Report

Meeting at Building 9, VAMC Campus

• Call to order – 09:30, Invocation – Pledge of Allegiance
• Greetings: Recognition of visitors and guests
• Announcements – Jerry Kyser, Chair; Mike Rivard, Vice Chair
• Introducing Joe Schmidt with the Department of Veteran Affairs in the Office of Finances.
• Introducing Jeff Johnson, VP of Community Relations Air Force Initiation Chapters
• Introducing Andrew Peterson with the American Federation of Government Employees at the Minneapolis VA and the National Cemetery at Ft. Snelling. He is also the acting chair of the AFG National Law Enforcement Committee.
• Introducing Greg Peterson with MN CVSOs.
• Introducing Chuck Jones with the Military Order of the Purple Heart.
• Introducing Third District Representative Dean Phillips

Representative Dean Phillips

I am a gold star son. Lost my dad in the Vietnam War when I was 6 months old. He went to the U of M on an ROTC scholarship. He was a captain in the army and was killed in July, 1969. I was adopted when I was 3 years old into a remarkable family. I revere the service and sacrifice of veterans. I am part of a group of 92 freshmen in Congress; many of them are veterans. I won’t stand for the national struggle for resources to take care of veterans when they come home. I’ve convened a veteran’s council in the third district to share what is working and what is not. I am member of problem-solvers caucus in Congress. Our enemies in the world are plotting to divide our country, I want to try to repair that. I am on your team no matter your political point of view.

1. Federal Congressional Representatives and Senators

Senator Amy Klobuchar- Kurt Johnson reporting

• We have been working with a specific veteran with over 32 years of service who had a complicated retirement due to a combination of active duty and Reserve service. We have helped him receive his full pension and back pay. We hope to work further on the issue and identify other veterans who might not be receiving their full pension or back pay.
• Johnson and several others will be conducting a staff tour later in November. They will be in Jackson, Arden, and Freeborn County on November 19th and will be joined by Ben Johnson from the MN Department of Veteran Affairs and several others. They will be in Olmsted and Winona County on November 20th. A press release will be forthcoming.
• We are tracking the Veterans Court Treatment Act, which was recently introduced into the Senate. Klobuchar is not currently on the bill, but that is in the works.

Senator Tina Smith – Alex Schueller

Not present.

1st District Representative – Jim Hagedorn – Joe Steck reporting

• We are getting ready to host our ninth town hall meeting in Austin.
• There was recently a Stand Down in Mankato.
• Hagedorn has been visiting a number of VA facilities to work on the Mayo issue, which has been a big problem in southern MN.
• Hagedorn cosponsored HR 3305, the Puppies Assisting Wounded Servicemen as part of the Veterans Therapy Act.

2nd District Representative – Angie Craig – Mike Siebenaler

Not present.

3rd District Representative – Dean Phillips

• November 7th will be dedicated to touring local veterans facilities.

Q. There is a bill under consideration where veterans who deployed prior to 2008 will not have that period considered to reduce their retirement.
A. We will look into it.

4th District Representative – Betty McCollum – Connie Haddeland

Not present.

5th District Representative – Ilhan Omar – Akolade Gbadamosi reporting

• We hope to attend UVLC meetings on a regular basis.
• Omar was happy to vote “yes” on the Blue Water Navy Act and the Veteran Treatment Courts Act.
• We recently held a roundtable on veteran issues, and specifically on veteran homelessness. Omar is currently working on the Homes For All Bill, which would be an initiative for affordable housing.
• Akolade Gbadamosi can be reached at (akolade.gbadamosi@mail.house.gov) or (202) 225-4755.

6th District Representation – Tom Emmer – Alejandra Henriquez

Not present.

7th District Representative – Collin Peterson – Meg Louwagie

Not present.

8th District Representative – Pete Stauber – Margaret Cavanaugh reporting

• We have ended our open application period for service academy nominations. We currently have thirteen applications, which is average for the 8th district. The panel will meet on November 23rd to interview the applicants.

Mayo Clinic – Christina Gerdes and Nicki Valender reporting

• Previously, when the VA Choice Act was passed, Mayo looked at the requirements of the program and given how Mayo’s systems and processes were set up, it was determined Mayo could not actively participate in the program. However, under the Choice Act, there was an opportunity for the VA to issue individual authorizations to allow veterans to receive care. Under those, Mayo has been able to serve thousands of veterans.
• With the Mission Act, Mayo has been taking a thorough look at the new specifications of the Mission Act and how they would align with Mayo’s systems and procedures. Many of the concerns Mayo had with the Choice Act have been addressed, there are still some barriers prohibiting Mayo from actively participating. Mayo is conducting ongoing conversations with VA leadership.
• In the meantime, there have been some initial successes with dialysis and hospice services utilizing the Veterans Care Agreement.
• When Mayo last spoke with the UVLC, they were in conversations with TriWest and Optum, along with VHA leadership. In the meantime, the most vulnerable veteran patients – those on dialysis or hospice care – Mayo went ahead and signed an enterprise-wide agreement for neurology services, dialysis, and hospice throughout the entire enterprise. All Mayo systems will accept VA patients who need that care. Mayo was also able to negotiate a unique agreement with TriWest and the VHA for patients who are already receiving care at Mayo so that care could be continued without transitioning patients to other facilities. The conversation around unique to Mayo patients is ongoing. Mayo has stated they will accept new patients that are veterans under their VA benefits if the VA refers them and if in fact their care is uniquely needed at Mayo.
• There are some difficulties with accommodating some of the Mission Act requirements with the destination medical practice in Rochester, MN, Phoenix, AZ, and Jacksonville, FL.
• In the future, Mayo hopes to move toward full participation with the Mission Act. However, Mayo has a limited capacity to take on additional patients. In conversations with the VHS, Mayo has suggested taking on patients who need care from Mayo in any of the three destination medical centers. There would be a full participation agreement throughout the health services system in Minnesota and Wisconsin. All veterans who qualified for Community Care would be welcome.

Q. Can you tell us what might be differential factor for the positive/collaborative discussion that’s happening? What do you see as the change that has allowed this to be a “yes” conversation?
A. The Mission Act has a clause in it called the Innovation Clause that allows the VHA to create an innovation project with a specified provider to do things differently. One of the asks for the Mayo’s destination medical practices is that once the request has been filtered and determined to be unique to Mayo Clinic, we do not want to come back and do an authorization for every treatment. We would like the VA to agree for the Mayo to do their care and have everything be approved. This is how Mayo operates with other clients; we do not agree to prior authorizations with commercial partners. This is not an easy ask for the VHA and is probably the biggest ask we are currently negotiating.

Q. In American medicine across the country, there’s approximately 20-25% waste. One issue is fee for service. How do you resolve that tension between the larger healthcare system versus what the VA and Mayo does?
A. It’s a complicated issue and I don’t have an easy answer. Mayo has entered into several agreements to test the waters with results based care to see how we perform, and how we learn to perform in those. For our destination medical practices, one factor that reduces this is the fact that physicians are salaried. We also have generous donors. We hope to drive cost down by appropriate utilization of resources. There has also been a push toward value-based care in the larger medical community.

Q. CVSOs have noticed a big issue with Mayo not allowing payment for emergent care.
A. This is a miscommunication and we have just finished a best practices document to send out on this issue. We do have a patient centered concern about this. Veterans Community Care will not pay for an emergency room unless it is fully in the network and contracted with TriWest. There is a funding stream that could potentially cover the cost if the care was service connected or pending on the amount of disability that veteran has been assigned. We have instructed the Mayo to take their VA information as primary first. If the VA declines it, then pick up any other coverage the patient may have. That way, if the VA denies it, we can automatically bill it through to whatever coverage the patient has. This means the patient has the least amount of out of pocket cost. We were distressed to learn the VA did not have a way to fund emergency care in this way. We will never turn anyone away from the emergency department.

Q. Roughly 5,000 veterans are enrolled in the VA unique care in the Rochester area. I truly hope you can figure something out because this has such a huge and immediate impact on veterans.
A. We agree.

Q. I would suggest having a veterans service officer involved in the process, especially for veteran specific issues.
A. This is part of the innovation project we have asked for. Tomah VA in Wisconsin has offered to place an individual from the VA on our campus to coordinate the authorization process. We also want to help patients get care in their own communities.

Q. In Minnesota, Mayo has developed a network of hospitals that provide care and bring primary care to veterans through the Veterans Choice Act. As of September 30th, care for those veterans was cut off unless they are on dialysis or in hospice with no coordination. Doesn’t Mayo have a responsibility to help with the transition?
A. Just to clarify, there were 8,000 unique veteran patients throughout our entire organization last year. We did work closely with the VA Care Coordinators to try and get that care transitioned to other places. The reason we needed to transition to other places was because there was not a system any longer for the VA to authorize or pay for services. The Mission Act stated it had to be through a contract with TBA. There was no room for unique situations or continuation of care. Now that we have had time to work through that with the VHA and TriCare, we have an interim process so that previous Mayo patients who need continued care can be reappointed. It can be a clumsy process, but we are working to improve it.

2. Federal Agencies

VISN 23 – Ron Woolery and Jason Peti reporting

• VISN 23 was fortunate in October to get three visits from Rob Wilkie. He visited the Fargo, Black Hills, and Des Moines facilities.
• On November 4th, St. Cloud welcomed a new director, Dr. Brent DeLand. Fargo also welcomed a new director, Dr. Breton Weintraub, whose oath of office was personally administered by Rob Wilkie.
• We are actively working to fill the Sioux Falls vacancy. There is currently an interim director.
• St. Cloud is performing well in all of the sales categories. Mental health continuity and care, mental health experience of care, primary care access, specialty care access, and primary care coordination, and specialty care coordination metrics were all in the first quintile.
• Minneapolis was in the first quintile for access to mental health, in second quintile for patient experience in both primary and specialty care, and in the first quintile for specialty and primary care coordination.
• The VA’s Survey of Healthcare Experience of Patients (SHEP) is a great feedback tool, and we encourage everyone to fill it out. Minneapolis scored above the national average in all categories, including psychiatry, medical, and surgical. Approximately 20,000 veterans were surveyed nationally for medicine, 3,000 for surgery, and 2,000 for psychiatry. We scored above the national average in communication with nurses, communication with doctors, communication about medications, responsiveness of hospital staff, providing patients with discharge information, communication about pain, and cleanliness of the hospital. We scored approximately the national average for quietness of the hospital. Overall, the hospital was ranked above the national average. Willingness to recommend the hospital was also above the national average.
• The national average was 84.5%. Minneapolis scored 92% across the board.
• In terms of urgent care access, Minneapolis and St. Cloud were above the national average of 46.8%. They were also above the national average for routine care checkups, helpful response using secure messaging, helpful response by phone as soon it was needed, providers explaining things clearly, provider listened carefully, provider showed respect (above the average in St. Cloud, right at the average of 80.5% in Minneapolis), and provider gave easy to understand information about healthcare questions.
• On the question of whether the provider spent enough time with the patient, the national average is 72.2%. Minneapolis scored 75% and St. Cloud scored 87%.

Q. The one question that bothered me was “do I feel like a valued customer?” I am not a customer, I am a veteran patient.
A. The word “customer” is used because it is a satisfaction survey.

Q. Are those scores posted anywhere?
A. They are posted nationally.

Q. What were they key areas that need improvement and what are your plans to address them?
A. One for Minneapolis was length of stay and whether or not the patient meets the criteria to stay longer. In the VA, we don’t discharge patients just because they meet the criteria. There are a lot of factors that go into that. We generally refer to the home care program, or encourage coordination between primary and emergency care for appropriate follow-up. Though we are looking for ways to improve this, it isn’t necessarily a bad thing.

VBA Regional Office – Kim Graves – Pete Philippi reporting

• Introducing Charles Martin, an assistant veteran services manager in St. Paul.
• Our fiscal year ended on October 1st. For VA purposes were are now on fiscal year 2020. A new assistant director, Ron Sackett, was recently brought on to the regional office. The acting assistant director is Jessica Gillette. We are anxious to fill this position.
• There were some staffing changes this fall in the veterans service center. There was a staffing increase of approximately 20 personnel. Currently the veterans service center has 414 staff members, the pension management center has 347 people, the support services division has 44 staff members, and the vocational rehab and counseling division has 14, for a total of 830 personnel in the regional office.
• In the past, the director was also responsible for the homeowner guarantee division. As of October, this is no longer the case. That division will report directly to the central office.
• Last year, compensation and service related death benefits were paid out in the amount of $76.71 billion to 5.67 million veterans. Pension paid out $5.2 billion to 463,000 beneficiaries. We paid $1.4 billion in vocational rehab and counseling. Insurance covered 1.2 trillion dollars in coverage to six million beneficiaries.
• Last year, 4,743,108 received 76.7 million in compensation benefits. Of that, 99,665 Minnesota veterans received $93.4 million in disability compensation.
• We will start processing Blue Water Navy Act claims in January 2020.
• The Appeals Modernization Act was started in February 2019. We plan on addressing all of the historical appeals by July 2020.

Q. What percentage of veterans in MN do you think we are missing, or are unaware of they should be receiving compensation?
A. I don’t have that specific data right now, but I would guess it is a small percentage.

Mpls VA HCS – Director Patrick J. Kelly – Jemima Faiella reporting

• There will be a town hall on December 16th from 5:00 to 7:00 PM in the Minneapolis VA auditorium. All are welcome.
• The public relations director has been hired and will likely start within the next two eeks.

St. Cloud VA HCS – Tyler Bieniek – Dave Hinchen reporting

• The new director, Dr. Brent Thelen, recently started work.
• There will be a town hall meeting in Alexandria on November 12th.
• There will be a job fair on November 14th.
• The Veterans Day ceremony will be held on November 11th at 1:30 PM in the auditorium.

Ft. Snelling Cemetery – John Knapp reporting

• Introducing the new executive director, Kimberly Wright.
• The national cemetery in Fargo is now open.
• The North Woods National Cemetery in Rhinelander, Wisconsin will not be open until the spring. Construction is ongoing.
• Wreathes Across America has started placing wreathes. The ceremony will be held on December 14th.
• The National Cemetery Administration participated in the American Customer Satisfaction Index Survey and scored a rating of 97, the highest in the history of the ACSI index, including among government and business entities.
• Every headstone in the cemetery is being GPS tagged and photographed for future use.
• Renovations of several historic buildings are underway.
• Approximately 5,000 burials were conducted last year. We remain the 4th busiest cemetery in the national system.

3. State Agencies and MN Veteran Assistance Organizations

MN Dept. of Veteran Affairs – Larry Herke – Ben Johnson reporting

• It will be the Gopher’s and Military Appreciation Day on November 9th. We will be sponsoring it as an agency.
• The state Veteran’s Day event will be on November 11th, with a complimentary breakfast from 8:30 to 9:30 AM at the Inver Grove Heights Community Center. The ceremony will be held from 10:00 to 11:00 AM. Governor Walz will be the keynote speaker.
• There will be a Pearl Harbor event on December 7th at the Veteran Services building at 9:30 AM. More information will be forthcoming.
• The final inspection for the bridge is forthcoming in the next month. We expect to open at the end of 2019 or the beginning of 2020, and are planning a ribbon cutting ceremony for when the weather is better.

MN Military Affairs – Jon Jensen – Brian Winter – Annette Kuyper reporting

• We are closely monitoring the National Defense Authorization process.
• The 34th Infantry Division Red Bulls recently had a change of command. Brigadier General Mike Whitman is now the commanding general and the CSM is Steven Whitehead.
• The 34th Expeditionary Combat Aviation Brigade deployed in October. They are now at Ft. Hood preparing to move equipment over to the Army Central Command.
• The 133rd Airlift Wing has approximately 200 members deploying to the Air Force Central Command.
• We will be hosting Congressman Philips over at the 133rd on November 6th for an orientation of the Air Wing and its mission.
• On November 6th, there will be a groundbreaking at the 148th Fighter Wing in Duluth for the second Starbase facility in MN, a STEM program funded through the DOD that reaches out to communities that are typically underserved with respect to STEM exposure and educational experiences. It will be open to elementary aged students from 4th to 6th grade throughout the entire school year.
• On November 6th, we will be proclaiming Anderson Windows as a Yellow Ribbon Company. Three more Yellow Ribbon Company proclamations are forthcoming in the next few weeks. Boston Scientific will be held on the 12th at their Arden Hills facility, Securion’s ceremony will be held on November 21st in downtown St. Paul, and Metronic on December 3rd.

MN Assistance Council for Veterans (MACV) – Neal Loidolt – Jon Lovald reporting

• The MACV offices in the metro area have moved back to St. Paul on University. The ribbon cutting ceremony will be held on November 7th at 2:00 PM. The mayor will be in attendance.
• The Minneapolis legal clinic will be held on November 12th at the VA.
• We are working again with WCCO on Home for the Holidays and will be featured on telethons on December 3rd and 18th at 6:00 AM, 9:00 AM, 12:00 PM, 5:00 PM, 6:00 PM, and 10:00 PM.
• We will be hosting another holiday meal in conjunction with the MN Twins on December 12th. We are working with the DAV to expand its reach this year and bus in participants from outside the Twin Cities area. More information is available on the website
  (www.macvso.org).
• For the holiday Stand Down event, we intend to bring employers who are prepared to make job offers that day and to have a more direct impact on the people who attend. Landlords who can link veterans to housing will also be in attendance.
• MACV is on board for a larger Stand Down event that will be held next summer at Target Field around July or August. More information will be forthcoming.

MN DEED Veteran Employment Program – Raymond Douha

Not present.

Military Action Group (MAG) – Jerry Kyser reporting

• The next MAG meeting will be held on January 13th at 10:00 AM.

Disabled American Veterans –Trent Dilks

Not present.

MN CVSO – Greg Peterson reporting

• There are ongoing issues with the Mission Act that need to be addressed.

Vets for Peace – David Cooley reporting

• We conducted informational picketing at the bridge.
• HR 4890, the Veterans Deportation Prevention and Reformat Act, is extremely important to us. Vets for Peace has a chapter in Mexico for veterans who have been deported. We as veterans should not be allowing other veterans to be deported. We are requesting that the congressional staff report back in December about what actions they are taking on this issue.
• HR 3495 and S1906, the Improved Wellbeing Veterans Act, is meant to cut down on veteran suicides. It will not be effective and we are asking congressional representatives to take another look at this. All it will is help outside contractors make money off of the VA, and will outsource VA healthcare. We are requesting that the congressional staff report back in December about what actions they are taking on this issue.

MN Humanities Center – Blake Rondeau

Not present.

Paralyzed Veterans of America – Todd Kemery

Not present.

Project Got Your Back / MNME – Allison Alstrin reporting

• We are currently working on the Minnesota Military and Veteran Exchange, which has become a statewide project on ensuring all groups that want to work to honor and support veterans, their families, and caregivers can come together for facilitation opportunities. From that, we are working on building a 9 regional structure. We are working closely with Duluth, Rochester, and St. Cloud, in addition to the Twin Cities.
• The next statewide meeting will be in December, bringing together the leaders of groups that work statewide. The congressional offices will be included in those conversations starting in December. Invites will be issued soon.
• The Twin Cities Military and Veteran Exchange would be for the regional structure. The last quarterly meeting was held in September, and was sponsored by Target. Over 120 people were in attendance and 89 participants signed up for taskforce groups. The next quarterly meeting will be held on December 5th. Best Buy will be hosting. Location TBD. It will go from 11:30 AM to 1:30 PM.
• The Twin Cities Business Magazine did not host Veterans in the Workplace this year because they could not find an organization to host them. However, the editor did an article on MNME’s work that will be released November 11th.
• The Veterans Experience Action Council (VEAC) event is an expansion of the current Stand Downs, with the goal of modeling the federal veteran experience office’s call to action to hold larger scale events where the community supports bringing organizations together to support veterans. It is community driven. We have met with VBA and VBHA, and received their blessing to move to the expanded two-day event. CVSOs have also committed to be on board. We are still galvanizing the leadership around this issue. We will be working with the DVA, WFWs, and the American Legions to arrange busing. It will be held at Target Field in 2020. Congressman Philips has been in conversations with us for over six months and we hope to bring in more congressional offices.
• The next meeting will be on December 3rd from 2:00 to 4:00 PM on the 5th floor of the Veterans Services building. Please attend if you are interested in contributing.

MN Military Museum – Randal Dietrich reporting

• The Vietnam War round table series continues at Concordia University. The next will be held on November 18th at 7:00 PM. It is free to attend. More information is available at (mnvietnam.org).
• We will be launching a website to gather stories from civilians and service members about the day of 9/11 in the upcoming year. We will be conducting on camera interviews with key people with stories on 9/11 and the years that followed on December 17th and 18th at the Veterans Service Building.

MN Historical Society – Chris Belland reporting

• November 15th is the final date for sending in public input concerning the greater story of the Ft. Snelling site.
• Both the MN Historical Society and Historic Ft. Snelling partnered with the MN Air Guard Museum to assist and support their 100th anniversary that will come up in 2021.
  

  4. The next UVLC meeting will be held on December 4th.

  5. UVLC Business Meeting

  Business Meeting

  • $100 was donated to Bob Connor’s funeral. $50 went to the DAV and $50 went to the Purple Heart Association.
  • As of November 1st, the balance is $2,263.17.
  • The balance as of October 1st was $2,503.17. The transcription expense was $150, $100 in memory of Bob Connor. Total expenses: $250. The balance was approved.
  • Three organizations – the Women Veterans Initiative, the National Guard Enlisted Association, and the Vietnam Veterans of America – are late for dues. If they have not paid by the end of the year, they will be removed from the UVLC. The motion was approved.
  • A letter will be sent out in late January concerning dues for next year.
  • Jerry Kyser will be running for the position of Chairman. It is unclear whether Todd Kemery will continue as the second Vice President.
  • The legislative session starts on February 11th. Mike Rivard will work with Trent Dilks to build the agenda.
  • Veterans Day on the Hill needs to be decided, preferably on a date when the weather will not be an issue.
  • Mike Rivard suggested hosting an event earlier in the legislative session, in addition to one later in the session.
  • Feedback has indicated the UVLC is focused on state level issues. This should be a concern moving forward.
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