July 10, 2014

Senator Bernie Sanders Representative Jeff Miller

Chairman, Senate Committee on Veterans Affairs Chairman, House Committee on Veterans Affairs
332 Dirksen Senate Office Building 336 Cannon House Office Building
Washington DC 20510 Washington DC 20515

Senator Richard Burr Representative Michael Michaud
Ranking Member, Senate Committee on Veterans Affairs Ranking Member, House Committee on Veterans Affairs
217 Russell Senate Office Building 1724 Longworth House Office Building
Washington DC 20510 Washington DC 20515

Dear Conference Committee Members,

As your committee meets to finalize VA reform language, CVA believes the final legislation must both
aggressively address VAs systemic problems and shield reforms from VA bureaucratic sabotage. CVA will be
closely watching four key areas of concern during the coming reconciliation process. We strongly urge that any
final bill closely adhere to the following provisions:

Establish clear, independent, and automatic wait time and geographic standards for seeking private care.
The final conference bill must reflect clear standardsno more than 21 days or 60 or less milesto define what
constitutes excessive wait times, or excessive travel, for VA care. If wait time and/or geographic standards are not
met, automatic triggers must be in place for the veteran to quickly seek private care. VA must not be permitted to
set their own standard for excessive waits or travel, nor impose high-level approval to seek reimbursed private
care.

Establish enforceable guarantees of timely reimbursement payments to private VA providers. It currently
takes months, even years, for VA to reimburse private medical providers. By comparison, under Medicare or
Tricare, the government pays within 30 days for most billing claims. In order to ensure private doctors accept VA
patients, there must be rapid reimbursementlest bureaucratic delays undermine choice provisions. Neither the
House nor Senate bill is currently sufficient; the final bill must include enforceable guarantees of prompt and
sufficient payment (at least Medicare rate) from the federal government.

Ensure additional VA spending is discretionary, limited, and paid-for. While solutions to VAs culture
problems are urgent, they should be addressed through real and systemic reformsnot emergency spending.
Likewise, to ensure ongoing congressional oversight and VA accountability, any spending associated with this
reform legislation should be discretionary and highly scrutinized. While the CBO score remains contested, any
final bill should seek to limit spending and ensure spending offsets to prevent adding to the federal budget deficit.

Ensure real accountability is maintained. A core aspect of this reform is the ability for poor VA managers to be
promptly removed for cause. Any effort to further dilute accountability measures must be resisted; and final
language should hew closely to the House accountability language.

Our members remain committed to ensuring Congress delivers real reforms, not watered-down half measures. We
will firmly hold this committee accountable to that clear standard.



Pete Hegseth
Chief Executive Officer