VA NEW ENGLAND HEALTHCARE SYSTEM
CENTRAL AREA SUB-REGION MANAGEMENT ASSISTANCE COUNCIL


A meeting of the Central Sub-Region Mini MAC was held at West Roxbury on
Tuesday, January 8, 2002 from 1:00 PM to 3:00 PM. The following individuals
were in attendance:

Michael Lawson, Director, Boston Healthcare System
Robert Noble, American Ex Prisoners of War
Ed DeBity, Veterans Benefits Clearinghouse
Thomas Daley, Disabled American Veterans
Raymond O'Brien, Veterans of Foreign Wars
Robert Hall, Mass Dept. of Veteran Services
Tom Materazzo, City of Boston Veterans Services
Rodney A. Zablan, Disabled American Veterans
Joseph E. Badzmierowski, Paralyzed Veterans of America
Edward Bryan, Persian Gulf War Veterans
George Guertin, American Legion
General Weeks, Blinded Veterans Association
Patrick J. Leonard, Disabled American Veterans
Michael Miller, Chief Medical Officer, VISN 1
Diane Keefe, Public Affairs, Brockton/West Roxbury
Deborah Outing, Facilitator, Bedford

Purpose: To conduct the business of the VA New England Healthcare System
Central Sub-Region Mini MAC.

Desired Outcomes: 1) VISN 1 Budget Update 2) Definition of Mini-Mac 3) Dry
Shave Issue 4) Boston Integration Update 5) Review Central Sub-Region
Mini-MAC Future Agenda Items

1. The minutes of December 11, 2001 was accepted but with the following
changes:

The word "sited" in the desired outcomes section was misspelled. It
should have said, "cited".
Mr. Raymond O'Brien's name was omitted as an attendee. It has now been
included.

2. VISN 1 Budget Issue Update.

Pharmacy expenses are projected to go up due to inflationary costs and
volume.
Number of inpatients has increased by 13% throughout the VISN (1). Based
on the success of the Community Based Outpatient Clinics (CBOCs) and the
expansion of Primary Care capacity.
Financially challenging year for this VISN.
None of the budgets have been finalized yet.
The $80 million deficit is based on VISN 1 projections.
There will also be a 4.6% pay raise for all employees, including specialty
groups such as (nurses) which will impact on the budget.
At this point in time we will continue to service Category 7 veterans.
There has been no change in this status.

After the presentation the following questions and answers were discussed:

How will the budget deficit affect the Community Outpatient Clinics,
particularly the Worcester Clinic?
The Worcester CBOC has been in business for a long time. It has a large
percentage of its veteran population in the Category 1 through 6 (80%). It
has not been in fluxed by the Category 7 veterans as much as the other CBOC'
s have been. This population is relatively established. I don't see us as
having a downsizing of primary care services at this clinic. We will
maintain all the services that we have maintained, but we are not sure of
the consolidation.
How are the positions within the VISN going to be replaced as staff
leaves?
The Network has a Network Resource Board that reviews all positions that
are sent forward from the medical centers. The positions are assigned by
Care Line Managers, locally these care lines go to the local resource board,
and petition to have a position approved, then it is approved by the Network
Care Line manager, which goes forward to the Network Resource Board and they
make a decision to go forward to approve or disapprove a position.
What is the percentage of approvals for positions by the Network Resource
Board?
At the last meeting we held, the percent of staff hired was approved between
the amount 10 and 20 percent. But, this was in part due to some of the
facilities submitting a higher number of positions without the review of the
local resource boards.
Are all security officers in the VISN armed?
No, a process for training medical center by medical center is currently
taking place. By a certain timeframe all medical centers will have armed
officers.
The ELC states in the minutes that veterans referred for powered
wheelchairs and powered mobility devices are evaluated using standardized
criteria and procedures and it mentions a strategic plan. Have any of those
been approved at the final level?
The powered wheelchair issue went forward. One of the ways the Network is
looking to save dollars is to have standardized policies for the purchase of
high cost, high dollars equipment. We're trying to get volume discounts on
equipment to save dollars. We've just recently looked at home oxygen
systems.
In creating policies in the VISN, whether it is for the home oxygen
program or the wheelchair program, is the Network looking at following the
guidelines of the prosthetics handbook?
That's what's driving us. Many other VISN's are doing the exact same
thing. Prosthetics service is looking for ways to save and reducing
quantities of prosthetics items for veterans by introducing savings through
blanket purchase agreements.
Ed Bryan wants follow-up information from Dr. Post regarding the Gulf War
meeting that was supposed to take place but didn't due to the September 11th
tragedy.
Dr. Miller requested posting in the minutes that a follow-up is requested
of Dr. post regarding the upcoming Gulf War meeting.

3. Boston Healthcare System Update

In the past you've heard me talk about what this (Mini-Mac) taskforce was
originally designed to do
Secretary Principi was told by the White House not to stop taking caring
of Category 7 veterans. They further indicated they (White House) would pay
the $140M to take care of this category of veterans.
We were told to increase security because of September 11th.
We were told to take efforts for decontamination and HSMET.
None of the above has been funded at ANY level.
In the last three years, the number of patients we take care of has gone
up by 23%. Our purchasing power has gone down by 20%.
The Secretary will not do anything to eliminate the Category seven
veterans.
Our education department is in the process of developing a customer
service-training program, which will be mandatory.
We have our staff listening to the needs of our veterans to find out how
we can help them.
We do advise staff that the veteran deserves their respect and
consideration.
Dry shave issue. (Mr. Lawson's response to the issue) I believe we have
taken care of the dry shave issue. I suspect that you (Tom M.) and I will
keep an eye on this and if it slides back to the way it was, we will
resurrect it, change it and continue to keep it on track. The story I heard
is, that it is standard practice in the Boston area. And the question I
asked is why can't shaving crme be used. The response I got, is that there
is shaving crme was not included in the budget.

After the presentation the following questions and answers were discussed:

How is the budget increasing if Network Directors have to certify their
budgets?
We have been asked in the past to certify that we could live with the
budget we were given and I was pleased that there would be no opportunity
for that to come about. This VISN just got its budget in the last couple of
weeks. Our commitments we have for various services exceed our revenues.
We are not going to be able to certify that we can stay within budget.
How is Congress ever going to agree to approve more money when service
organizations are saying the VA doesn't have enough money, but the VA is
saying they can make the budget this year and live within that budget?
I'm not sure how to answer that. Congress has been very generous in the
past with the VA budget. That generosity has changed and it's shifted.
Veterans have been moving to the Southwest and to the Southeast because of
the expensive healthcare in the Northeast. Secretary Prinicipi has said
that the VA is $140 million short. And as more time as gone by, Category 7
veterans have increased, costing the agency even more.
What would the impact be if you closed some of the Community Based
Outpatient Clinics?
The new CBOC's are 85% Category C veterans that come to visit. The problem
is, if we close the clinics we are obligated to see those veterans somewhere
else. A fair amount of these patients are coming to us for medication.
There has also been a dramatic increase of patients of primary care.
What is the cost of running a CBOC per year?
$800,000 per year.
What about closing a hospital within VISN 1?
That's been talked about. We will probably experience the same problems
next year. We need to start restructuring what we do. Particularly within
Massachusetts. I'm not saying that we should close, but I am saying that
we should change the mission. If not a hospital, than a nursing home,
single occupancy center, or residential care center. We change the
intensity of what it does, so we don't have to spend as much money
maintaining the hospital.

4. Handouts - The following information was made available for the
participants:

CD-Rom diskette on enrollment
CLC Minutes
ELC Minutes
Copy of the "News At A Glance" weekly
Management Assistant Council report

5. Future Agenda Items - The members suggested the following for the next
meeting:

Discussion of Champ VA, and when eligibility starts for spouses and
children.
Co-Pay for Category C veterans.
Gulf War issues

6. The meeting adjourned at approximately 3:00 PM. The next meeting will
be held on February 12, 2002 from 1:00-3:00 at the West Roxbury facility.

Deborah Outing

House Committee on Veterans' Affairs
Legislative Update
December 19, 2001
Strengthening Veterans and their Families.

H.R. 801, the Veterans' Survivor Benefits Improvements Act of 2001,
created new life insurance and health care benefits for up to two million
eligible spouses and children of veterans. (Bill | Summary)

Expands Servicemembers Group Life Insurance (SGLI) to military
spouses (up to $100,000) and children ($10,000).

Makes last year's increase of the SGLI maximum ($250,000)
retroactive to October 1, 2000 to cover military personnel who have died in
recent service-related tragedies between October 1, 2000 and April 1, 2001.

H.R. 801 also provides the over-65 spouses of severely disabled
veterans enrolled in CHAMPVA the same health benefit presently provided to
military retirees enrolled in TRICARE.

Signed into law by President Bush June 5, 2001 as Public Law No.
107-14.

Overdue Tribute to World War II Veterans.

H.R. 1696 will expedite the construction of the World War II
Memorial in the District of Columbia and has finally put an end to years of
delays by removing the last obstacle to building a national memorial on the
Mall in Washington, D.C.. ( Bill )

A prominent, national memorial on the Washington Mall is a fitting
tribute for those who participated in the triumph of democracy and freedom
over the forces of hatred and tyranny.

According to the Department of Veterans Affairs, more than three
million World War II veterans have died since Congress first authorized the
Memorial in 1993.

It has been nearly six years since Congress authorized a World War
II Memorial, and nothing has been built. Six years is a period of time that
is longer than it took to win World War II itself.

Signed into law by President Bush May 28, 2001 as Public Law No.
107-11.

A Budget Plan that Values our Veterans.

H. Con. Res. 83, introduced by Budget Chairman Jim Nussle,
contained a spending blueprint that appropriately honors the sacrifices of
our veterans. ( Bill )

The Budget Resolution provided funding for, and recommended the
enactment of two important initiatives: H.R. 801, the Veterans' Survivor
Benefits Improvements Act, and H.R. 1291, the 21st Century Montgomery GI
Bill Enhancement Act.

The Budget blueprint adopted by Congress authorized an increase in
discretionary funding for veterans programs of up to $1.7 billion for fiscal
year 2002.

The House-passed Budget Resolution provided for a 12 percent
increase in total funding for veterans programs over the previous fiscal
year.

Veterans Funding: Keeping the Promise.

The conference report on H.R. 2620 increases total spending for
veterans by $3.2 billion dollars, including a $1.3 billion increase for VA
medical care, one of the largest in history. ( Bill )

Provides a 16 percent increase in spending for the Veterans
Benefits Administration to remedy the backlog of compensation claims.

Provides $100 million for Veterans State Extended Care Facilities,
$50 million over the President's request.

Signed into law by President Bush November 26, 2001 as Public Law
107-73.

Emergency Funding for the Repair of VA Hospitals.

H.R. 811, the Veterans Hospital Emergency Repair Act, would
authorize $550 million over fiscal years 2002 and 2003 to repair dilapidated
and obsolete VA medical facilities. (Bill | Summary)

VA Secretary may choose individual projects recommended by VA's
capital investments board. (VA has already compiled a list of 20 such
projects.)

Construction projects that address patient safety, privacy,
earthquake protection, and accommodation for disabled veterans will get top
priority under H.R. 811.

Passed the House on March 27, 2001; pending in the Senate.

Helping Veterans Achieve their Education Goals.

H.R. 1291, the Veterans Education and Benefits Expansion Act of
2001, would increase the rates of Survivors' and Dependents' Educational
Assistance from $608 to $670. (Bill | Summary)

Restores educational assistance entitlement to participants in
VA-administered programs called to active duty.

Allows an accelerated payment of MGIB benefits of up to 60 percent
for short-term, high technology courses.

Includes certain private technology entities (primarily businesses)
in the definition of educational institution so that veterans enrolled in
technical courses can qualify for VA educational assistance benefits.

Permits veterans to use VA educational assistance benefits for a
certificate program offered by an accredited institution of higher learning
by way of independent study.

Repeals the 30-year presumptive period for respiratory cancers
associated with exposure to herbicide agents.

Adds Diabetes Mellitus (Type 2) to the list of diseases presumed to
be service-connected in Vietnam veterans exposed to herbicide agents.

Expands, effective March 1, 2002, the definition of illnesses
presumed service-connected for Gulf War veterans to include a medically
unexplained chronic multisymptom illness such as chronic fatigue syndrome,
fibromyalgia and irritable bowel syndrome defined by a cluster of signs or
symptoms.

Repeals the limitation on assets for payment of benefits to
incompetent institutionalized veterans.

Provides a non-service-connected pension to low-income wartime
veterans aged 65 and older without requiring a determination of disability.

Provides VA the authority to operate transition assistance offices
overseas so as to furnish "one-stop" assistance to servicemembers in such
areas prior to their separation from military service.

Increases the home loan guaranty from $50,750 to $60,000.

Extends to December 31, 2005, VA's direct home loan program for
Native American veterans living on trust lands.

Increases the grant for specially adapted housing for severely
disabled veterans from $43,000 to $48,000, and increase the amount for less
severely disabled veterans from $8,250 to $9,250.

Increases the burial and funeral expense benefit for a
service-connected veteran from $1,500 to $2,000, and increase the burial
plot allowance from $150 to $300.

Creates a five-year program requiring the Secretary to furnish a
bronze marker to those families that request a government marker for the
marked grave of a veteran at a private cemetery.

Increases the automobile and adaptive equipment grant for severely
disabled veterans from $8,000 to $9,000.

Senate agreed to House amendment to Senate amendments on December
13, 2001.

Cost-of-Living Adjustment.

H.R. 2540, the Veterans' Compensation Rate Amendments of 2001,
would provide a cost-of-living adjustment (COLA), effective December 1,
2001, increasing the compensation of disabled veterans and their survivors
by $2.7 billion over five years. (The COLA will be 2.6 percent.) (Bill |
Summary)

Presented to the President on December 13, 2001.

Promoting Better Coordination of Health Care for Military Families and
Veterans.

H.R. 2667, the Department of Defense-Department of Veterans Affairs
Health Resources Access Improvement Act of 2001, would expedite VA-DoD
sharing of medical resources, improving the health care of both military
personnel and veterans. (Bill | Summary)

Currently, military health care facilities and veterans medical
treatment centers often treat the same patients, yet there is virtually no
cooperation and coordination of care. This leads to unnecessary red tape
for patients who utilize both facilities.

The General Accounting Office (GAO) reports that American taxpayers
could save as much as $300 million a year in pharmaceutical procurement
alone with greater coordination between the two agencies.

The bill would establish an integrated demonstration project at
five locations where both VA and DoD have health care facilities in close
proximity.

Examines such aspects of integrated operation as unified management
systems, technology and staffing.

Introduced July 27, 2001.

Major Initiative to Help Homeless Veterans.

H.R. 2716, Homeless Veterans Comprehensive Assistance Act of 2001,
would authorize the VA Secretary to establish ten new domiciliary programs
to serve homeless veterans. (Bill | Summary)

Authorizes a set-aside of 500 additional section 8 housing vouchers
for rental assistance for each of the next four years.

Authorizes appropriations of $60 million for FY 2002 for the VA's
Homeless Grant and Per Diem Program, and $75 million annually for
2003-2005.

Directs the Secretaries of Labor and the VA to undertake a
demonstration program at a minimum of six penal and other long-term
institutions to determine the costs and advantages of providing counseling
on health care, benefits and job placement to veterans soon to be discharged
from long-term institutional care.

Encourages the Secretaries of HUD and the VA to work together in
assuring that recipients of funds from any government program are aware of
the need to serve the large number of homeless veterans, and to jointly
devise a method to track veterans who participated in homeless programs.

Presented to the President on December 13, 2001.

Expanded Access to Health Care for Veterans.

H.R. 2792, the Disabled Veterans Service Dog and Health Care
Improvement Act of 2001 would introduce innovative solutions to the specific
health care needs of an aging veterans' population. (Bill | Summary)

Authorize the provision of service dogs for disabled veterans to
assist the veteran with various activities of daily living. The new benefit
would also include travel reimbursement for the costs incurred in training
the service dog.

Require each regional Veterans Integrated Service Network (VISN) to
maintain a proportional share of national capacity in VA's specialized
medical care programs.

Establish a four-year, four-VISN pilot program of applied managed
care through an outside contractor in VA's $500 million fee-basis and
contract hospitalization program. The program would accommodate those
service-connected veterans who:

Live too far away from a VA medical center.

Suffer from health conditions which an available VA hospital cannot
treat.

Find themselves in health- or life-threatening emergencies when no VA
medical facility is reasonably available.

Passed the House on October 23, 2001; pending in the Senate.

Major provisions of bill incorporated on December 11, 2001; see
H.R. 3447.

Protection of VA Education Benefits for Reservists.

H.R. 3240, the Reservists Education Protection Act, protects
educational benefits for servicemembers called to active duty, reassigned or
relocated in the war on terrorism. (Bill | Summary)

Extends, for a member of a reserve component who was called to
active duty, the period during which the Reservist may use his or her VA
educational benefits by the length of active service plus four months.

Provides that the Reservist will not be considered as having been
separated from the Selected Reserve for education purposes by reason of
active-duty service.

Passed the House November 13, 2001; pending in the Senate.

New Bioterrorism Research and Emergency Preparedness Centers.

H.R. 3253, the National Medical Emergency Preparedness Act of 2001,
establishes four or more new National Medical Emergency Preparedness Centers
at VA medical centers to: (Bill | Summary)

Conduct medical research on and develop health care responses for
chemical, biological, and radiological threats to the public;

Provide related education, training and advice to VA and community
health care professionals; and

Provide rapid response laboratory assistance to local health care
authorities in the event of a national emergency.

Requires the new centers to arrange the participation of medical
schools and public health schools in the related education and training of
health care professionals.

Authorizes $100 million over five years to fund the new centers.

Introduced November 8, 2001.

Arlington National Cemetery; Expanded Eligibility.

H.R. 3423 would make eligible for in-ground burial at Arlington
National Cemetery a member or former member of a reserve component of the
Armed Forces who at the time of death was under 60 years of age and but for
age, would have been eligible for military retired pay under title 10. The
bill would also extend eligibility to the member's dependents. (Bill |
Summary)

Makes eligible for in-ground burial at Arlington National Cemetery
a member of a reserve component of the Armed Forces who dies in the line of
duty while on active duty for training or inactive duty training. The bill
would also extend eligibility to the member's dependents.

Authorizes the Secretary of the Army to construct a memorial at
Arlington National Cemetery honoring the victims of the acts of terrorism
perpetrated against the United States on September 11, 2001. The Secretary
of the Army would be required to consult with the families of the victims of
such acts of terrorism prior to the exercise of such authority.

New 2002 Health Service Enhancements for Disabled Veterans.

H.R. 3447, the Department of Veterans Affairs Health Care Programs
Enhancement Act of 2001, would renew VA's requirement to maintain capacity
in its specialized disability programs, such as severe mental illness,
spinal cord injury and blind rehabilitation, and stiffened reporting
requirements to ensure these unique VA programs are not curtailed. (Bill |
Summary)

Changes VA's "means test" for poverty determinations to reduce
hospital co-payments by 80% for nearly 150,000 veterans nationwide.

Establishes national VA chiropractic care program, and provided VA
authority to furnish service dogs for severely disabled veterans who are
enrolled in VA health care.

Requires VA to study feasibility of providing a new Global
Positioning System-based emergency response capability to service-connected
disabled veterans.

Provides new and enhanced methods for VA to recruit and retain
nurses in the veterans health care system, including renewal and extension
of scholarship and loan-repayment programs for VA nurses, simplification of
locality-based nurse pay system; and, establishment of a blue-ribbon
commission to recommend new policies and legislation on the future of the VA
nursing profession.

Passed the House on December 11, 2001.