream2535suicide prevention services, grants cannot be used for direct mental2536health care under current law. WWP supports reauthorization of the SSG2537Fox SPGP, and we encourage consideration to adopt the RECOVER Act into2538this system and buildupon a program already committed to improving2539mental health and preventing veteran suicide through early community-2540based intervention and support.25412542H.R. 2426: Veterans Mental Health and Addiction Therapy Quality of Care2543Act25442545    Comparative studies of VA and community-based care have drawn2546several conclusions that can inform public policy. Most recently, a25472025 Government Accountability Office (GAO) report, Veterans' Community2548Care: VA Needs Improved Oversight of Behavioral Health Medical Records2549and Provider Training, highlighted systemic oversight gaps in the2550Veterans Community Care Program (VCCP). Nearly 225,000 veterans used2551more than 357,000 behavioral health referrals between Fiscal Year 20212552and Fiscal Year 2023, yet 33 percent of referrals lacked initial2553medical reporting, and VA did not track final documentation, posing2554risks when veterans return for follow-up care. GAO also found that only25552 percent of community providers completed any of VA's eight core2556trainings, including opioid safety, suicide prevention, and military2557cultural competency. These gaps can weaken care coordination and2558quality assurance.2559    Unfortunately, these findings are not dissimilar to VA Office of2560Inspector General (OIG's) 2025 inspection of the Martinsburg VA Medical2561Center, which revealed fundamental breakdowns in leadership2562communication, lack of recovery-oriented programming, unclear discharge2563instructions, and non-compliance with suicide prevention and other2564trainings. These observations highlight systemic challenges in care2565coordination and lack of adherence to safety standards.2566    To address key quality gaps which exist in both VA direct care, as2567well as the Community Care Network (CCN), WWP supports the Veterans2568Mental Health and Addiction Therapy Quality of Care Act. This bill2569takes a critical next step by mandating an independent, outcome-based2570study comparing VA and non-VA mental health and addiction treatment2571using metrics such as symptom improvement, suicide risk reduction, and2572adherence to evidence-based practices. The bill seeks external2573benchmarking of care quality, including assessments of military2574cultural competency, integrated care coordination, and success of2575record-sharing and outcome monitoring. This approach prioritizes2576comparative value and quality assurance, ensuring veterans receive the2577best possible care, wherever they seek it.2578    Wounded Warrior Project is pleased to support this legislation.25792580Discussion Draft: Veterans TBI Breakthrough Exploration of Adaptive2581Care Opportunities Nationwide Act of 2025 (BEACON Act of 2025)25822583    By fostering creativity and innovation in neurorehabilitation and2584treatment methodologies for TBI, VA can close critical gaps in evidence2585and practice. For example, military-related TBI significantly increases2586the risk of developing new mental health conditions and, both directly2587and indirectly, raises suicide risk. Research also consistently shows2588that TBI is a major risk factor for suicide among veterans.\1\ Findings2589like these underscore the urgent need for sustained investment in TBI2590research and care. By identifying mechanisms behind these risks and2591developing evidence-based interventions, we can improve mental health2592outcomes, accelerate recovery, and ultimately reduce suicide among2593veterans living with the long-term effects of brain injury.2594---------------------------------------------------------------------------2595    \1\ See, e.g., Lisa A. Brenner et al., Associations of Military-2596Related Traumatic Brain Injury With New-Onset Mental Health Conditions2597and Suicide Risk, JAMA NETWORK (July 2023), available at https://2598jamanetwork.com/journals/jamanetworkopen/fullarticle/2807787; Rajeev2599Ramchand & Tahina Montoya, RAND, SUICIDE AMONG VETERANS (May 2025),2600available at https://www.rand.org/pubs/perspectives/PEA1363-1-v2.html.2601---------------------------------------------------------------------------2602    One pathway to continued brain health innovation is through the2603Veterans TBI Breakthrough Exploration of Adaptive Care Opportunities2604Nationwide Act of 2025 (BEACON Act of 2025), which establishes two2605major initiatives to improve care for veterans with chronic mild2606traumatic brain injury (mTBI), a condition affecting over 400,0002607veterans since 2000.\2\ First, it establishes the TBI Innovation Grant2608Program, a 3-year, $30 million initiative that authorizes VA to award2609individual grants of up to $5 million to nonprofits, academic2610institutions, and non-VA providers. These grants would support the2611design and testing of innovative, patient-centered neurorehabilitation2612treatments, prioritizing non-pharmacological approaches. Grants would2613also fund clinical studies to measure the effectiveness of these2614approaches in improving mental health outcomes and reducing suicide2615risk. VA would be required to align the program with the Staff Sergeant2616Parker Gordon Fox Suicide Prevention Grant Program (SSG Fox SPGP),2617issue regulations within 180 days, and require annual reports and2618evaluations.2619---------------------------------------------------------------------------2620    \2\ DEF. HEALTH AGENCY, U.S. DEP'T OF DEF., https://www.health.mil/2621Military-Health-Topics/Centers-of-Excellence/Traumatic-Brain-Injury-2622Center-of-Excellence/DOD-TBI-Worldwide-Numbers (last visited Jan. 9,26232026).2624---------------------------------------------------------------------------2625    Second, the bill would authorize a 3-year, $10 million research2626grant program to fund collaborative studies to pioneer new TBI2627treatment methodologies, including randomized controlled trials. The2628program would be overseen by an independent third party to ensure2629thorough evaluation and identification of evidence-based practices. It2630would also require annual reporting to VA and would be reviewed after2631the 3-year pilot to determine whether it should be reauthorized and/or2632expanded.2633    Wounded Warrior Project is pleased to support this legislation;2634however, we believe that more clarity on funding - which current bill2635language allows to be drawn from ``amounts available [...] for general2636mental health care programs'' - would help ensure that resources will2637not be diverted away from mental health services that veterans rely on.26382639H.R. 6444: Blast Overpressure Research and Mitigation Task Force Act26402641    Blast overpressure, a sudden spike in air pressure caused by an2642explosion or blast wave that exceeds normal atmospheric pressure, has2643been linked to cumulative neurological effects, including cognitive2644decline, neuroinflammation, and increased risk of traumatic brain2645injury (TBI) and psychiatric conditions, such as PTSD and depression.2646Studies have demonstrated that exposure to blast overpressure is linked2647to measurable brain changes, cognitive and gait deficits, and higher2648rates of TBI and mental health conditions among service members and2649veterans.\3\ These findings were highlighted during a February 28,26502024, Senate Committee on Armed Services, Subcommittee on Personnel2651hearing where Dr. Lester Martinez-Lopez, Assistant Secretary of Defense2652for Health Affairs, emphasized the need for comprehensive research and2653insight to better understand risks, protect Service members, and2654improve brain injury treatment.2655---------------------------------------------------------------------------2656    \3\ See, e.g., Andrea Diociasi et al., Distinct Functional MRI2657Connectivity Patterns and Cortical Volume Variations Associated with2658Repetitive Blast Exposure in Special Operations Forces Members,2659RADIOLOGY (Apr. 2025), available at https://pubmed.ncbi.nlm.nih.gov/266040167438/; Kyle Bourassa et al., Traumatic Brain Injury and Accelerated2661Epigenetic Aging Among Post-9/11 Members, J. HEAD TRAUMA REHAB. (Aug.26622025), availble at https://pubmed.ncbi.nlm.nih.gov/40828005/.2663---------------------------------------------------------------------------2664    In this context, more comprehensive coordination between the2665Department of War (DoW) and VA can help drive progress to support2666Service members and veterans throughout and beyond the military2667lifecycle.2668    Currently, VA and DoW collaborate on TBI and blast injury research2669through the Traumatic Brain Injury Center of Excellence (TBICoE).2670However, gaps remain in integrating longitudinal data, coordinating2671research infrastructure, and conducting comprehensive long-term2672studies. Ultimately, these knowledge deficits limit the provision of2673premium care for those exposed to blast overpressure, particularly as2674Service members transition from active duty to veteran status.2675    H.R. 6444, the Blast Overpressure Research and Mitigation Task2676Force Act, aims to close these critical gaps through the VA-DoW Joint2677Executive Committee (JEC) and a new Blast Overpressure Task Force at2678VA. The Task Force would be required to establish physiological and2679cognitive baselines, align research agenda and acquisition strategies2680for blast-related care, and prioritize translational studies in areas2681such as cumulative mild TBI, vestibular dysfunction, autonomic2682dysregulation, as well as neuroinflammation, conditions that map2683directly onto documented blast sequelae and operational exposures in2684special-operations and weapons training cohorts.\4\2685---------------------------------------------------------------------------2686    \4\ See, e.g., Hadiyah Brendel, UNIFORMED SERVICES UNIVERSITY,2687INVICTA Study: Uncovering Blast Exposure's Impact on Special Operations2688Forces (Apr. 2025), available at https://www.dvidshub.net/news/555517/2689invicta-study-uncovering-blast-exposures-impact-special-operations-2690forces.2691---------------------------------------------------------------------------2692    By mandating annual reports, cross-agency coordination, and2693integration of mobile, longitudinal diagnostics, H.R. 6444 would create2694the infrastructure needed to translate emerging evidence into2695standardized screening, targeted mitigation strategies, and benefits2696adjudication for blast-exposed veterans. Further, the inclusion of Task2697Force recommendations related to VA claims processing and disability2698evaluations hold the promise of ensuring that veterans affected by2699blast overpressure injuries are connected to the care and support they2700have earned with their service. WWP supports H.R. 6444 and the2701objectives of the proposed Task Force. We believe the data currently2702being collected and assessed across systems represents an invaluable2703resource. Findings should be fully leveraged for robust analysis and2704research to drive evidence-based improvements.27052706Discussion Draft: Data Driven Suicide Prevention and Outreach Act of2707202527082709    Veterans continue to face very high risks of suicide, and current2710screening methods, rooted in self-reporting and periodic assessments,2711often fail to detect early warning signs.\5\ According to VA's 20242712National Veteran Suicide Prevention Annual Report, more than half of2713veterans lost to suicide had not accessed VA healthcare in over 2 years2714at the time of their death. This underscores the urgent need for2715innovative approaches that integrate complex datasets and proactively2716identify risk factors before a crisis occurs.2717---------------------------------------------------------------------------2718    \5\ See, e.g., OFF. OF INSP. GEN., U.S. DEP'T OF VET. AFFAIRS,2719INADEQUATE STAFF TRAINING AND LACK OF OVERSIGHT CONTRIBUTE TO THE2720VETERANS HEALTH ADMINISTRATION'S SUICIDE RISK SCREENING AND EVALUATION2721DEFICIENCIES (Dec. 2024).2722---------------------------------------------------------------------------2723    The Data Driven Suicide Prevention and Outreach Act of 2025 would2724direct VA to establish a pilot program awarding grants to organizations2725with expertise in AI and predictive analytics to develop models that2726evaluate suicide risk among veterans. These models could help2727clinicians prioritize interventions and tailor care, improving outcomes2728and saving lives.2729    This pilot program would not be VA's first attempt to incorporate2730predictive models into its suicide prevention efforts. REACH VET2731(Recovery Engagement and Coordination for Health - Veterans Enhanced2732Treatment) is a VA initiative that uses predictive analytics to2733identify veterans at the highest statistical risk for suicide and2734proactively connect them with tailored care and outreach. Research on2735VA's REACH VET program has found that veterans flagged by REACH VET2736received more proactive care, such as safety planning and outpatient2737visits, and experienced a modest reduction in nonfatal suicide2738attempts.\6\2739---------------------------------------------------------------------------2740    \6\ Kallisse Dent et al., The REACH VET Program and Mortality2741Outcomes Among Veterans at High Risk of Suicide, JAMA NETWORK (July27422025), available at https://jamanetwork.com/journals/jamanetworkopen/2743fullarticle/2836124.2744---------------------------------------------------------------------------2745    While predictive analytics can improve engagement and care2746processes, they will not guarantee reductions in veteran suicide. As2747Congress considers new AI-driven initiatives like the Data Driven2748Suicide Prevention and Outreach Act, it is critical to build on these2749lessons, ensuring integration with existing VA models, transparency in2750algorithms, and commitment to making system improvements based on2751evidence-informed research. We also believe that innovation should2752complement, rather than replace, proven strategies for veteran suicide2753prevention.2754    Wounded Warrior Project is pleased to support this legislation.27552756Discussion Draft: Veterans Health Desert Reform Act of 202527572758    Veterans living in rural communities encounter persistent obstacles2759to care, from long travel times and limited specialty services to2760transportation challenges that often delay treatment. While VA2761Community Care was designed to bridge these gaps, provider shortages2762and hospital closures in rural areas can leave veterans with few2763practical options, even when referrals are approved.2764    Under Community Care, VA generally contracts with individual2765providers and facilities rather than enrolling an entire hospital as a2766blanket participant, though care often occurs in hospitals. Individual2767providers join VA's Community Care Network and may practice within2768hospitals, and facilities can also participate through contracts or2769agreements. However, participation is service-and provider-specific,2770not automatic for all hospital services. This structure means not every2771department or provider within a participating hospital is available to2772VA patients, and access depends on network status, contracted services,2773and referral authorization. Ultimately, Community Care operates through2774networked providers and contracted facilities, not universal hospital2775participation, which can lead to variability in access even within the2776same hospital.2777    The Veterans Health Desert Reform Act of 2025 would create a VA2778pilot program to improve access to hospital care for veterans living in2779rural areas. Under this program, VA would enter agreements with at2780least three hospitals in high-need rural regions to furnish the same2781hospital care and medical services that veterans are eligible to2782receive under the Veterans Community Care Program. Participating2783hospitals would be reimbursed at rates no lower than Medicare. VA would2784review best practices from Medicare, Medicaid, and TRICARE to inform2785payment models. Throughout the pilot, VA would monitor access, cost,2786quality, and veteran satisfaction and submit a report to Congress after2787the program's authority ends in 2029.2788    Wounded Warrior Project is pleased to support this legislation;2789however, we recognize that more development may be needed within the2790legislative text or Center for Innovation for Care and Payment2791implementation process to resolve issues such as conflicts with2792existing hospital-based providers.27932794H.R. 6526: Clarity on Care Options Act27952796    Witness testimony from this Subcommittee's recent hearing,2797``Strengthening CHAMPVA for Survivors and Dependents,'' highlighted2798that caregivers, survivors, and dependents often struggle to find2799community providers who accept Civilian Health and Medical Program of2800the Department of Veterans Affairs (CHAMPVA) coverage. Currently, there2801is no central repository for beneficiaries to look up community care2802network providers who accept CHAMPVA.2803    The Clarity on Care Options Act would improve outcomes for these2804families by creating a public-facing directory of providers in the2805CHAMPVA network. The bill directs the VA to mandate Community Care2806Network (CCN) third party administrators to query their network of2807providers to confirm whether those providers accept CHAMPVA2808assignments, and then maintain an accessible, nationwide directory,2809helping families improve access to timely care. The legislation sets2810clear and intentional timelines: initial provider queries must be2811completed within 90 days of enactment, and the first public directory2812must be published within 180 days. VA would also be required to submit2813annual reports to Congress for 5 years, detailing provider2814participation rates and identifying geographic gaps (broken down by2815both State and Veteran Integrated Service Network (VISN).2816    Wounded Warrior Project recognizes the critical importance of this2817effort. Surviving families often face heightened mental health risks.2818Spouses, children, and caregivers in these families are vulnerable to2819trauma and require consistent, comprehensive support. In addition,2820families of veterans rated 100 percent permanent and total; families of2821veterans in receipt of Total Disability based on Individual2822Unemployability (TDIU) and approved Primary Family Caregivers in VA's2823Program of Comprehensive Assistance for Family Caregivers (PCAFC)2824depend on reliable access to care. CHAMPVA plays a vital role in2825meeting these needs, but a lack of clarity on participating providers2826undermines its promise, and leaves too many without timely, quality2827care.2828    We support H.R. 6526 and urge continued efforts to expand access to2829essential healthcare information. A national CHAMPVA provider registry2830would ensure caregivers, survivors, and dependents have a powerful tool2831to secure the care and support they deserve.28322833H.R. 4509: NoPAIN for Veterans Act28342835    While post-9/11 service has become closely associated with2836invisible wounds like PTSD and TBI, pain management is one of the most2837critical health issues in the community we serve. Chronic pain can2838impact an individual's physical and mental well-being and quality of2839life\7\ and there is evidence to suggest veterans have higher2840prevalence of chronic pain that civilians\8\. Nearly all (95 percent)2841respondents to WWP's most recent Warrior Survey reported some pain in2842the last 3 months, and 3 in 4 (75.5 percent) provided responses2843indicating moderate to severe interference with activities and2844enjoyment of life. In addition, VA's 2024 National Veteran Suicide2845Prevention Annual Report indicates that pain in the year prior to death2846was the most common risk factor (53.8 percent) among veterans lost to2847suicide from 2020 to 2022.2848---------------------------------------------------------------------------2849    \7\ Kosuke Kawai et al., Adverse Impacts of Chronic Pain on Health-2850related Quality of Life, Work Productivity, Depression, and Anxiety in2851a Community-Based Study, FAMILY PRACTICE (Nov. 2017), available at2852https://pubmed.ncbi.nlm.nih.gov/28444208/.2853    \8\ Kenneth Taylor et al., Seventeen-year National Pain Prevalence2854Trends Among U.S. Military Veterans, J. PAIN (May 2024), available at2855https://pubmed.ncbi.nlm.nih.gov/37952861/.2856---------------------------------------------------------------------------2857    Medication for pain can be part of the solution, but opioid-based2858medications carry notable risks. When prescribed after surgery or a2859severe injury (acute pain) for example, opioid treatment can increase2860the risk of addiction, especially if opioids are used for prolonged2861periods, at higher doses, or in individuals with a history of substance2862use disorders (SUD) - and nearly 14 percent (2.8 million) veterans2863struggle with SUDs.\9\2864---------------------------------------------------------------------------2865    \9\ SUBSTANCE ABUSE AND MENTAL HEALTH SERVS. ADMIN., U.S. DEP'T OF2866HEALTH & HUMAN SERVS., KEY SUBSTANCE USE AND MENTAL HEALTH INDICATORS2867IN THE UNITED STATES: RESULTS FROM THE 2023 NATIONAL SURVEY ON DRUG USE2868AND HEALTH (July 2024), available at https://www.samhsa.gov/data/sites/2869default/files/reports/rpt47095/National %20Report/National %20Report/28702023-nsduh-annual-national.pdf.2871---------------------------------------------------------------------------2872    In this context, non-opioid medication for pain can and should be2873more easily accessible for veterans enrolled in Veterans Health2874Administration (VHA) care. Under current law, VA is not required to2875include non-opioid pain management drugs in its National Formulary,2876leaving interested patients - and their providers - to navigate a2877waiver system that requires increased effort, may result in delayed2878access, and can ultimately lead to higher costs for the veteran. The2879NOPAIN for Veterans Act would require VA to include certain non-opioid2880pain management drugs as part of the National Formulary to align with2881Medicare laws that mandate coverage of non-opioid pain drugs,2882biologics, or devices with an FDA-approved indication to reduce post-2883operative pain or produce post-surgical or regional analgesia.2884    Wounded Warrior Project supports the intent of providing faster,2885easier access to non-opioid pain management drugs to veterans; however,2886distinctions between Medicare and VHA prescription drug coverage may2887require different solutions. The most notable distinction in this2888context is that VHA is a direct purchaser (and distributor) of the2889drugs included in its National Formulary whereas the Medicare system2890relies on private insurance plans offering Part D and Medicare2891Advantage plans to handle drug purchasing and network with pharmacies.2892Without deeper understanding and knowledge of how previous requests to2893cover applicable non-opioid alternatives through the VA Pharmacy2894Benefits Management (PBM) Services and VA Medical Advisory Panel-VISN2895Pharmacist Executives (MAP-VPE) have fared, we encourage this matter to2896be further explored as part of the recent majority announcement of its2897VA Reauthorization Series, which features an intent to modernize VA's2898National Formulary governance.\10\2899---------------------------------------------------------------------------2900    \10\ Press release, House Comm. Vet. Affairs, Chairman Bost, House2901Republicans Launch a Veteran First Initiative to Modernize VA2902Healthcare for the 21st Century (Dec. 10, 2025), available at https://2903veterans.house.gov/news/documentsingle.aspx?DocumentID=7810.29042905H.R. 5999: To Amend Title 38, United States Code, to Direct the2906Secretary of Veterans Affairs to furnish an opioid antagonist to a2907---------------------------------------------------------------------------2908veteran without requiring a prescription or copayment29092910    Veterans living with chronic pain face a heightened risk of opioid2911overdose, as symptom management often leads to increased reliance on2912these medications.\11\ While some VA Medical Centers allow veterans to2913request opioid antagonists directly from the pharmacy, most still2914require a provider-issued prescription, placing administrative and cost2915barriers before a vulnerable population.2916---------------------------------------------------------------------------2917    \11\ See, e.g., OFF. OF RSCH. & DEV., U.S. DEP'T OF VET. AFFAIRS,2918OPIOID USE DISORDER - FACT SHEET: DATA ON VETERANS USING VA HEALTH CARE2919(Apr. 2022), available at https://www.vacsp.research.va.gov/CSPEC/2920Studies/CSPEAR/Docs/Opioid-Use-Disorder.pdf.2921---------------------------------------------------------------------------2922    Many states already allow antagonists, such as naloxone, to be2923obtained over the counter or through standing orders, yet VA lacks a2924consistent, system-wide approach to ensure timely access. Standardizing2925protocols and expanding availability across VA facilities would2926strengthen overdose prevention and give veterans a critical,2927potentially life-saving tool.2928    Providing opioid antagonists, such as naloxone, at no cost to2929veterans can save lives among a high-risk population. Community-based2930naloxone distribution programs have consistently demonstrated2931effectiveness in reversing overdoses and reducing fatalities. Evidence2932shows that jurisdictions eliminating prescription requirements and2933copayments achieve higher naloxone uptake and better outcomes in2934combating overdose deaths. RAND research further indicates that2935policies offering naloxone free of charge and without prescription2936substantially increase distribution and have the potential to reduce2937fatal overdoses. For veterans facing elevated risks due to chronic pain2938and mental health challenges, removing these barriers - as proposed -2939would align VA policy with proven public health strategies, ensuring2940immediate, cost-free access to this lifesaving medication.\12\2941---------------------------------------------------------------------------2942    \12\ RAND, STATEWIDE FREE NALOXONE (Dec. 2023), available at2943https://www.rand.org/pubs/research_briefs/RBA3054-15.html.2944---------------------------------------------------------------------------2945    Wounded Warrior Project is pleased to support this legislation.29462947H.R. 6001: Veterans with ALS Reporting Act29482949    Amyotrophic Lateral Sclerosis (ALS) is a devastating2950neurodegenerative disease without a cure or effective treatment. It is2951always fatal, with most individuals tragically living only two to 52952years after diagnosis. Veterans face an even greater risk, with studies2953showing they are twice as likely to develop ALS as the general2954population.\13\ VA recognizes ALS as a service--connected condition and2955grants a 100 percent disability rating upon diagnosis, but we still2956lack a clear picture of why veterans are disproportionately affected or2957how to reduce that risk.\14\, \15\2958---------------------------------------------------------------------------2959    \13\ See, e.g., NAT'L ACADS. OF SCI., ENG., & MED., LIVING WITH ALS29602024, available athttps://nap.nationalacademies.org/resource/27739/2961ALS_One_Pager_Veterans.pdf.2962    \14\ I AM ALS, UNDERSTANDING VETERANS AT RISK FOR ALS, https://2963www.iamals.org/understanding-veterans-risk-for-als/ (last visited Jan.29649, 2026).2965    \15\ Hari Krishna Raju Sagiraju et al., Amyotrophic Lateral2966Sclerosis Among Veterans Deployed in Support of Post-9/11 U.S.2967Conflicts, MILITARY MED. (Mar. 2020), available at https://2968pubmed.ncbi.nlm.nih.gov/31642489/.2969---------------------------------------------------------------------------2970    The Veterans with ALS Reporting Act takes an important step toward2971answering these questions, requiring VA, in collaboration with the2972Centers for Disease Control (CDC), to report on ALS incidence and2973prevalence among veterans, identify gaps in care and support, and2974outline strategies for risk reduction. This bill also calls for better2975access to clinical trials, expanded research participation, and2976continuous tracking through the CDC's ALS registry and biorepository as2977this younger veteran cohort age. By mandating regular updates to2978Congress, this legislation ensures accountability and drives progress2979toward better understanding, prevention, and treatment of ALS in the2980veteran community.2981    Wounded Warrior Project is pleased to support this legislation. To2982strengthen the bill further, we recommend adding provisions that2983require VA to develop and implement an action plan based on the2984report's findings related to gaps in care and support, rather than2985limiting the bill to data collection. Including specific outcome2986metrics and timelines for improving care access, clinical trial2987enrollment, and support services would ensure accountability. The bill2988could also mandate public reporting of corrective actions, require2989consultation with veteran advocacy and ALS organizations, and authorize2990dedicated funding for implementation so recommendations lead to real2991improvements. These enhancements would transform the bill from a2992reporting requirement into a catalyst for meaningful change in ALS care2993for veterans.29942995Agenda items not addressed in this Statement for the Record29962997      Discussion Draft: U.S. Vets of the FAS Act29982999      Discussion Draft: Whole Health for Veterans Act30003001Concluding Remarks30023003    Wounded Warrior Project once again extends our thanks to the3004Subcommittee on Health for its continued dedication to our Nation's3005veterans. Our commitment to keeping the promise by rebuilding the lives3006of warriors impacted by war and military service remains as strong as3007ever, and we are honored to contribute our voice to your discussion3008about pending legislation. As your partner in advocating for these and3009other critical issues, we stand ready to assist and look forward to our3010continued collaboration.30113012                 Prepared Statement of K. Conwell Smith30133014    Chairwoman Miller-Meeks, Ranking Member Brownley, and distinguished3015Members of the Subcommittee, on behalf of the American Psychological3016Association (APA), thank you for the opportunity to testify and provide3017comments regarding legislation being considered today. I am Conwell3018Smith, APA Deputy Chief for Military and Veterans Policy.3019    The American Psychological Association and its companion3020organization APA Services, Inc. (APA/APASI) serve as the Nation's3021largest scientific and professional nonprofit organization representing3022the discipline and profession of psychology. Our organization has more3023than 190,000 members and affiliates who are clinicians, researchers,3024educators, consultants, and students. Within the Veterans Health3025Administration, there are over 7,000 psychologists serving veterans.3026That number has declined by nearly 300 psychologists since November30272024.\1\ APA is proud of the decades of clinical and research3028advancements made in mental and behavioral health thanks to3029psychology's role within the VA since World War II. The VA has long led3030the way in establishing standards for practice, training and research3031that serve veterans and our entire healthcare system.3032---------------------------------------------------------------------------3033    \1\ SECVA Workforce Dashboard3034---------------------------------------------------------------------------3035    We appreciate the Committee's willingness to take on the challenges3036surrounding the critical delivery of and access to mental health care3037for our Nation's veterans. Demand for VA mental health care has3038increased steadily over the past 20 years and continues to outpace3039other care within the VA.\2\ Meeting this demand while maintaining the3040VA's high level of clinical excellence should be the priority.3041---------------------------------------------------------------------------3042    \2\ htps://www.govinfo.gov/content/pkg/CMR-VA1-00181657/pdf/CMR-3043VA1-00181657.pdf3044---------------------------------------------------------------------------3045    My testimony will focus primarily on ways in which legislation3046discussed today should aim to provide veterans with care of the highest3047quality, regardless of site of service - care that is on par with the3048current standards of practice that exist within the Veterans Health3049Administration. Several bills being considered today create new3050delivery models, access points, and processes separate and apart from3051VHA. APASI is concerned that the creation of new systems of care3052outside of VA direct care or the Veterans Community Care Program (VCCP)3053and without VA authorization or referral only further fragments veteran3054care, isolating veterans and compromising the benefits of an integrated3055care model. APASI is also concerned that two well intentioned bills3056focused on access to care, the Recognizing Community Organizations for3057Veteran Engagement and Recovery or RECOVER Act (H.R. 2283) and the3058draft Health Desert Reform Act, risk reducing the quality of veteran3059health care without certain safeguards put in place.3060    APASI recognizes the need to supplement VHA care due to staffing,3061funding, specialty care and location considerations; however, veterans3062should expect the following when receiving mental health care outside3063of the VHA integrated health system: (1) Providers who have received3064key trainings currently required within the VA; (2) The use of3065treatments scientifically proven to be effective; (3) Quality3066assurance, oversight, and accountability; (4) Coordinated care and3067shared health records; and (5) Adequate information for informed3068choice.30693070Providers Trained to Best Serve Veterans\3\3071---------------------------------------------------------------------------3072    \3\ Veterans' Community Care: VA Needs Improved Oversight of3073Behavioral Health Medical Records and Provider Training U.S. GAO30743075    For years, the VA has made tremendous strides in universal suicide3076prevention risk assessments and required trainings for providers3077including training in suicide prevention, lethal means safety, military3078culture, and military sexual trauma. The RECOVER Act, which would3079provide $60 million in grants to mental health facilities serving3080veterans, fails to require that its clinicians meet the training rigor3081and responsibility of VA providers. Even suicide prevention training is3082not required, even though the legislation appropriately targets areas3083with high veteran suicide risk.3084    APASI supports requiring key trainings for all VA community3085providers, including those providing mental health services through3086separate VA funded grant programs. A May 2025 Government Accountability3087Office (GAO) report recommended that VA better monitor whether3088community providers have completed any of eight core trainings,3089following findings that a mere ``two percent of the community providers3090with a behavioral health referral from fiscal years 2021 through 20233091had completed one or more of these trainings.''30923093The Use of Treatments Scientifically Proven to be Effective30943095    APA strongly believes in leading with psychological science and3096takes seriously the development of treatments scientifically proven to3097be effective for the assessment and treatment of mental health3098disorders.\4\ The RECOVER Act does not require provider training in3099evidence-based practices, overlooking the clear need for knowledge and3100training on common veteran conditions such as post-traumatic stress and3101traumatic brain injury.3102---------------------------------------------------------------------------3103    \4\ Guidelines for Practitioners3104---------------------------------------------------------------------------3105    Another bill being considered today, the Veterans TBI Breakthrough3106Exploration of Adaptive Care Opportunities Nationwide or BEACON Act of31072025, aims to increase research on mild traumatic brain injury and3108mental health interventions outside ``the scope of traditional3109Department of Veterans Affairs pathways.'' APASI is concerned that this3110approach might also undermine the bedrock of rigorous scientific study3111that is the gold standard of existing VA traumatic brain injury3112research and treatment. APASI views this alternative pathway as3113unnecessary, likely to duplicate internal efforts, and potentially3114reducing standards necessary for evidence-based care.31153116Quality Assurance, Oversight and Accountability31173118    APASI encourages strong quality assurance standards and facility3119accreditation for any grant recipient providing mental and behavioral3120services to veterans. The RECOVER Act currently does not require3121accreditation from either The Joint Commission or the Commission on3122Accreditation of Rehabilitation Facilities (CARF). This is a3123significant departure from quality assurance standards within the VA.3124APASI also encourages that both the RECOVER Act and the Veterans Health3125Desert Act incorporate utilization review to ensure that3126overutilization and unnecessary duplication of services are adequately3127addressed both for the quality of care for veterans and good3128stewardship of taxpayer funds. Finally, it is important that the3129RECOVER Act create a meaningful standard and process to ensure that the3130expressed intention to demonstrate improved clinical outcomes is fully3131met and enforced. We should learn from recent findings in the3132congressionally mandated final report of the Staff Sergeant Parker3133Gordon Fox Suicide Prevention Grant Program whereby, despite3134requirements for recipients to administer both baseline and follow-up3135assessments, significant numbers of grantees failed to do so. Without3136evidence of grantee level effectiveness, we fail to understand both3137positive and negative impacts on veterans.31383139Care Coordination and Shared Health Records31403141    Known benefits of integrated health care systems include improved3142care coordination, transdisciplinary care teams, efficient resource3143utilization, prevention and early intervention, and improved patient3144experience. Perhaps this is why, in 2024, VA hospitals outperformed3145non-VA hospitals in both patient satisfaction and hospital quality3146ratings\5\ and 79.5 percent of Veterans using VA services responded in31472025 that they trust the VA. Removing the VA as coordinator of care and3148creating increased fragmentation of VA services will further weaken3149communication and coordination among veterans' health care providers.3150---------------------------------------------------------------------------3151    \5\ htps://news.va.gov/press-room/va-health-care-outperforms-non-3152va-care-in-two-independent-nationwide-quality-and-patient-satisfaction-3153reviews/3154---------------------------------------------------------------------------3155    Furthermore, the same GAO report listed above\6\ found that 333156percent of VA referrals for behavioral health services were missing3157initial visit records. The quality of care for veterans can be3158negatively impacted by the lack of shared health records. APASI3159recommends that all providers of veteran care be required to3160participate in timely medical record exchange.3161---------------------------------------------------------------------------3162    \6\ Veterans' Community Care: VA Needs Improved Oversight of3163Behavioral Health Medical Records and Provider Training U.S. GAO31643165---------------------------------------------------------------------------3166Adequate Information for Informed Choice31673168    APASI lauds two bills today that aim to better inform veterans.3169APASI is encouraged by the creation of a publicly available directory3170of health care providers that accept assignments under the CHAMPVA3171program, as required in the draft Clarity on Care Options Act.3172    The Veterans Mental Health and Addiction Therapy Quality of Care3173Act, H.R. 2426, also strives to provide veterans with information3174needed to make informed healthcare choices. APASI supports the intent3175of the legislation but is concerned that it falls short of intended3176goals as currently written. For example, the bill does require3177contracts with Third Party Administrators to include the expectation of3178assessing patients' treatment progress. It also does not authorize the3179VA to access VCCP health care records. Unless the bill requires VCCP3180providers to submit key uniform measurement and health care record3181information to the VA, valid comparisons cannot be made. APASI also3182suggests that wait time, provider training, and additional quality3183metrics be added.3184    Finally, APASI would like to acknowledge H.R. 4509, the NOPAIN for3185Veterans Act and the draft Whole Health for Veterans Act for their3186focus on the health and well-being of veterans. By making it easier for3187veterans to access and afford non-opioid medications and whole health3188well-being services, these bills contribute to prevention and3189resiliency.31903191Conclusion31923193    Chairwoman Miller-Meeks, Ranking Member Brownley, and distinguished3194Members of the Subcommittee, APASI thanks you for your leadership and3195for allowing us the opportunity to provide feedback on legislation. We3196know that each of you are earnest in your efforts to improve veteran3197health care access and quality. The VA has consistently led the way in3198groundbreaking mental health care research, the development of3199effective treatments, and the training of an exceptional health care3200workforce serving all Americans and we are proud of psychology's role3201within the VA. APASI believes in this high standard of care and in3202meeting the expectation of veterans to receive it.3203    In closing, it is an honor to serve the American Psychological3204Association, advocating for the vital work psychologists do every day3205for our veterans and military. Importantly, I speak as the spouse of an3206Army veteran who receives his care through the Hampton VA Medical3207Center. There is nothing more important to me than ensuring he and all3208others who serve receive the best care in every setting. Thank you.32093210                        Statement for the Record32113212                              ----------32133214  Prepared Statement of Veterans of Foreign Wars of the United States32153216    Chairman Miller-Meeks, Ranking Member Brownley, and members of the3217subcommittee, on behalf of the men and women of the Veterans of Foreign3218Wars of the United States (VFW) and its Auxiliary, thank you for the3219opportunity to provide testimony regarding this pending legislation.32203221H.R. 2283, RECOVER Act32223223    The VFW supports the intent of this legislation that would3224establish a pilot program providing grants to outpatient mental health3225facilities for culturally competent, evidence-based care for veterans.3226Too many veterans, especially in rural, underserved, and high-risk3227communities, still face barriers to timely mental health and addiction3228services. This proposal offers a targeted way to expand access while3229reinforcing veteran-centered, evidence-driven care.3230    The VFW is encouraged by the focus on accountability, clinical3231outcomes, and the commitment not to charge veterans for care. Removing3232cost as a barrier is essential, especially for veterans who are3233uninsured, underinsured, or concerned about finances. Prioritizing3234services in high suicide risk communities aligns this pilot with3235national suicide-prevention strategies.3236    To that end, the VFW strongly urges Congress to ensure that veteran3237and military service organizations have a formal role in helping3238establish the standards for cultural competency under this program.3239Even if these organizations are not eligible for grant funding, they3240represent and serve the veteran population every day and bring an3241essential perspective on what culturally competent care should look3242like in practice. Their involvement would help ensure that standards3243reflect veterans' lived experiences rather than narrow or academic3244interpretations. The VFW urges that community-based mental health care3245must complement, not replace, Department of Veterans Affairs (VA)3246services. This pilot must strengthen the overall system, not create3247disconnected silos. Set and enforce strong standards for care3248coordination, medical record sharing, and referral paths back to VA to3249guarantee continuity of treatment, especially for veterans with3250complex, chronic, or co-occurring conditions. Do not drop coordination3251demands, remove record sharing, or weaken VA's role. Such actions would3252fragment care and jeopardize outcomes. The success of this initiative3253depends on direct action to maintain and improve integration across3254care points.3255    The VFW urges Congress to take immediate action to ensure this3256pilot supplements but does not replace investment in VA's mental health3257system. Congress must fully invest in VA's own capacity and guarantee3258that expanding access through trusted partners strengthens, rather than3259undermines, VA's central role in coordinating veteran care. Do not let3260privatization weaken accountability and disrupt continuity for those3261who served.32623263H.R. 2426, Veterans Mental Health and Addiction Therapy Quality of Care3264Act32653266    The VFW strongly supports improving the quality, safety, and3267accountability of mental health and addiction care for veterans.3268However, we cannot accept this legislation as written because it does3269not provide VA with the authority, data access, or tools needed to3270conduct the required comparison.3271    The legislation requires an independent review of quality across VA3272and non-VA care. However, community providers do not collect or3273standardize data like VA does. Without comparable clinical metrics such3274as suicide-risk screenings, treatment adherence, or use of evidence-3275based practices, comparing outcomes would be flawed. Any study based on3276incomplete data risks producing misleading results.3277    The VFW is also concerned that the legislation relies heavily on3278raw utilization measures, such as the number of visits, as proxies for3279quality and effectiveness. Visit counts alone do not capture changes in3280symptom severity, functional status, treatment intensity, or care3281transitions over time. Veterans' mental health and substance use needs3282often fluctuate, and meaningful evaluation must account for clinical3283trajectories, not just service volume. Without this context, the3284legislation risks reducing complex care decisions to superficial3285metrics that do not reflect real outcomes.3286    This legislation also omits key tools VA would need. It does not3287guarantee access to community-provider data, reporting standards for3288non-VA providers, or risk adjustment for patient complexity and social3289factors. Without these, VA cannot make a fair or accurate comparison.3290This approach could unintentionally undermine accountability. It may3291create the appearance of oversight without the substance needed for3292improvement. Worse, incomplete or poorly contextualized findings could3293be misused to justify policy decisions that restrict access or shift3294resources based on unreliable conclusions.3295    Veterans deserve real accountability, not just rhetoric. Any3296legislation claiming to measure the quality of mental health and3297addiction care must initially ensure the tools, data, and standards3298exist to make those measurements accurate, fair, and actionable.3299Without these foundations, this legislation risks creating conclusions3300that neither improve care nor serve the best interests of veterans.33013302H.R. 4509, NOPAIN for Veterans Act33033304    The VFW does not support legislation that would amend Title 38 to3305require VA to add non-opioid pain drugs and biologicals to its3306formulary on a set timeline. These products must be FDA-approved,3307reduce certain types of pain, and not work on opioid receptors. The VFW3308has not yet issued a resolution on this matter.33093310    H.R. 5999, To amend title 38, United States Code, to direct the3311Secretary of Veterans Affairs to furnish an opioid antagonist to a3312veteran without requiring a prescription or copayment33133314    The VFW strongly supports expanding access to opioid antagonists3315through VA without prescription or copayment barriers. Overdose deaths3316are rising, including among veterans. Removing obstacles to emergency3317treatment shows commitment to prevention and harm reduction.3318    Veterans face unique risks for opioid misuse, such as chronic pain,3319injuries, and mental health conditions like post-traumatic stress3320disorder. Broad, stigma-free access to overdose-reversal medication3321lets veterans, families, and communities act quickly when seconds3322count. This approach aligns with proven public health plans that3323emphasize early action and local responses.3324    While the VFW supports the intent of this legislation, we believe3325safeguards are needed. Opioid antagonists are generally safe but may3326pose risks for veterans with certain health issues or medicines. If3327available without a prescription, veterans should get counseling from a3328VA pharmacist. This would ensure informed use, help find risks, and3329reinforce safe use. Informed consent and patient safety must remain3330central, even if the drug is over the counter.3331    The VFW is also concerned about the fiscal implications of removing3332all copayments for these medications. VA has faced budget pressures in3333recent years despite funding increases. Congress must consider how a3334no-copay requirement would affect pharmacy budgets if demand increases.3335Expanding access should not come at the expense of sustainability or3336force VA to divert resources from other critical services.3337    The VFW believes making opioid antagonists widely available through3338VA should serve as a gateway to care, not a standalone solution. When3339paired with strong referral pathways to substance use disorder3340treatment, mental health services, and peer support, this policy can3341save lives while strengthening long-term recovery.33423343H.R. 6001, Veterans with ALS Reporting Act33443345    The VFW supports this legislation that would require the VA3346Secretary to establish a triennial amyotrophic lateral sclerosis (ALS)3347monitoring, tracking, and reporting program. Under this requirement, VA3348would assess the incidence and prevalence of ALS among veterans,3349describe the resources VA and the Centers for Disease Control and3350Prevention (CDC) provide to veterans living with ALS, identify any gaps3351in those resources, develop a strategy to evaluate risk--reduction3352therapies aimed at lowering ALS incidence and prevalence among3353veterans, establish pathways for veterans receiving VA-provided ALS3354care to participate in VA-sponsored clinical trials and research, and3355recommend legislative solutions to address barriers to reducing ALS3356incidence and prevalence in the veteran population.3357    Additionally, this legislation would direct VA to track ALS3358prevalence among veterans through the VA ALS Registry and the CDC's3359biorepository. According to VA's va.gov website, studies indicate that3360veterans are approximately 1.5 times more likely to develop ALS than3361individuals with no history of military service. Establishing this3362comprehensive monitoring and reporting framework would better equip VA3363to evaluate the effectiveness of risk-reduction strategies and improve3364outcomes for veterans living with ALS.3365    The VFW has long been a staunch advocate for legislation benefiting3366ALS patients and their survivors. Notably, during the 2021-20223367timeframe, the VFW Department of Virginia authored national VFW3368resolutions calling for commonsense modifications to ALS survivors'3369benefits. These advocacy efforts helped advance the Justice for ALS3370Veterans Act of 2025, in support of which the VFW provided favorable3371testimony.33723373H.R. 6444, Blast Overpressure Research and Mitigation Task Force Act33743375    The VFW supports this legislation that would directly advance the3376VFW's longstanding legislative priorities and active resolutions3377focused on traumatic brain injury (TBI), blast overpressure exposure,3378and related neurological and cognitive health conditions.3379    Modern service members, particularly those in combat arms and high-3380exposure occupational specialties, face repeated blast exposure that3381can result in cumulative, often poorly understood injuries with3382lifelong consequences. This legislation takes an important step toward3383addressing those gaps by directing VA, in coordination with the3384Department of Defense, to establish a task force to align research,3385improve clinical care, and develop mitigation strategies for blast-3386related injuries.3387    The VFW's support reflects our commitment to strengthening3388research, diagnosis, and treatment of blast overpressure injuries,3389ensuring affected veterans receive timely, evidence-based care, and3390improving long-term health outcomes for those who have borne the3391physical and cognitive costs of military service.33923393H.R. 6526, Clarity on Care Options Act33943395    The VFW supports the intent of this legislation to improve access,3396transparency, and accountability within the Civilian Health and Medical3397Program of the Department of Veterans Affairs (CHAMPVA). Far too often,3398CHAMPVA beneficiaries--primarily surviving spouses and dependents--3399struggle to identify health care providers who accept the program,3400leading to delays in care, unexpected out-of-pocket costs, and3401unnecessary stress during difficult times.3402    This legislation appears to be designed to create a more accurate3403and reliable understanding of provider participation in CHAMPVA by3404surveying current and prospective providers. If the purpose is to3405strengthen VA's internal data and build the foundation for a CHAMPVA3406provider data base, the VFW supports that goal. However, the3407legislation's wording is too vague and leaves open whether this effort3408would result in a public, searchable directory that beneficiaries could3409use.3410    While the legislation's title suggests improved access for CHAMPVA3411users, the body does not clearly require VA to establish and maintain a3412public data base for beneficiaries to locate participating providers.3413If Congress intends this legislation to improve real-world access, that3414requirement must be explicitly stated with clear definitions of who can3415access the data base, how often it will be updated, and how it will be3416integrated into VA and CHAMPVA communications. Clarity between the3417title and substance is essential to ensure the policy delivers on its3418promise.3419    The VFW is encouraged by the inclusion of annual reporting to3420Congress, which can help identify geographic gaps in provider3421availability and inform future reforms. However, transparency alone is3422not enough. A directory, no matter how well designed, will not solve3423the problem if providers continue to decline CHAMPVA participation due3424to reimbursement challenges and administrative burdens. Congress and VA3425must use the data from this effort not only to inform beneficiaries,3426but to drive reforms that strengthen provider participation and ensure3427CHAMPVA networks are adequate in every region.3428    Families who rely on CHAMPVA have already sacrificed enough in3429service to this Nation. They deserve clear, dependable access to care,3430and this legislation is an important step toward delivering it. The VFW3431welcomes the opportunity to discuss CHAMPVA reform with the committee3432to ensure that all of VA's community care programs (Community Care3433Network, CHAMPVA, and the Foreign Medical Program) offer a similar3434structure and clarity to beneficiaries.34353436H.R. 6652, U.S. Vets of the FAS Act34373438    The VFW supports legislation to expand access to health care for3439veterans living in the Freely Associated States (FAS), many of whom3440served honorably alongside U.S. forces yet face significant barriers to3441receiving the care they have earned. Geography should never determine3442whether a veteran can access timely, high-quality health services.3443    The VFW strongly supports the legislation's requirement that VA3444establish formal agreements with FAS governments and expand the use of3445telehealth and mail-order pharmacy services. These tools offer3446practical, cost-effective solutions to improve access in remote and3447underserved regions where traditional VA facilities are unavailable.3448Providing beneficiary travel assistance for in-person care further3449strengthens this legislation's commitment to equity and fairness.3450    The VFW emphasizes that expanding access must be accompanied by3451strong implementation planning and sustained funding. Delivering care3452across international borders presents logistical, technological, and3453administrative challenges that cannot be solved by statute alone.3454Congress must ensure VA has the resources and infrastructure needed to3455make these services reliable, not just available on paper.3456    The VFW urges that this effort be viewed as part of a broader3457commitment to veterans in the FAS, not a limited or temporary solution.3458Telehealth and pharmacy access are critical first steps, but must be3459paired with long-term strategies to address specialty care, emergency3460services, and treatment continuity.34613462Discussion Draft, BEACON Act34633464    The VFW supports legislation that creates grant programs within VA3465to support research and development of innovative treatments for3466traumatic brain injury, especially chronic mild TBI. It authorizes3467funding through 2028 for academic and nonprofit organizations to test3468new therapies and clinical approaches, with required oversight, annual3469evaluations, and coordination with existing mental health initiatives.3470The legislation mandates detailed reporting to Congress on research3471outcomes and recommendations to enhance TBI care for veterans. It also3472promotes the development, evaluation, and implementation of novel,3473evidence-based interventions to deliver more effective, patient-3474centered care for veterans with mild TBI.34753476Discussion Draft, Data Driven Suicide Prevention and Outreach Act34773478    The VFW does not support this legislation that would establish a3479program to award grants for the development of predictive models to3480evaluate risk factors that contribute to the incidence of suicide among3481veterans, because it does not resolve fundamental gaps in data access3482and risks duplicating programs already in place at VA.3483    VA already operates multiple suicide-prevention and predictive-3484analytics initiatives, including existing risk-stratification tools and3485outreach models designed to identify veterans at elevated risk. Rather3486than strengthening these established programs, this legislation would3487create a parallel grant structure that republishes work VA is already3488authorized and funded to do, diverting attention and resources away3489from improving and fully implementing current efforts. More critically,3490the legislation fails to address one of the most significant barriers3491to effective suicide-prevention analytics: the absence of complete,3492timely data from non-VA providers. As more veterans receive care3493through community providers under the VA MISSION Act of 2018 (Public3494Law 115-182), VA does not consistently receive behavioral health,3495substance use, and crisis intervention data in a way that allows for3496meaningful system-wide risk modeling. Without fixing this fundamental3497data-sharing gap, any new predictive model will be incomplete by3498design, limiting its accuracy and undermining its value.3499    The VFW is also concerned that expanding artificial intelligence-3500driven surveillance of veterans without first resolving3501interoperability, consent, and trust issues risks creating a system3502that feels focused on monitoring rather than on care. Veterans must not3503feel that technology is used to track them rather than support them.35043505Discussion Draft, Whole Health for Veterans Act35063507    The VFW supports legislation to reduce financial barriers to3508wellness-focused services that promote veterans' physical, mental, and3509emotional well-being. As VA continues its transformation toward a Whole3510Health System of Care, veterans must not be deterred from accessing3511preventive and supportive services because of cost, especially those3512with the greatest needs.3513    Whole Health well-being services such as coaching, stress3514management education, mindfulness practices, and integrative therapies3515play an important role in helping veterans manage chronic pain, post-3516traumatic stress, and the long-term effects of military service. By3517eliminating copayments for veterans in Priority Groups 1 through 5 and3518capping monthly copayments for other enrolled veterans, this3519legislation would improve access for the most vulnerable while3520maintaining a reasonable cost-sharing structure for higher-income3521veterans.3522    The VFW recognizes that Congress and VA must establish clear3523implementation guidance and oversight to ensure consistent application3524across all VA medical centers. Whole Health services should be3525delivered in a manner that is evidence-informed, veteran-centered, and3526fully integrated with clinical care, not as a substitute for needed3527medical treatment, but as a complement that strengthens overall3528outcomes.35293530Discussion Draft, Veterans Health Desert Reform Act35313532    The VFW supports the intent of this legislation that would improve3533access to hospital care and medical services for veterans living in3534rural and medically underserved areas. Too many veterans must travel3535excessive distances or face long delays simply to receive basic3536inpatient and specialty care. No veteran should be denied timely3537treatment because of where they live.3538    The VFW is encouraged by this legislation's efforts to use existing3539rural hospitals to close access gaps, while ensuring that veterans3540receive care comparable to that available through the Veterans3541Community Care Program (VCCP). Reimbursing participating hospitals at3542or above Medicare rates is a practical way to encourage provider3543participation, and the legislation's emphasis on oversight, quality3544tracking, and veteran satisfaction is essential for accountability.3545While this is a positive step, the VFW believes the language should be3546stronger and more precise. Rather than stating that rural hospitals3547should receive priority, the legislation should require the Secretary3548to select hospitals in rural and highly rural areas to ensure the3549policy reaches veterans facing the greatest access barriers.3550    The VFW emphasizes that any expansion of hospital care through non-3551VA providers must remain anchored within the VA health care system.3552Veterans receiving care under this program should continue to meet VA3553enrollment requirements and qualify for care under the VCCP. Expanding3554access should not mean removing veterans from VA oversight or creating3555parallel systems that weaken accountability.3556    The VFW is encouraged by the legislation efforts to leverage3557existing rural hospitals to close access gaps, while ensuring veterans3558receive care comparable to that available through the VCCP. Reimbursing3559participating hospitals at or above Medicare rates is a practical way3560to encourage provider participation, and the emphasis on oversight,3561quality tracking, and veteran satisfaction is critical to maintaining3562accountability.3563    The VFW stresses that any expansion of hospital care outside the VA3564system must be paired with strong care coordination and continuity3565standards. Veterans, especially those with complex or chronic3566conditions, depend on seamless communication between providers. Without3567clear requirements for information sharing, referral management, and3568follow-up care, even well-intended access solutions risk creating3569fragmented treatment and poorer outcomes.3570    The VFW cautions against policies that could unintentionally3571accelerate the privatization of veteran health care. Community3572partnerships should strengthen VA, not replace it. Expanding rural3573access must complement VA's mission and preserve its role as the3574coordinator of care, not erode it.3575    Chairman Miller-Meeks and Ranking Member Brownley, this concludes3576my statement. Again, thank you for the opportunity to offer comments on3577this pending legislation.35783579Information Required by Rule XI2(g)(4) of the House of Representatives35803581Pursuant to Rule XI2(g)(4) of the House of Representatives, the VFW has3582not received any Federal grants in Fiscal Year 2026, nor has it3583received any Federal grants in the two previous Fiscal Years.35843585The VFW has not received payments or contracts from any foreign3586governments in the current year or preceding two calendar years.35873588                   Prepared Statement of Easterseals35893590[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]35913592Prepared Statement of American Federation of Government Employees, AFL-3593                                  CIO35943595[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]35963597                 Prepared Statement of ALS Association35983599    On behalf of the more than 30,000 Americans living with amyotrophic3600lateral sclerosis (ALS) and their caregivers that we serve, The ALS3601Association thanks you for this opportunity to share our views on H.R.36026001, the Veterans with ALS Reporting Act. In addition, we would like3603to thank the co-chairs of the congressional ALS Caucus for their3604leadership in the fight to make ALS a livable disease while we develop3605a cure for this devastating disease.3606    The ALS Association is the largest philanthropic funder of ALS3607research around the world. The Association funds global research3608collaborations, supports people living with ALS and their loved ones in3609their communities, and advocates for better public policies for people3610with ALS. The ALS Association builds hope and enhances quality of life3611while urgently searching for new treatments and a cure. For more3612information about The ALS Association, visit our website at3613www.als.org.3614    ALS, sometimes called Lou Gehrig's disease, is a rapidly3615progressive and always fatal neurological disease that attacks the3616nerve cells responsible for controlling voluntary muscles. The life3617expectancy of a person with ALS averages about two to 5 years from the3618time of diagnosis. The cause of ALS is not known and there is no cure.3619Annual costs associated with ALS, both direct for medical care and3620indirect costs like lost income, are over $1 billion in the US.3621    For military veterans, the reality is even more sobering. Decades3622of research have confirmed that veterans, whether they serve in times3623of war or peace, are at significantly greater risk of developing ALS3624compared to their civilian counterparts. Because of ALS's connection to3625military service, the Department of Veterans Affairs has recognized ALS3626as a service-connected disease and assigns a 100 percent disability3627rating upon diagnosis. While this link is recognized, the causes and3628ways to protect military personnel defending our freedoms are still3629unclear.3630    H.R. 6001, the Veterans with ALS Reporting Act, represents an3631urgent opportunity for Congress to support our veterans living with ALS3632and their loved ones. This bill is no-to low-cost for the Veterans3633Administration (VA). Even though the VA provides excellent care for our3634veterans living with ALS and their caregivers through their ALS System3635of Care, there are gaps in care that need to be addressed for this3636vulnerable population. H.R. 6001 aims to find those gaps.3637    H.R. 6001 requires the Secretary of Veterans Affairs, in3638consultation with the Director of the Centers for Disease Control and3639Prevention, to submit a report to Congress on the incidence and3640prevalence of ALS in veterans. The report must include:36413642        1. An assessment of ALS incidence and prevalence in veterans.36433644        2. A description of resources and support provided to veterans3645        with ALS.36463647        3. Identification of any deficiencies in those resources and3648        support.36493650        4. A strategy to develop and test risk reduction strategies for3651        ALS.36523653        5. A pathway for veterans receiving ALS care within VA clinics3654        to participate in clinical trials and research.36553656        6. Recommendations for further legislative action to address3657        the challenge of ALS among our military and veterans.36583659        7. Ongoing tracking of ALS prevalence in veterans using the3660        CDC's National ALS Registry and Biorepository, with updates to3661        Congress every 3 year.36623663    This bill serves not only as a report, but also as essential3664support for veterans living with ALS and their families. It represents3665a commitment to actively pursue solutions that address this serious3666disease, reinforcing efforts to promote the health and readiness of the3667military community.3668    We appreciate the Committee's consideration of H.R. 6001, the3669Veterans with ALS Reporting Act. The ALS Association strongly endorses3670this legislation and urges swift advancement of this bill. Veterans3671living with ALS do not have the luxury of time. This bill is a key step3672toward ensuring veterans receive the protection, information, and care3673they deserve.36743675                    Prepared Statement of ALS United36763677[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]36783679                    Prepared Statement of Jason Crow36803681[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]36823683                  Prepared Statement of Dennis Boothe36843685[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]36863687                    Prepared Statement of Endeavors36883689[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]36903691            Prepared Statement of Fleet Reserve Association36923693[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]36943695               Prepared Statement of Jewish War Veterans36963697[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]36983699   Prepared Statement of Association of VA Nurse Anesthesiologists,3700   Association of VA Psychologist Leaders, Association of VA Social3701  Workers, National Association of VA Physicians and Dentists, Nurses3702   Organization of Veterans Affairs, and Veterans Healthcare Policy3703                               Institute37043705    Chairman Miller-Meeks, Ranking Member Brownley, and distinguished3706members of the committee:37073708    On behalf of our six organizations, we thank you for inviting us to3709submit a statement for the record for today's health subcommittee3710legislative hearing on improving the healthcare and services for3711veterans. Members of our organization are veterans, have family members3712who are veterans, had long careers dedicated to serving veterans,3713published papers on veterans' healthcare in peer-reviewed journals,3714presented testimony to your committee, and have served on President3715Trump's President's Roadmap to Empower Veterans and End a National3716Tragedy of Suicide (PREVENTS) task force.3717    In today's statement, we wish to convey our appreciation for your3718leadership and commitment to ensuring that veterans receive the highest3719level of healthcare within the Veterans Health Administration (VHA) and3720supplementary care in the private sector when it's both needed and3721authorized by the VHA.3722    We address our comments to five of the seven bills considered at3723today's hearing.37243725H.R. 2283 The RECOVER Act (Recognizing Community Organizations for3726Veteran Engagement and Recovery Act)37273728    The RECOVER Act, a 3-year pilot reintroduced by HVAC Chairman Rep.3729Mike Bost, would provide grants of up to $1.5 million ($60 million3730total) to non-profit mental health facilities serving veterans,3731prioritizing areas with large numbers of veterans at high risk of3732suicide. It would establish a parallel care system operating outside3733of, and disjointed from, the VA and the Veterans Community Care Program3734(VCCP), severely weakening the quality of services provided to3735veterans, as we detail below.37363737Undermines the Veterans Community Care Program37383739    The RECOVER Act creates a parallel mental healthcare system that3740fundamentally conflicts with the existing VCCP operations and erode the3741MISSION Act's intention to create a single overarching, coordinated3742program by:37433744        Introducing competing eligibility rules. For the past 7 years,3745        veterans needing mental health care qualified for services3746        through the VCCP when VA cannot provide care within 20 days or3747        30 minutes of drive time. This bill would bypass the VA's3748        authorization process entirely, allowing veterans to access VA-3749        paid mental health care from grant recipients whenever they3750        choose, ending the foundational principle of the VA as the3751        authorizer and overseer of veterans' care,37523753        The bill subverts the VA's established system for veterans'3754        priority group eligibility and co-payments. Unlike the VA and3755        VCCP, no veteran would have a co-payment.37563757        Duplicating existing services. Unlike the Fox Grant program,3758        which funds services unavailable through the VA, this bill3759        duplicates mental health services delivered by the VA and VCCP.37603761        Removing VA as the coordinator of care. The MISSION Act3762        designated VA as the overall coordinator of care that is3763        furnished in the community. Mental health care delivered3764        through these grants circumvents that coordinated framework.37653766Reduces Quality and Evidence-Based Care Standards37673768    Despite its stated goal of providing culturally competent,3769evidence-based care, the bill's requirements fall far short. At each3770grant-receiving facility, only one clinician--not all--must be trained3771in ``culturally competent'' veterans mental health care. No providers3772must be trained in evidence-based practices. In sharp contrast, VA3773clinicians have recognized expertise in military-related conditions3774such as PTSD and traumatic brain injury.3775    Furthermore, despite prioritizing the awarding of grants in areas3776where there are large numbers of veterans at high risk for suicide, the3777bill includes no requirement for suicide prevention training.37783779Fails to Improve Timely Delivery of Services37803781    The bill establishes no concrete standards for timeliness of3782service. Grantees' wait times could be longer than those currently3783experienced with VA and VCCP services.37843785Pays Twice for the Same Care37863787    The bill explicitly enables existing VCCP facilities to receive3788grant funding without any requirement to increase services--allowing3789providers to layer awards on top of the VA and insurance reimbursements3790that grant recipients already receive for delivered care.37913792Eliminates Oversight, Accountability and Adherence to Standards37933794    The bill lacks crucial quality standards and facility accreditation3795requirements. Unlike VA facilities, grant recipients would not be3796required to obtain accreditation from The Joint Commission or the3797Commission on Accreditation of Rehabilitation Facilities.3798    There is no mandate for semi-annual peer review, quality assurance3799standards integral to VA-delivered mental health care.3800    There is neither utilization review nor limits to the number of3801appointments per treatment episode.3802    Pre-post symptom improvement is not reported, and grants are not3803allocated based on successful outcomes.3804    Unlike VCCP providers, recipient facilities face no requirement to3805share health records with VA--a fundamental breakdown in care3806coordination that could leave a veteran's treatment fragmented and3807potentially compromised.38083809Undermines the network of the 300+ Vet Centers and 80 Mobile Vet3810Centers38113812    These options exist to serve veterans who hesitate to seek mental3813health care at VA facilities--presumably one reason for the grants that3814subsidize private sector clinics.38153816Summary and Recommendation38173818    This legislation would severely weaken VA's healthcare model and3819further diminish the VA's ability to provide veterans with high-quality3820mental health care. Changes to the delivery of veteran mental health3821care and suicide prevention cannot come at the expense of VA's3822integrated system, which--when properly staffed and funded--3823consistently succeeds in providing comprehensive, coordinated mental3824healthcare for our Nation's veterans.3825    The more effective solution would be expanding VA's mental health3826workforce while maintaining its critical role coordinating care and3827leveraging community resources, rather than creating a parallel system3828with negligible oversight and lower standards of care.3829    Finally, this legislation could set a dangerous precedent, with3830veterans' mental health services being a test case for broad3831transformation of the VA from a provider of care provider to an3832insurance payer for care. That's not what the overwhelming number of3833veterans and prefer. The VA's central role in authorizing and3834coordinating veteran healthcare must be preserved while judiciously and3835effectively leveraging community resources within that framework.38363837Veterans Health Desert Reform Act of 202538383839    The Veterans Health Desert Reform Act of 2025 would establish a3840pilot program allowing three or more rural private sector facilities to3841provide hospital care and medical services to veterans outside of the3842Veterans Community Care Program (VCCP). Rather than protecting3843veterans, it could seriously compromise the healthcare access that most3844veterans currently depend on.3845    The VA MISSION Act of 2018 created a comprehensive private sector3846network through the VCCP, guaranteeing veterans emergency medical and3847psychiatric care, as well as walk-in urgent care, anywhere in the3848country. Veterans can also access private sector outpatient care if3849they would wait more than 20 to 28 days for an appointment or must3850drive more than 30 to 60 minutes to reach a VA facility. This new bill3851creates a parallel system that fundamentally conflicts with the3852existing VCCP structure in three critical ways.3853    First, it introduces competing eligibility rules that eliminate3854VA's role as authorizer of community care. Under VCCP, VA authorizes3855community care when veterans meet specific eligibility criteria. Under3856this bill, enrolled veterans could obtain VA-paid care at selected3857hospitals and their outpatient clinics simply by calling for an3858appointment or walking in, without any VA authorization.3859    This represents a dangerous departure from standard practice. Prior3860authorization is a routine feature of any insurance payer that pays for3861patient care and services. It offers critical protections to veterans3862who might otherwise receive unnecessary tests or procedures, or care3863that isn't based on scientific evidence. VA oversight also protects3864taxpayers from the fraudulent billing practices that are endemic in3865America's profit-driven healthcare system.3866    Second, this bill could duplicate services already available in the3867VA and VCCP--including in the same geographic locations. There's no3868stipulation that participating hospitals must be located more than a386960-minute drive from existing VA (or VCCP) facilities. Veterans might3870end up traveling longer distances than they currently experience with3871VA and VCCP services, defeating the bill's purported purpose of3872addressing health deserts.3873    Third, unlike VCCP providers, facilities face no requirement to3874share health records with VA. This represents a fundamental breakdown3875in care coordination that could leave a veteran's treatment fragmented3876and potentially compromised.3877    Pilot programs are designed to start small before scaling up. This3878legislation would serve as a test case for arrangements that could3879eventually encompass far larger numbers of hospitals, representing3880another step in the accelerating privatization of VA's integrated3881healthcare system. As veterans shift their care to these facilities,3882funding follows. Declining patient volumes at VA facilities trigger3883budget cuts that force specialized programs to be scaled back or3884eliminated, ultimately depriving many veterans of the VA care they3885prefer and depend on.3886    We support a provision in the legislation that aligns healthcare3887reimbursement for veterans with rates paid for non-veteran patients.3888Financial incentives should never create a system where certain3889patients receive priority based on reimbursement disparities. However,3890this worthy reform can and should be accomplished within the existing3891VCCP framework, without creating a parallel system that undermines VA3892care and abandons the safeguards veterans need.38933894Recommendation38953896    The VA's central role in authorizing and coordinating veteran3897healthcare must be preserved while effectively leveraging community3898resources within that framework. The existing VCCP already provides the3899structure needed to address access challenges in underserved areas.3900Rather than creating a competing parallel system, the bill should3901incentivize medical facilities not currently participating in VCCP to3902join that existing program.39033904Veterans Mental Health and Addiction Therapy Quality of Care Act H.R.3905242639063907    The Veterans Mental Health and Addiction Therapy Quality of Care3908Act seeks to fulfill one of the VA MISSION Act of 2018's most important3909unmet promises: equipping veterans with the information they need to3910make informed healthcare choices and ensuring high-quality mental3911health care across both VHA facilities and the Veterans Community Care3912Program (VCCP). This is an inherently worthy objective. However, the3913bill as currently drafted risks undermining its own goals. Substantial3914revisions are needed to ensure it achieves its intended purpose.3915    The most fundamental flaw is the absence of any requirement for VA3916to modify its contracts with Third Party Administrators. Without3917contractual obligations, community care providers will have little3918incentive to assess patients' treatment progress. This means the3919intended comparison between VA and VCCP quality will collapse into a3920one-sided evaluation of VA care alone, completely defeating the bill's3921central intent.3922    Compounding this problem, the bill fails to authorize the VA or its3923designated evaluators to be able to access VCCP health care records.3924This creates a critical limitation: any comparison will be restricted3925to whatever records community providers happen to forward. Recent3926scientific studies and GAO reports reveal that only a fraction of3927initial records currently reach VA, with virtually nothing forwarded3928after initial treatment. The bill should explicitly require VCCP3929providers to submit both measurement data and veterans' complete health3930care records to VA for analysis, following the model established by the3931Fox Grant program.3932    The study design itself also needs clarification. The comparison3933must specifically contrast veterans treated in VA facilities with3934veterans treated through VCCP. As written, the bill could inadvertently3935compare VA patients with non-veterans in the private sector--an apples-3936to-oranges comparison that would yield far less meaningful results.3937    The bill should also specify the use of gold-standard outcome3938measurements that are widely accepted in the field. For PTSD, this3939means the PTSD Checklist. For depression, the PHQ-9. For substance use3940disorder, the Brief Addiction Monitor. These standardized instruments3941are essential for valid comparisons.3942    Several additional quality indicators are conspicuously absent from3943the current bill. There is no assessment of whether mental health and3944substance use providers have completed Department-accredited or other3945recognized training specific to the conditions they treat--a3946fundamental gap in any quality evaluation. Similarly, the bill includes3947no requirement to track how many providers collect initial and follow-3948up data and enter it into the electronic health record. Provider peer3949review, another cornerstone of quality assurance, is entirely absent3950from the bill's requirements.3951    Wait times to commence treatment also need to be assessed.3952    Conducting a rigorous study of this complexity requires expertise3953that goes well beyond administrative capacity. The bill should3954designate that a scientific institution (such as the National Academies3955of the Sciences, Engineering, and Medicine) with demonstrated expertise3956in health outcomes evaluation oversee the study's design, methodology,3957measurement protocols, and analysis.3958    Finally, when evaluating the use of evidence-based practices in3959mental health and addiction therapy, the bill should reference the3960rigorously developed VA/DOD Clinical Practice Guidelines rather than3961the American Society of Addiction Medicine criteria.3962    With these revisions, the Veterans Mental Health and Addiction3963Therapy Quality of Care Act could fulfill its promise of empowering3964veterans with meaningful quality information. Without them, it risks3965creating an illusion of accountability while leaving veterans no better3966informed than they are today.39673968Veterans TBI Breakthrough Exploration of Adaptive Care Opportunities3969Nationwide Act of 2025 (BEACON Act of 2025)39703971    The BEACON Act fundamentally undermines the VA's existing traumatic3972brain injury research and treatment infrastructure, particularly the VA3973Transitional Research Center for TBI and Stress Disorders (TRACTS).3974Rather than strengthening current programs and improving the lives of3975effected veterans, the legislation risks fragmenting and weakening the3976VA's coordinated efforts in this critical area.3977    The bill's stated purpose--to ``increase research and development3978on integrated mTBI and mental health interventions outside the scope of3979traditional Department of Veterans Affairs pathways, interventions,3980programs, procedures, and pharmaceuticals''--appears designed to3981circumvent established clinical channels, potentially creating an3982alternative pathway for peer-based interventions that lack rigorous3983scientific validation.3984    This approach is unnecessary and counterproductive. The VA has3985already compiled extensive research on mild traumatic brain injury and3986its treatment. Veterans with mTBI currently have access to evidence-3987based psychotherapies that have been refined and improved over two3988decades of clinical practice. Creating a parallel treatment framework3989for mTBI ignores this substantial body of ongoing work and risks3990duplicating efforts and diverting needed resources.3991    Further, placing research grant administration outside the VA3992introduces organizational fragmentation and accountability gaps.39933994Data Driven Suicide Prevention and Outreach Act of 202539953996    The Data Driven Suicide Prevention and Outreach Act of 2025 would3997create a grant program to develop predictive models for evaluating3998suicide risk factors among veterans. While improving suicide prevention3999is undeniably critical, this legislation fundamentally duplicates the4000VA's existing big-data predictive analytics approach. Rather than4001strengthening the current program, it risks fragmenting and weakening4002the VA's efforts in this vital area.4003    Over the last decade, the VA has developed and refined a4004sophisticated suicide risk prediction algorithm and implemented the4005Recovery Engagement and Coordination for Health-Veterans Enhanced4006Treatment (REACH VET) program. REACH VET identifies VA patients at4007extraordinarily high risk for suicide--specifically, the top 0.14008percent risk tier, patients predicted to die by suicide at a rate 304009times that of the overall VHA patient population. This risk4010identification is then provided to local REACH VET program4011coordinators, who inform the patient's clinicians so both can work4012proactively to enhance care.4013    The program has demonstrated tangible results. A 2021 study found4014that REACH VET was associated with more outpatient encounters,4015increased documentation of new suicide prevention safety plans, and4016fewer inpatient mental health admissions, emergency department visits,4017and documented non-fatal suicide attempts. While the study did not4018identify differences in suicide or all-cause mortality, these process4019improvements represent meaningful enhancements to care coordination and4020crisis response.4021    The bill's stated purpose--awarding grants to develop predictive4022models evaluating risk factors that contribute to veteran suicide--4023creates a parallel framework that ignores this substantial body of4024ongoing work. This approach is both unnecessary and counterproductive.4025Any algorithms developed through the grant program would be based on4026much smaller populations than the VA's comprehensive data base,4027inherently reducing their predictive value.4028    Creating competing systems fragments resources and effort. Rather4029than paying twice for the same application of artificial intelligence4030and predictive analytics, Congress should invest in expanding,4031refining, and properly resourcing the existing REACH VET4032infrastructure. The VA's program already has the population-scale data,4033established clinical integration pathways, and demonstrated track4034record needed to identify at-risk veterans and connect them with4035enhanced care.4036    Thank you for the opportunity to offer our input on these important4037pieces of legislation.40384039           Prepared Statement of Cohen Veterans Network, Inc.40404041[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]40424043              Prepared Statement of Aspire Health Partners40444045[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]40464047                    Prepared Statement of Berry Law40484049[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]40504051               Prepared Statement of Easterseals DC/MD/VA40524053[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]40544055          Prepared Statement of Voices for Non-Opioid Choices40564057[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]40584059                   Prepared Statement of Centerstone40604061[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]40624063                  Prepared Statement of The Up Center40644065[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]40664067         Prepared Statement of Air Force Sergeants Association40684069    Chairwoman Miller-Meeks, Ranking Member Brownley, and distinguished4070Members of the Subcommittee:40714072    On behalf of the Air Force Sergeants Association (AFSA), thank you4073for the opportunity to submit this statement for the record for today's4074Health Subcommittee Legislative Hearing. We appreciate your leadership4075and sustained commitment to ensuring veterans receive timely, high-4076quality, and compassionate care.4077    AFSA is the premier professional military association for enlisted4078Airmen and Guardians, representing active duty, Guard and Reserve4079members, veterans, retirees, and their families. Our mission is to4080advocate for a stronger quality of life for those who serve and have4081served--through effective legislation, informed policy engagement, and4082support to the military community. We work closely with Congress, the4083Department of Veterans Affairs, and partner organizations to advance4084commonsense reforms that strengthen readiness, improve health outcomes,4085and honor the Nation's commitment to those who wear or have worn the4086uniform.40874088AFSA Strongly Supports H.R. 4509, the NOPAIN for Veterans Act40894090    Veterans have earned care that is not only available in theory, but4091accessible in practice. Especially when they are recovering from4092surgery or serious medical procedures. Yet too many veterans still4093describe situations where appropriate acute pain care is delayed,4094difficult to obtain, or constrained in ways that do not reflect the4095realities of individual medical need. When acute pain is not4096effectively managed, the consequences can be serious: unnecessary4097suffering, delayed recovery, avoidable complications, and increased4098risk of reliance on medications that may not be clinically optimal for4099that patient.4100    This legislation is a practical, veteran-centered step toward4101ensuring the Department of Veterans Affairs can provide clinically4102appropriate, individualized post-surgical pain management, including4103non-opioid options that can reduce unnecessary exposure to opioids4104while still treating pain effectively. It reinforces a simple4105principle: decisions about acute pain control should be guided by4106medical evidence and provider judgment, not one-size-fits-all4107constraints that can unintentionally leave veterans without the right4108tools at the right time.41094110Restoring Clinical Judgment While Supporting Responsible Safeguards41114112    AFSA supports responsible efforts to prevent misuse of controlled4113substances and to promote patient safety. However, policies designed to4114curb misuse must not inadvertently restrict access to legitimate,4115medically necessary pain treatment--especially for veterans managing4116complex injuries, surgical recoveries, or service-connected conditions.4117Veterans are not a monolith. Their injuries, comorbidities, medication4118histories, and responses to treatment vary widely. A pain management4119approach that works for one veteran may be ineffective for another.4120    The NOPAIN for Veterans Act appropriately reinforces clinical4121judgment by ensuring VA providers can access a broader set of post-4122surgical pain management options, including non-opioid therapies, and4123apply them based on the needs of the individual veteran. At its core,4124this bill supports the ability of the care team to treat the whole4125patient--reducing pain, supporting mobility and rehabilitation, and4126improving recovery outcomes--without forcing unnecessary tradeoffs that4127can compromise care.41284129Conclusion41304131    AFSA urges Congress to advance H.R. 4509 without delay. Veterans4132should never be forced to endure unmanaged pain as a consequence of4133well-intended but overly restrictive policy barriers. When a veteran4134enters a VA facility for surgery or a serious procedure, they should4135have confidence that their care team has access to a full range of4136appropriate tools to manage pain safely and effectively.4137    Again, we thank the Subcommittee for its leadership and continued4138dedication to improving veterans' health outcomes. AFSA stands ready to4139work with you to move the NOPAIN for Veterans Act forward and ensure it4140is implemented in a way that strengthens patient-centered care for all4141veterans.41424143     Prepared Statement of Tragedy Assistance Program for Survivors41444145[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]41464147                     Prepared Statement of VoteVets41484149[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]41504151  Prepared Statement of Embassy of the Federated States of Micronesia41524153[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]41544155                                 [all]