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Hon. Jeff Miller

Hon. Jeff Miller, a Representative in Congress from the State of Florida

H.R. 2623

Mr. Chairman, thank you for considering H.R. 2623.  This bill would prohibit the collection of co-payments for all hospice care furnished by the Department of Veterans Affairs (VA).   

VA offers a complement of hospice and palliative care options as part of the comprehensive heath care benefit provided to all enrolled veterans.  Hospice and palliative care is a continuum of comfort-oriented and supportive services provided across settings, including hospital, extended care facility, outpatient clinic and private residence. 

Under current law, a veteran receiving hospice care in a nursing home is exempt from any applicable co-payments.  However, if the hospice care is provided in any another setting, such as in an acute-care hospital or at home, the veteran may be subject to an inpatient or outpatient primary care co-payment.

Essentially, VA’s current policy penalizes a veteran who chooses to remain at home for their hospice care or out of medical necessity receives hospice care in an acute care setting.   

Mr. Chairman, this legislation would correct this inequity by exempting all hospice care provided through VA from co-payment requirements. 

This bill is important to ensuring that every veteran’s preference for end-of-life care is provided in an equitable and compassionate manner. 

 I appreciate the opportunity to testify on H.R. 2623, and will be happy to answer any questions on the bill.   

H.R. 1925

Thank you, Mr. Chairman.

Nearly 12 year ago, the VA’s Veterans Integrated Service Network, or “VISN,” plan was set in motion as a way to make the large VA healthcare network more attuned to the needs of its patients.  For certain, VA provides some of the best care in this nation.  The VISNs were implemented as a way to maintain the high quality of care while allowing more regional management so that the central office in Washington did not unnecessarily micromanage the day-to-day aspects of healthcare delivery.

The VISN network has enjoyed its successes in providing better access and more patient-centered care.  However, there is room for improvement, and the Gulf Coast region of our nation is an area where such improvement is needed.  Having already seen a consolidation of two VISNs since their creation, it is clear that flexibility within the VA healthcare system is necessary.  My bill, H.R. 1925, would create a VISN specifically targeted to improving the delivery of healthcare to the large and ever-increasing population of veterans living in the Gulf Coast- a “Gulf Coast VISN.” 

A new Gulf Coast VISN would create a healthcare network that could better respond to the unique needs and problems facing veterans in the area.  The area involved covers the coastal counties just west of Tallahassee, Florida over to the Louisiana state line, an area home to few VA clinics and lacking hospitals providing inpatient care.  It is an area identified by the CARES report as underserved, and its unique geographical location is no doubt part of that reason.  Most of the area that would make up the Gulf Coast VISN is in the region where VISN 8 meets VISN 16.  VISN 8 encompasses the rest of the state of Florida .  VISN 16, the largest single VISN in the country, reaches all the way west past Houston, Texas, and all the way up through Oklahoma . 

Looking at the map, you can see how this largely rural region can get overlooked in such a huge VISN with major metropolitan areas.  The more than 300,000 veterans that would be directly served within this VISN do not want their access to care overlooked - and that has happened for far too long.   With even basic outpatient care being difficult for many to obtain, it is time to ensure that the Gulf Coast ’s veterans are provided the full range of services they have earned. 

There are several reasons why I see this bill as being successful.  With an increased focus on the unique, shared needs for veterans in the area, the Gulf Coast VISN director could take great advantage of the sharing opportunities with the Department of Defense (DoD) that are available in that region.  The Gulf Coast is home to multiple DoD installations, and while a few joint VA/DoD facilities exist now, there is a tremendous opportunity for expanding this relationships to deliver a wider range of healthcare services.    

The VISN system was founded on good principles to improve access and quality of care by eliminating the inefficiencies of a centralized bureaucracy and promoting a local, patient-focused system of healthcare delivery.  However, it is not perfect, and with the findings of the CARES Commission as well as the simple fact that veterans in the Gulf Coast area have to drive upwards of three hours in many instances to receive inpatient care, it is abundantly clear that improvements are still needed.  I feel the creation of a Gulf Coast VISN can do just that.  Its implementation would be neither costly nor particularly difficult.  In addition, the bill would give VA the authority to decide on the location of the VISN headquarters. 

The Gulf Coast ’s veteran population clearly deserves more timely access to VA health care.  Creating a Gulf Coast VISN would be a significant step toward providing that access. 

Thank you, Mr. Chairman, for considering this important legislation and I am pleased to answer any questions on the bill. 


VISN 16Map

Bar Chart showing 2006 VISN Enrollment and Patients