As the 117^th Congress comes to a close, the fog of urgency seems to be settling on the Hill. Congress is weighing the options to fund the Federal Government for FY23 and meanwhile in the process, NAVREF along with the FOVA Coalition are advocating Congress to meet the recommended $980 million for the VA research program. As a note, the House passed the recommendation of $926 million.

The current continuing resolution, which keeps funding at FY 2022 levels, fails to keep pace with biomedical inflation and impedes VA research in all priority areas, including preventing veteran suicide, chronic pain, post-traumatic stress disorder, precision oncology, and other conditions with increased incidences in veterans.

A meaningful funding increase in FY 2023 for the VA research program would enhance the investment in veteran-centric research on a trajectory of meaningful growth above inflation, allowing for sustained support for efforts to address long-term health impacts of COVID-19, health disparities, and increase clinical trials access, while renewing support for groundbreaking programs like the Million Veteran Program (MVP), VA’s participation in the Cancer Moonshot Initiative, and research on chronic and emerging needs of our nation’s veterans. Increased funding for the VA research program will also support researchers as they recover from slowed research progress during the pandemic and allow for additional investments to support the strained IT capacity through computational science purchases to enhance the collection and use of big data. Sustained and predictable funding growth for VA research is imperative to help ensure the best return on investment in improving the health of veterans and all Americans.

The VIPER Act has garnered some progress last week as it moved through the house by roll call vote at the request by Virginia Congressman, Rep. Bob Good. The bill passed the house with a final vote of 381-39. It now heads to the Senate where NAVREF will be working closely with the Senate VA Committee leadership to bringing the bill to the final steps of becoming law.

The VIPER Act was first introduced in October 2021 and aims to improve the VA Medical and Prosthetic Research program by providing additional authority and resources for VA research.

The legislation would add stability and efficiency for the VA research program by formally authorizing VA’s Office of Research and Development and excluding VA research from the Paperwork Reduction Act requirements, better aligning VA with other federal research agencies. The VIPER Act will also work to enhance the diversity of the VA research workforce, increasing scientific opportunities and leading to improved health care for veterans.

The bill also includes provisions to:

• End the Section 209 interpretation by the DOJ.
• Expand the VA’s hiring authority for certain classes of research occupations, including data scientists and statisticians.
• Create a career development award grant program for researchers at smaller universities.
• Mandate a Government Accountability Office study on the retention of VA clinician-scientists and the productivity of their research.

WASHINGTON – Today, U.S. Representatives Diana Harshbarger (R-TN) and Chip Roy (R-TX) introduced the Innovative Cognitive Care For Veterans Act to address the needs of veterans suffering from cognitive impairments through a pilot program initiative. This bill instructs the U.S. Department of Veterans Affairs (VA) to implement a program that partners with private organizations to provide Veterans access to new and innovative care solutions.

The pilot will launch as a part of the Veterans Community Care Program with the goal of connecting veterans who have cognitive impairments with new and innovative care models. It will also allow for more veterans to age gracefully at home or other appropriate settings, with the freedom of using private partners to obtain the care they need.

"It is an honor to represent our veterans in Congress. This legislation is part of my mission to improve health care quality and accessibility for our veterans by providing access to telehealth and other innovative technologies that slow the progression of cognitive disorders," said Congresswoman Diana Harshbarger. "As I tell my son and grandsons, when America mourns the lost life of a veteran, we also mourn the loss of their stories, lessons, and patriotism. We owe each hero inexpressible thanks. Given the projected increase in the number of veterans developing cognitive impairments, the VA must explore alternative care models to ensure our veterans and their caregivers have access to top-of-the-line care when and where they need it, a small symbol of gratitude for their career of service and sacrifice. This bill is a step forward."

"Veterans should have the freedom to avail themselves of the incredible innovative healthcare options that are available in the private sector. This is particularly vital when we consider the growing need for long-term care for our nation’s aging heroes and the myriad challenges and struggles associated with cognitive impairment," said Congressman Chip Roy. "I am proud to stand alongside Rep. Harshbarger and co-sponsor her bill to open up more care options for veterans suffering from cognitive impairment under the VA’s Community Care Program."

Marlon Ferguson, Chief Executive Officer of National Association of Veterans' Research and Education Foundations:

“Creating an evolved and inclusive space for veteran cognitive care goes beyond the status quo and puts veterans at the forefront of a transition to an improved form of care. The Innovative Cognitive Care for Veterans Act has potential to be a crucial step forward and we fully support its purpose and mission.”

Russ Duerstine, Executive Director of Concerned Veterans for America:

“It’s tragic veterans still don’t have the same options as most Americans regarding where and when they can access health care. The Innovative Cognitive Care for Veterans Act would hold the VA accountable to help veterans access health care in different ways, rather than act as a bureaucratic barrier by keeping them trapped in a failed VA system. CVA supports telehealth which can help thousands of veterans. There are thousands more who need access to dozens of varieties of specialty care, timely and quality specialty care, that need in person treatment. Rep. Harshbarger’s bill would make getting that specialty care a reality for veterans, rather than an exception.” 

BACKGROUND:

• According to a 2020 study by the Office of the Assistant Deputy Under Secretary for Health for Policy and Planning at the VA, it is projected that the number of VA patients with Alzheimer’s dementia will increase by 28.9 percent between FY 2021 and FY 2033, amounting to an estimated 48,000 new patients with cognitive impairments.
• VA expenditures for long-term care are growing fast. A GAO reportfrom 2020 estimates that the amount the VA will spend for long-term care is projected to double to $14.3 billion by 2037.
• As described in the above GAO report, the VA also faces both current and future workforce shortages, and other challenges with providing long-term care services to the more than 2.8 million estimated VA enrolled veterans living in rural areas.
• As observed by the VA, Veterans can also be prone to unique factors that increase their risk for future cognitive impairment. For example, it has been found that Vietnam-era veterans exposed to Agent Orange are nearly twice as likely as those without exposure to receive a dementia diagnosis. This and other data underscore the need for the U.S. government to do more for Veterans with respect to cognitive care. 

Participation in the program is limited to the first 500 veterans who apply and are diagnosed with a cognitive disorder associated with aging such as Alzheimer’s, Parkinson’s, or others. The duration of the program would be five years.

Solicitation of private partners would focus on their ability to support both patients and caregivers at home and through home care agencies. Consideration would be given to partners with experience working with cognitively impaired populations and are capable of providing a level of care that enables Veterans to age at home, if available and appropriate. The Secretary of Veterans Affairs will provide a list of eligible partners based on their application for participation in the program.

An evaluation of the program will report to the VA Secretary and be distributed to relevant committees in Congress.

Bill text can be found HERE

This article originally appeared here: https://harshbarger.house.gov/media/press-releases/harshbarger-introduces-innovative-cognitive-care-veterans-act

Senate Appropriations Committee Chair Patrick Leahy (D-Vt.) released all 12 draft FY 2023 Senate appropriations bills this morning, including text of the draft MilCon-VA spending bill and the accompanying explanatory statement and bill summary.

The bill provides a total of $916 million (+$24 million over FY 2022, +3.85%) for the VA Medical and Prosthetic Research program in FY 2023. This is in alignment with the FY 2023 president’s budget request and falls below the House-passed $926 million investment.

As a reminder, the Senate draft bills were crafted by the chairs of the 12 subcommittees as the Senate has yet to agree to topline funding for the FY 2023 budget. In his press statement, Leahy noted, “It is my goal to finish our work before the end of the 117th Congress to avoid these consequences.  I look forward to continuing to work with my dear friend, Vice Chairman Shelby, and I encourage good faith, bipartisan negotiations on toplines to resume with the urgency that this moment requires.”

Leahy added, “Enacting full year bills as soon as possible is imperative.  A long-term continuing resolution, which continues prior fiscal year funding levels, during the record inflationary pressures the country is currently experiencing would result in devastating cuts to programs that the American people rely on and for our national security.” 

Senate Appropriations Committee Ranking Member Richard Shelby (R-Ala.) issued a press statement in response to the release of the draft FY 2023 bills. “If we are going to get full year bills during this Congress, Democrats must commit to a bipartisan framework that abandons poison pills, preserves legacy riders, and demonstrates a serious commitment to our military. Wasteful, off-budget spending that fuels inflation will be a non-starter.  Today’s effort shows we have a long way to go.  Democrats need to get serious or, regrettably, I believe we will end up with a long-term CR,” Shelby said.

No additional action in the House or Senate on the FY 2023 spending bills are expected before the chambers recess for the month of August.

The US Senate Committee on Health, Education, Labor and Pensions (HELP) held a hearing on December 14 to nominate Dr. Robert Califf as the next FDA Commissioner. Several Senate HELP Committee Republicans following Dr. Califf’s hearing said they would support returning him to the commissioner position—a position he previously held towards the end of the Obama administration. Their support will likely push Califf through a committee vote and, later, a full Senate vote on the nomination. However, it would be fair to note members on both sides of the aisle publicly expressed concerns regarding Dr. Califf’s previous history as FDA Commissioner and with his health and policy work with Google’s parent company, Alphabet.

A confirmation vote in January would give the FDA a permanent leader for the first time during the Biden administration and perhaps more importantly, during a time when the agency faces several important decisions. Six former FDA commissioners have endorsed Califf's candidacy in a letter to the committee, saying he was committed to public service, advancing science and clinical evidence.

NAVREF and Dr. Califf crossed paths in 2020 during the NAVREF Annual Conference which was conducted virtually due to the COVID-19 pandemic. During his presentation entitled Evidence Generation - Learning from the Pandemic, he acknowledged his supportive position of VA Research and recognized NAVREF for working closely with VA ORD to advance veterans health research.

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NAVREF is still working with veterans affairs committee staffers to pass key provisions contained in the VIPER Act.  We are cautiously optimistic the provisions will be included in an end of year legislative package focused on veteran issues that will likely be pushed to January. 

The VIPER Act was introduced on October 25 and aims to improve the VA Medical and Prosthetic Research program by providing additional authority and resources for VA research. NAVREF along with the FOVA executive committee has been working closely with lawmakers to  bring key language to fruition.

The bill also includes provisions to:

· Expand the VA’s hiring authority for certain classes of research occupations, including data scientists and statisticians.

· Create a career development award grant program for researchers at smaller universities.

· Mandate a Government Accountability Office study on the retention of VA clinician-scientists and the productivity of their research

 

President’s FY2022 Budget Request – On May 28^th the White House released the FY2022 Budget Request.  The Request includes $882 million for VA Research, an increase of 10.9% from the FY2021 enacted level.  See pages 24-26 for more details:    https://www.va.gov/budget/docs/summary/fy2022VAbudgetInBrief.pdf 

FOVA Testimony  - On May 27^th, the House Veterans Affairs Committee held a hearing on VA infrastructure. The FOVA Executive Committee (of which NAVREF is a member) submitted the attached written testimony.

Legislative Update – the House FY22 MilCon-VA bill was posted on June 24th and proposed $902M for VA research per the request advocated by the FOVA coalition!  This level of funding is $20 million above the Administration’s request.  NAVREF, as part of The Friends of VA Medical Care and Health Research (FOVA) executive committee, is endorsing $902 million for VA research by submitting a Statement for Record to the Senate Appropriations Subcommittee on Military Construction, Veterans Affairs, and Related Agencies in advance of their upcoming hearing.

The Friends of VA Medical Care and Health Research Executive Committee submitted a letter to congressional leaders encouraging additional investment in VA research facilities and IT infrastructure.  The letter is posted here: http://www.friendsofva.org/resources/2021/05.20.21Letter.pdf. 

The House Veterans Affairs Committee will hold a hearing on VA infrastructure this week

b.      The National Science Foundation for the Future Act (H.R.2225) was marked up and reported out of the House Science Research and Technology Subcommittee by a unanimous voice vote. 

c.       The Schumer/Young Endless Frontier Act was marked up last week by the Senate Commerce Committee.  On Monday, Senators voted to invoke cloture, allowing the measure to move to a floor debate and likely a final vote later this month.

a.            Public Service Announcement.  On April 22, 2021, Senate Veterans’ Affairs Committee Chairman Jon Tester (D-Mont.) and Ranking Member Jerry Moran (R-Kan.) launched a bipartisan public service announcement (PSA) encouraging veterans and their families to get vaccinated. Tester and Moran teamed up with committee members and Veterans Service Organizations — Blinded Veterans Association (BVA), Disabled American Veterans (DAV), The American Legion, Nurses Organization of Veterans Affairs (NOVA), Iraq Afghanistan Veterans Association (IAVA), Military Veterans Advocacy, Vietnam Veterans of America (VVA), as well as Veterans and Military Families for Progress (VMFP) — to highlight the safety and efficacy of the COVID-19 vaccine in a bipartisan effort to increase vaccine confidence among veterans—especially those in rural areas—and help communities recover from the pandemic as quickly as possible.  Click here to watch the Senators’ PSA.

b.            Foreign Influence.  The Senate Health, Education, Labor and Pensions (SHELP) Committee met April 22 to discuss how to protect US biomedical research from “undue foreign influence.”  Policymakers have long been concerned that other countries, particularly China, are stealing intellectual property resulting from biomedical research conducted in the United States. They point to the relatively large number of foreign graduate students involved in academic research programs. Over the past year, there have been charges of hacking attempts from North Korea to gain access to information concerning the COVID-19 vaccines.

c.             Veterans’ toxic exposures.  So far, several pieces of legislation have been introduced to expand coverage of veterans’ health conditions that appear to have been caused by toxic exposures. In a Congress with deep, deep political divides, this appears to be the single most bipartisan issue on both sides of the Hill.

d.            Endless Frontier Act (EFA) Update: Another important development in the R&D arena is the reintroduction (with bipartisan support) of the Schumer/Young Endless Frontier Act. The legislation would add a Technology and Innovation Directorate to NSF and authorize $100 billion for the directorate over five years. The bill would also authorize $10 billion for regional technology hubs. The new bill reflects the recommendations of key science & technology leaders.