Legislature(2015 - 2016)ANCHORAGE
07/28/2015 09:30 AM House MILITARY & VETERANS' AFFAIRS
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| Presentation: North Star Behavior Health System, | |
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ALASKA STATE LEGISLATURE
HOUSE SPECIAL COMMITTEE ON MILITARY AND VETERANS' AFFAIRS
July 28, 2015
9:37 a.m.
MEMBERS PRESENT
Representative Bob Herron, Chair
Representative Gabrielle LeDoux, Vice Chair
Representative Jim Colver
Representative Shelley Hughes
Representative Chris Tuck
MEMBERS ABSENT
Representative Bob Lynn
Representative Max Gruenberg
Representative Chris Tuck
COMMITTEE CALENDAR
PRESENTATION: NORTH STAR BEHAVIOR HEALTH SYSTEM - COUNSELING FOR
PTSD, SUBSTANCE ABUSE, AND DEPENDENCE TREATMENT FOR VETERANS
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
DEBORAH GURIS, M.D.
Staff Psychiatrist
North Star Behavioral Health
Anchorage, Alaska
POSITION STATEMENT: Discussed PTSD and substance abuse.
MICHAEL ALCORN, M.D., Psychiatrist
North Star Behavioral Health
Anchorage, Alaska
POSITION STATEMENT: Discussed PTSD and substance abuse.
ANDY LANNING
Chief Master Sergeant, Air Force, (Ret)
Division Director of Military Programs
Universal Health Services Patriot Support Program
Kansas City, Missouri
POSITION STATEMENT: Discussed program facilities across the
country.
WILLIAM J. MCDANIELS, M.D.
Rear Admiral, U.S. Navy, (Ret)
Universal Health Services Patriot Support Program Board Member
Kansas City, Missouri
POSITION STATEMENT: Discussed treatment and recovery.
LAURA MACKINZIE
Alaska Veterans Administration Healthcare System
Anchorage, Alaska
POSITION STATEMENT: Discussed veteran homelessness and alcohol
abuse.
ANN HUTCHINSON, PsyD.
Interim Chief of Psychology
Alaska Veterans Administration Healthcare System
Anchorage, Alaska
POSITION STATEMENT: Discussed PTSD and substance abuse.
VERDIE BOWEN, Director
Office of Veterans' Affairs
Alaska Department of Military and Veterans' Affairs (VA)
Anchorage, Alaska
POSITION STATEMENT: Discussed the Alaska Veterans
Administration Healthcare System payment procedure.
ACTION NARRATIVE
9:37:57 AM
CHAIR BOB HERRON called the House Special Committee on Military
and Veterans' Affairs meeting to order at 9:37 a.m.
Representatives LeDoux, Hughes, Tuck, Colver, and Herron were
present at the call to order.
9:38:29 AM
^PRESENTATION: NORTH STAR BEHAVIOR HEALTH SYSTEM,
COUNSELING FOR PTSD, SUBSTANCE ABUSE, AND DEPENDENCE
TREATMENT FOR VETERANS
PRESENTATION: NORTH STAR BEHAVIOR HEALTH SYSTEM,
COUNSELING FOR PTSD, SUBSTANCE ABUSE, AND DEPENDENCE
TREATMENT FOR VETERANS
9:39:29 AM
DEBORAH GURIS, M.D., Staff Psychiatrist, North Star Behavioral
Health, advised that substance abuse disorder involves 10
separate classes of drugs, including alcohol, stimulants,
opioids, [indisc.] are issues in the State of Alaska. [Indisc.]
activating and repeated activation of the [indisc.] system and
when they are in excess behavior associated with these in
assessing, many of which are not adaptive, and lead to intense
[indisc.] experienced by the individual [indisc.] abuse
[indisc.]. She explained they diagnose substance abuse disorder
based on the amount [indisc.] associated with an individual's
abuse. Behaviors can be classified into three major categories:
(1) Impaired control as patients use larger amounts and over a
greater period of time they originally intended and report
repeated attempts to cut down or [indisc.] and spend more time
either trying to [indisc.] or recover [indisc.]. The usual
experience is then [indisc.] when exposed to the environmental
substance abuser and that could lead to relapsing; (2) social
impairment as when individuals suffer from substance abuse
disorder over time they fail to provide major goal obligations,
their families, work, and community, and continue to use despite
negative consequences in those areas and ignore [indisc.] family
obligations [indisc.]. They repeatedly go into high risk
situations in order for [indisc.] substance infraction and
continue using despite the fact they have experienced some type
of physiological impairment from the drugs such as, mood
disorder, repeated intoxication withdrawal, liver ailment,
[indisc.]. With most drugs, people build up tolerance and
increase their use of drugs if they have been using it for a
long time. She pointed out that with alcohol, for example,
withdrawal syndrome precipitated by discontinuing use can be
dangerous or life threatening. There is a very high problem of
substance abuse disorder and it can affect anyone in any walk of
life. [Indisc.] and for alcohol [indisc.] substance abuse
disorder [indisc.]. [Indisc.] which increases [indisc.] for
inherent and [indisc.] substantive function. She advised they
found that substantive [indisc.] caused the disorder and
prolonged use can lead to nerve impairment. When a patient
first arrives, she explained, a thorough assessment is performed
to identify the nature of the substance abuse disorder, nature
of substances used, the degree of inherent and substance abuse
disorder, and identify any [indisc.] disorder or preexisting
disorder [indisc.] if necessary perform neuropsychological
testing. [Indisc.] they carefully use medication when
appropriate to address any [indisc.] mood disorder and offer
medication that may assist with the patient moving to sobriety.
Within group psychotherapy, the focus is on education as the
patients learn about substance abuse disorder, but they suffer
from [indisc.] and understand there are triggers in developing
coping skills [indisc.]. [Indisc.] suffering.
9:46:58 AM
CHAIR HERRON asked whether combat victims of PTSD are at a
higher risk versus post-traumatic events happening in lives not
related to combat.
9:47:10 AM
DR. GURIS responded that the percentage of [indisc.] combat
victims but certainly [indisc.] in the risk factor in general
[indisc.].
9:47:42 AM
REPRESENTATIVE LEDOUX surmised that Dr. Guris could not speak to
the percentage of PTSD soldiers with substance abuse problems
versus the general population.
9:48:12 AM
DR. GURIS responded that she cannot answer that question.
9:48:17 AM
REPRESENTATIVE TUCK noted that substance abuse disorders could
lead to mood disorders and asked whether mood disorders could
lead to substance abuse disorders.
9:48:34 AM
DR. GURIS replied that often those events co-occur and when
talking about substance abuse disorder it is known that
depression [indisc.] alcohol, sedatives, and [indisc.] over time
can lead to [indisc.] usually for four to six weeks. It is not
known that [indisc.] lead [indisc.] but it is known they are
highly [indisc.].
9:49:23 AM
REPRESENTATIVE HUGHES asked whether suicide risk and substance
abuse is higher in Alaska as opposed to other places in the
nation.
DR. GURIS [indisc.] military but in general substance abuse is a
high risk factor [indisc.] assessments improve their ability to
assess.
9:50:05 AM
MICHAEL ALCORN, M.D., Psychiatrist, North Star Behavioral
Health, said he was recently discharged from the military where
he had been working with the active duty military population.
He noted that during the first part of his practice as a
psychiatrist trained in a Veteran's Administration Hospital
regarding PTSD and substance abuse issues. He pointed out that
PTSD and traumatic brain injury have been the cardinal injuries
of the Iraq and Afghanistan wars, and statistics reveal that
2004-2012 the rate of PTSD in military retirees rose from 4
percent to 20 percent. During the period 2003-2013 the number
of service connected disability cases for PTSD rose from 109,000
to over 653,000, and overall PTSD is the third most common
disability amongst military retirees involving hearing loss and
ringing in the ears. The increase overall for PTSD cases, and
PTSD hospitalizations from 2006-2012 increased by 192 percent
and he noted that PTSD is at the point of condition that
requires a lot of treatment. During his practice of working
PTSD patients, and also training medical students and psychiatry
residents he pointed out that it is a very diverse condition as
there are no stereotypical PTSD patients. He said there are
typically 20 symptoms when evaluating a diagnosis and among 4
different categories in that an individual must have a
combination of 6 of the 20 symptoms. He calculated there are
clinically over 636,000 combinations of symptoms that can make
up the diagnosis for a different patient. Due to that, he
trains people that PTSD can only be on the differential
diagnosis partly because trauma in general is high even for the
general population. Not everyone that is traumatized develops
PTSD as possibly one-third of people exposed to trauma will
develop PTSD. He remarked that the rates are so high he teaches
people that any mental health guidelines [indisc.] really anyone
who is in and out of [indisc.] screen for exposure to trauma for
PTSD. A person diagnosed with PTSD can look like they are very
depressed, anxious, preoccupied with [indisc.] concentration
problems, ADHD, and often before they come to the clinic develop
substance abuse issues, and no matter what they come in with,
PTSD is something the doctors are always looking for to
determine whether this is a case.
9:54:37 AM
DR. ALCORN continued that the symptoms they are going with are
very diverse, every patient with PTSD can take their own
[indisc.] or patients will develop the first symptoms flare
shortly after they are exposed to the trauma, but other times a
patient can go years or decades without their first symptoms
flare. Likewise, he related, that some patients are very
sensitive and anything psychologically stressful can cause
symptoms that flare whereas other patients need a specific
reminder that reminds them of the trauma, such as smell, sound,
or place. When it comes to aligning a treatment plan the
doctors consider out-patient treatment, in-patient, what do they
need, and must evaluate the patient where they are at. Out-
patient therapy has a good chance of succeeding when patients
are ready to get their experience off their chest and form a
therapeutic relationship and talk. Whereas other patients have
tried to avoid thinking about or talking about their experience
and for those individuals out-patient wouldn't work because they
cannot get comfortable when seeing their therapist once a week
and a level of trust can't be developed in order to raise
themselves to reveal the things they've experienced. He opined
that sometimes with PTSD there is a lot of shame and guilt that
goes along with it, and the doctors determine whether a
residential treatment program would be better where they can see
their therapist every day, break through and build a trust
relationship, and progress with their treatment. Dr. Alcorn
commented that the program is structured in a manner that is
consistent with the evidence as the first phase of the program
is working with the patient developing their coping skills,
making sure they are comfortable, and build a level of trust
before they are pushed into the next phase in starting to
address their trauma and work through those issues. Over the
last five-seven years, he noted, there is a benefit to offering
a program in Alaska and working with the military. He advised
they have sent a large number of patients from the clinic to the
lower-48 for residential treatment either for PTSD, substance
abuse, or both. It has been successful for some of the patients
but, he described, definite challenges in that it is difficult
to provide family therapy and services to the family that will
need to work with the patient when they return to their home.
He offered there are programs tied to teleconferencing, but it
is not the same and frequently sees that patients come back from
the lower-48 and look improved during their first visit.
Unfortunately, rapidly thereafter they change to how they were
before they went to treatment and it triggered an increase in
symptoms. Within out-patient treatment, he said, he initiates
the family therapy component and provides psycho-education for
the individual's trusted figure so at least they have an
elementary understanding of PTSD, and understand why the patient
experiences symptoms. He noted that he includes discussing
changes the family can make at home or work so it is a little
more tolerable for the patient. He conveyed that having local
programs available is also beneficial cost-wise as patients sent
to the lower-48 requires an escort. [Indisc.] Anchorage or in
Alaska for the soldier [indisc.] and how [indisc.] with the
program here. The ability to treat both substance abuse and
PTSD under the same roof is vital as many patients with PTSD
look for any way possible to make their symptoms more tolerable,
he pointed out. Treating a person with a substance abuse
problem to fully engage in PTSD treatment therapy must be
treated at the same time otherwise facing their trauma becomes
that much more difficult when treatment is sequentially, he
opined.
10:01:22 AM
REPRESENTATIVE LEDOUX surmised there has been a huge increase in
the number of diagnosed PTSD cases. She asked whether there are
more PTSD cases in those increased numbers or whether it has
something to do with the focus put on PTSD and the diagnoses of
PTSD. She pointed out that the cases that might be diagnosed
now with PTSD may not have been diagnosed previously.
10:01:56 AM
DR. ALCORN responded there are a combination of things that play
into the increase in PTSD. He pointed out the previously it was
called "shell shock," and currently people would be diagnosed
with PTSD, including schizophrenia. He described a greater
awareness of PTSD with regard to the Iraq and Afghanistan wars
including advances in battle field medicine and technology which
allows a lot of soldiers to survive wounds they previously would
not have. While that is a good thing, obviously psychological
trauma becomes more prominent, especially later in life. He
noted that the military must determine whether PTSD is a
legitimate diagnoses, whether they are they trying to mimic what
their buddy just said, or trying to gain their symptoms. When
diagnosing PTSD, there are different psychological tests and the
more information the patient can offer the more helpful it is,
he remarked.
10:03:26 AM
REPRESENTATIVE LEDOUX asked whether a physical injury must be
involved or another person's injury observed.
10:03:37 AM
DR. ALCORN replied it can be witnessed or even repeatedly listen
to an event in stories. He related that if the soldier's
response at the time of observing or witnessing it indicates
they're significantly affected, a soldier can be diagnosed with
PTSD. He said it is fairly rare that he has diagnosed PTSD
involving [indisc.] in some way experienced it directed toward
themselves. He offered that possibly the soldier does not have
the actual physical injury, although [indisc.] five feet away
from them and didn't explode but assumed they were going to be
killed. He opined that it is rare someone watching a program on
television or hears something is diagnosed with PTSD.
10:05:02 AM
ANDY LANNING, Chief Master Sergeant, Air Force, (Ret), Division
Director of Military Programs, Universal Health Services Patriot
Support Program, [Indisc.] said there are over 27 medical
surgery facilities across the country, including Puerto Rico,
Virgin Islands, and England, with continued care. He said that
within that piece is the Patriot Support Program and almost
eight percent of the facilities are affiliated with [indisc.]
and people are seen from [indisc.] down to 4-years old. He
explained that the Patriots Support Program is focused on
veteran and active duty service members and noted that 14
facilities have dedicated programs similar to the Chris Kyle
Program in Anchorage with a dedicated treatment program for
active duty members and veterans. He explained that at the
height of the wars it was determined that veterans react to
treatment better when in groups as they go through some of the
trauma cases, combat trauma and stresses of military life, and
felt better corresponding with their brothers and sisters. He
advised that was the prelude to opening facilities in treating
substance abuse, combat trauma, [indisc.] and military sexual
trauma for females and men. In addition to that, last year they
have 13 other basic core service centers with programs [indisc.]
established, all are best practices and repeated visits to
facilities to ensure that the core executive programs are
[indisc.] hit or miss with the civilian population. Some of the
installations are uncomfortable with that, they may be [Indisc.]
out in [indisc.] integration in with the civilian population is
actually beneficial to them to learn social skills to
reintegrate back into civilian life after living solely with
military members. He referred to the Military Advisory Board
which includes seven officers, military consultants, [indisc.]
medical integrity programs [indisc.]. He advised he spent a lot
of time at facilities regarding communication, understanding
military culture, and providing training for doctors and staff
that have not been in the military as to the culture of the
military and when men and women come in, staff has a better
understanding of military life.
10:09:35 AM
WILLIAM J. MCDANIELS, M.D., Rear Admiral, U.S. Navy, (Ret),
Universal Health Services Patriot Support Program Board Member,
[Indisc.] advised an effective way to treat recovery is to get
groups together and talk it out, and is involved in the 28-day
program [indisc.] that turns out to be phenomenally effective.
[Indisc.] when veterans came home from World War II they spent
three weeks on a cruise ship with 5,000 buddies all in unknown
pain and trauma with nothing to do on the ship except talk. In
this manner, he explained, the returning soldiers provided their
own therapy extremely well [indisc.] but in fact it was believed
one of the reasons it continued [indisc.] than what occurs now
is [indisc.] blown up [indisc.] back with their family with no
chance to decompress and no chance to compare events with
military friends, and no chance to talk it out. He said that's
hard [indisc.] tracking inefficacies, rapid diagnosis, and
patient [indisc.]. The history of this disease [indisc.].
[Indisc.] three two-star and three three-star adjutant generals
from the Army, Navy, and Air Force, two two-star and one one-
star [indisc.]. These individuals have all been to combat and
dealt with this condition [indisc.] all of their professional
lives and all continue to have the desire to still give the best
treatment possible to the people who were once under their care
and in their memories. He pointed out that these individuals
have many opportunities, as [indisc.] officers to serve on
various committees and everyone wants to just because [indisc.].
Previously they very carefully looked around at systems trying
to [indisc.] and when they were approached by Universal Health
Services (UHS) as to whether they would be interested in an
endeavor with them they looked very carefully [indisc.] and
realized that what UHS was doing follows very closely to what
they aspired to do which is to give the best help possible to
the young men and women who put their lives on the line for the
nation. [Indisc.] and that is what they do. [Indisc.], he
advised he is an orthopedic surgeon [indisc.] and usually
[indisc.] giving a talk in that very profession but [indisc.].
10:13:17 AM
CHAIR HERRON asked what is the Universal Health Services (UHS)
and why did Admiral McDaniel affiliate himself with it.
10:13:35 AM
REPRESENTATIVE LEDOUX questioned whether Dr. McDaniel has seen
an increase in PTSD because people go from a battle zone to the
states in a brief period of time instead of being on a carrier
for 18 days having a chance to decompress with their buddies.
She suggested going back to a carrier system to bring the
soldiers back to the states or some sort of camp or something
for them to decompress.
DOCTOR MCDANIEL responded that they have [indisc.] with that but
the answer is political as these people have been gone 6-12
months, they get [indisc.] if they know that in the event they
show symptoms of PTSD and will be held someplace for three weeks
for treatment, he guarantees there will be no signs or symptoms.
Then [Indisc.] political windstorm that no one would survive and
that is [indisc.] war zones and can't see their family for
another three weeks as they will be held just in case, would
never work. He offered that the idea had been discussed at
length and disregarded as it absolutely politically impossible
[indisc.]. [Indisc.] using blood tests and behavioral tests
before they go [indisc.] and before they come back [indisc.] but
people will hide if they think there is any chance that
[indisc.] their family and friends. [Indisc.] there are a
number of groups around the country that approached the Patriot
Support Advisory Board [indisc.] who want to be involved
[indisc.]. A program must have a majority [indisc.] or military
associated programs [indisc.] and must understand military
culture. He remarked that some of the psychiatric groups don't
[indisc.] they think any [indisc.] facts will do. The Patriot
Support Advisory Board believes the culture of having a military
[indisc.] and need to have a program set up so there are three
choices in the military and [indisc.] what you do here [indisc.]
you have [indisc.] program and get up every morning and go to
physical therapy, which many veterans have twice a day. He
pointed out that there must be a regiment very akin to what they
underwent in the military and that is what UHS does and if a
program is set up as closely as possible to what veterans are
accustomed to in their military lives, the results will be
better. He said that UHS offers those programs which is why the
Patriot Support Advisory Board chose to associate with it.
10:17:19 AM
REPRESENTATIVE LEDOUX asked whether Universal Health Services is
a governmental agency or non-profit.
10:17:44 AM
DOCTOR MCDANIELS answered that [indisc.]. The founding
gentleman of Universal Health Services is in Anchorage and will
make the dedication this morning. He [indisc.] very patriotic
and believes in it totally which is one of the reason for the
dedication today. [Indisc.].
10:18:05 AM
REPRESENTATIVE HUGHES referred to previous discussion regarding
increases in veterans [indisc.] active duty [indisc.].
[Indisc.] Viet Nam [indisc.] so they are managing it on
[indisc.] and help them [indisc.]. [Indisc.] mission but does a
person once identified [indisc.] do they ever recover or will
always require services throughout their lifetime [indisc.].
10:19:11 AM
DOCTOR MCDANIELS responded [indisc.] there are varieties of
grief issues [indisc.] function throughout their lives, they
don't have episodes. He offered that within his experience when
they get stressed they may [indisc.]. [Indisc.]. The vast
resources are in that [indisc.]. [Indisc.] a very small amount
of [indisc.] just since [indisc.]. [Indisc.]. He advised that
he spoke long ago on this condition and hired professionals to
work together in Seattle, and thought [indisc.] on the other
side of the bar there are [indisc.]. He said the Viet Nam era
[veterans] have learned to treat themselves. Successfully he
couldn't say but in fact they get along in the [indisc.].
10:20:52 AM
LAURA MACKINZIE, Alaska Veterans Administration Healthcare
System, [Indisc.] active duty service members and veterans.
[Indisc.] located at the [indisc.] facility which provides
residential treatment for both homeless veterans and [indisc.].
She said [indisc.] provides comprehensive residential treatment
which is greatly needed for this population. Substance abuse
and mental health services [indisc.] there are an estimated 23.4
million veterans in the United States and approximately 2.2
million will [indisc.]. Within Alaska there are approximately
77,000 veterans and 25,000 active service members. She noted
Alaska has the highest per capita numbers of veterans in the
country. The demanding environment of military life and
experiences of combat during which they may experience
psychological distress can be further complicated by substance
abuse and related disorders, she remarked. Many service members
face critical issues, such as trauma, suicide, homelessness, and
toward [indisc.] emotions, and approximately [indisc.] percent
of service members returning from Iraq and Afghanistan have Post
Traumatic Stress Disorder (PTSD) or depression. In [indisc.],
experienced in traumatic brain [indisc.]. Between 2005-2006
approximately 20 percent [indisc.] substance abuse disorder, 70
percent of the total [indisc.] substance abuse disorder.
[Indisc.] PTSD, substance abuse in the military population for
men and women. More than [indisc.] PTSD. [Indisc.] combat does
[indisc.] PTSD and alcohol [indisc.]. [Indisc.]. [Indisc.]
soldiers in the VA have a problem with alcohol or drugs.
[Indisc.] more women are serving in the military than at any
point in the history of this country. She pointed out that the
gender shift creates new challenges of [indisc.] returning
veterans [indisc.] disorder. [Indisc.] military women are
doing. Included in this need are service [indisc.] issues arise
[indisc.] dominantly males. [Indisc.]. [Indisc.] more than
quadrupled the numbers [indisc.]. Recent reports in the last
[indisc.]. [Indisc.] hospital discharge [indisc.] nearly
doubled [indisc.]. She related that the current availability
of treatment provided for Alaskans is inadequate because
[indisc.] communities. [Indisc.] over [indisc.]. The top 10
percent per capita in alcohol related [indisc.]. [Indisc.]
active duty [indisc.]. The VA provides services on an out-
patient and residential basis for [indisc.]. Industry programs
[indisc.] utilize [indisc.]. [Indisc.]. Substance abuse
treatment provides [indisc.]. [Indisc.]. She conveyed that the
VA is working on [indisc.] grateful launching [indisc.].
[Indisc.] welcome partnership in providing care for veterans
[indisc.]. Additional treatment [indisc.] potential providers
[indisc.] substance abuse treatment [indisc.]. Welcome
[indisc.] and support Safe Harbor in Anchorage. [Indisc.].
10:27:41 AM
ANN HUTCHINSON, PsyD, Interim Chief of Psychology, Alaska
Veterans Administration Healthcare System, [Indisc.] This
position was created to better serve the needs of veterans, she
explained. [Indisc.] 70 percent of those suffering from PTSD
also have an alcohol use disorder problem over the course of
their life. [Indisc.] veterans population that also parallels
the Viet Nam veterans hospital. She expressed that is one of
the main reason she developed this position for better analysis
and treatment [indisc.]. The evidence of psychotherapy
[indisc.]. [Indisc.] preferred treatment of the veteran
[indisc.] treatment of PTSD and training process [indisc.].
[Indisc.] get that training and get back to [indisc.]
prevention. [Indisc.] treated by VA physicians and as Dr.
Alcorn mentioned, he can see as often [indisc.] treated.
[Indisc.] primary care, social workers [indisc.] She advised
that shows her they are doing a great job identifying PTSD and
able to treat the condition early for a brief behavioral care
intervention. A veteran seen in outpatient care [indisc.] her
role [indisc.]. [Indisc.] offer a one-time [indisc.] may be
asked to go on and take some symptom management classes
[indisc.] identify different symptoms and offer practical
skills. [Indisc.] PTSD is often recommended [indisc.].
[Indisc.] gold standards of treatment [indisc.] provided good
feedback as it has been a hopeful group and the VA also has a
[indisc.] treatment called [indisc.] which is another great
therapy [indisc.]. [Indisc.] group and individual therapy
[indisc.] the second is the [indisc.] version which are also
gold standards [indisc.] The VA has the ability to send
veterans to the lower-48 to American Lake or Wyoming for
residential treatment. [Indisc.]
10:32:08 AM
CHAIR HERRON asked whether the Veterans Administration (VA)
embraces this private sector effort.
MS. MACKENZIE responded that the VA welcomes additional
resources for veterans and recognizes that the need is greater
than what the VA can meet at this time and is good for veterans.
10:32:44 AM
REPRESENTATIVE LEDOUX questioned the payments for the services,
and whether Tri-Care pays for services or whether the Veterans
Administration refers people to the private health sectors and
the VA pays for it.
MR. LANNING explained that the VA's column of money is separate
from Tri-Care money as the veteran's treatment is paid through
the VA or charged to [indisc.]. [Indisc.] would pick up that
cost.
REPRESENTATIVE LEDOUX surmised that the VA refers veterans to
UHS or a similar entity when the VA does not believe it has the
services in-house.
10:34:17 AM
VERDIE BOWEN, Director, Office of Veterans' Affairs, Alaska
Department of Military and Veterans' Affairs (DMVA), explained
that the VA refers patients to out-patient care and the service
can be paid in three different processes: the VA can offer
direct payment to the facility providing care to the veteran; or
[indisc.] they have a network of care [indisc.], or they use the
[indisc.] which is available for the next three years and
veterans [indisc.] as well.
REPRESENTATIVE LEDOUX inquired as to the veteran's choice per
family [indisc.].
MR. BOWEN advised that recently President Barack Obama signed
the Veterans Access, Choice and Accountability Act of 2014
(Choice Act) allowing veterans to choose health care in two
ways: [indisc.] choice 30/40 program or the Veteran's First
Program which is a referral process within the VA system and is
utilized for non-critical care, urgent care is provided under a
different vehicle which is [indisc.]. The PT3 contract is
nationwide and is outside contracts, Tri-Care, United Health
Care, the State of Alaska, and the VA system, have other PT3
contracts [indic.] which is a third-party administrator for that
program as well.
10:36:26 AM
ADJOURNMENT
There being no further business before the committee, the House
Special Committee on Military and Veterans' Affairs meeting was
adjourned at 10:36 a.m.
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