Hello execution working very good Well, thank you all for coming I really really appreciate it issue area near Dear to draw I think all of our arts and critical for a lot of of our country and sometimes fake early and have an opportunity through the system to get the care hopefully in a best way easiest way was for the way that they can there's been a lot of work Washington you see with regard to veterans has been as I've talked to you all and other forms actually freedom by partisanship moisture is how to be heard faster and you guys a feedback will get today will help us but as a result of a lot of some good things some very bad things have happened throughout the system since my candidate United States Congress. There's an interest in make assistant little more seamless and the war responsibility as I think stepped up in in that regard the big way and it's all right Snack and there's some great stuff in there. Some great concern about what might be in there. I get that hopefully we can talk about that amongst ourselves I'm frustrated in your congressional representative of the fifth Congressional District We're in the Center of it basically right here in Salem, Oregon includes five scout in Polk County Lincoln in counties. Also we have with us today a couple of experts we'll be doing most of the talking frankly Good speed director the Portland Medical Health Care system at Doctor Passionately with Dry West. there's a lot of help and support working with the health care system and we have a couple of people helping out director Tiffany Anderson, acting director, community care and Rachel store belly the assistant manager community care so they they can ask your questions now but can't so A few remarks if I may I think it's really important that we get going get this panel or had interest you. You guys know what's gonna work is both of the directors and their basic knees will talk a little bit about what they're doing when they're trying to fulfill and then most are gonna have questions that's basically you know there's index cards so hopefully you've got or can get you if you haven't already, my team will hand those out when your regular questions now hold your card up at any point in time my team will circulate grab the cards and the answer Alright, you're gonna go ahead of the curve Excellent excellent I talked a little bit about what my view of the mission Act so far is and you guys can correct me and hopefully will build on the discussion here today I will go into details as talked speed and his team will go into that but I the mission act basically is follow up on what we called the Choice Act which was a follow up on some problems of recurring in the veterans One of the questions I've been hearing certain recent advances Walker. Why guys trying to broadcast you know most most people really like to be when you get in the doors there the answer is we're not trying to privatize a okay. That's no one in Congress. I don't know any member of Congress both sides of the aisle Any part of the country that's interested prioritizing the Veterans Health Care program. I just it's just not not real Get no support from any member of the United States Congress. I wanna say that there may be some things going on that could be done a little better that concern you and that's again why we're having the form here today I often hear that people really love the service to get into the but getting into the problem or challenge you get points of time Salem Seahawk his face certain challenges, big challenges at recruiting and hiring staff and I'm talking about that has been Notice this is top priority for at least this congressman. I think folks in this area is I think up to the mission to help take care of that the nice thing about the mission Act for my standpoint. Speaking specifically to the sale I'm Seahawk is the goal is to provide more providers in the system and actually encourage recruitment and retention has been a problem we got a lot of good pieces of this built-in scholarships loan repayment programs that hopefully will centralize young dogs the for go many private practice for their true love which make a straight talking these doctors and other professionals. They wanna serve serve the veteran community but sometimes can hardly afford to do so Mission act was not thrown together. This is not a passive things included to us from about three years of work some good stuff so worsens learn through the choice act and trying to make things better for you guys. The main thing is to make sure you get health care when you need it Reversion situation you're not waiting for space to open up in Portland or Seattle at the end of the day the falls here is the streamline, the different community care programs make it a little more clear better care put some certainty into how you go about getting it I think one of the biggest pieces that bring their customer service portion of communicate back to the and it is really important that whatever care you get the communities understood and translate it to the system so that it seem less There's a continuity of care of left hand knows what the right hand Make sure you get the best possible care from your health care providers the eligibility rules very confusing coming out of the choice act. You know it was a Crow flies standard into recite actually growth to the and all sorts of things and Congress that loud and clear the assure that player so hopefully it's a more responsible way to respond to your answer community cares office all week in Congress or the Washington DC. Think by applying some A little more flexible representing the different geographies We have your Oregon frankly around the around the country Other piece. It has been a top of priorities in dealing with the urgent care benefit for too long veterans have been missing the ability to get emergency care and non emergency setting and for non emergency issues forcing them into the expensive R and that's not what we're wanting to do. So hopefully this new system will help with that make things a little bit It's actually a big issue here in in the sale urgent care facility right here. Hopefully some of our participants may speak to that today. We don't have a question on that the other thing is supposed to the mission exposed to increase and modernize or I could be you know I was on the first car ventilation SE. So actually go to electronic health records to make sure that there is less human error and transposing cracker is directly to follow you wherever you want in this country Frankly, maybe getting beyond us and very very aware they need to modernize their original electronic system in this school feel rights of the assets of some of the opportunity to actually do so back to the recruitment piece. this is a big deal as I said our refugee who's huge implications right here on sale trying to centralize these folks. We have scholarships but we're expanding that actually in debt reduction program Expanding that used to be like for the debt reduction program, there was a limit of 20 - 5000 is gonna increase the $40000 for a total of $200000 over the life of the program which is a big. It was A hundred and 20 - five before so this way these dogs health nurse practitioners to come out of school with these huge debt burden is not getting any cheaper out there actually say wow you know okay, I can make money and private practice. They're not gonna pay off Actually serve the men and women so that's your be a really trying to respond to some of the concerns we've seen right here in Salem There's also the vet Center program deals with mental health aspect. You know it's a tough world out there and no matter what your warrior or civilian and the goal here is to have a little more seamless delivery of the health care system and organize you know we practice or holistic health care. So I just bought you walk in the door whatever physical ailment you have that they're talking about Your metal you know actually the whole nine years make sure you're getting quality here when you walk in the door The VA is following suit I think in in that regard So I think we're in a good spot frankly at this point in time or a better spot than we were certainly a little while ago and hopefully at this point we can get you approved the system That's why we're doing this forms around the country right now mister be the first up to chat with us a little bit it was former director Sioux Falls have a out in the Midwest for a bunch of years he worked in frankly a different health care settings both with Veterans Department defense, private sector for over 20 - five years most importantly to be Frank with you for my standpoint for credibility and did the served United States Navy active duty 20 - five years. So walk in your shoes little bit if you ever say it's like some some folks don't exactly understand With that in mind saying a few words, right appreciate your team Much to the because I wanted to help my fellow veterans and nothing gives me more pleasure than helping my fellow veterans get the health care benefit that they've earned the mission Act changes almost everything about how we provide care in the community. How we coordinate that care how we pay for it and we got it benefits. The urgent care benefit is a tremendous resource for folks I'm not gonna take a lot of your time The two layers of the Our subject matter experts they help us implement this program in our area They will be able to answer any questions you have about how the Mission Act is going to change how you access care in the community Nobody here has access to your medical records So if you have questions specific to what about my appointment or whatever when is my prescription going to arrive if you could just save those to the end and talk to one of the we'll take a note and we'll have someone get back with you tomorrow but today no He has a way to answer those personal questions at the program level. We should be able to answer all the questions you have Thank you for being here tonight. It's great to see such a good turnout and hopefully we can provide a lot of good information on mission The Tiffany Anderson and I'm the acting director of community Care is important at the bar so you got pretty good based on what the mission is overall and Rachel and I are here we want to be able to give you some more details at are included in the program first of all I really just I wanna stress that what we really wanna do it. The is to help you as a veteran and their family members to make an informed decision as to whether or not you choose care in the community or at the So very important that when you talk to staff at the that was transparent as we can be and explain the full you know the process that you will go through if you choose hair in the community versus at the because there's some of you who have been in the choice program know that I got a little chaotic. It was messy and sometimes it took longer to get your care in the community than it did a 30 - eight. So we want to this a huge change and I'm very excited about it because we can at least sit down and have a good conversation with each of you when you're you know with the schedule or whoever the provider and they can What it means to choose care of the community versus the it is mister kids be able to this is a lot cleaner than the choice program It has its more streamlined. there aren't as many different ranches to the full tree so to speak and there are some good improvements to it and I'm gonna have Rachel go through the specific eligibility criteria that is included in the mission Act and then I'll talk about the urgent care benefits Okay, so for those of you who are familiar with the choice program as I'm sure you all are you're familiar with the eligibility criteria right? If we couldn't get you in for an appointment within 30 days then you are eligible for community care so they have changed those standards now So if we cannot get you into an appointment at the VA for mental health or primary care within 20 days you are eligible for care in the community and as Tiffany mentioned That doesn't necessarily mean that we can get your provider in the community within that time frame but you are instantly eligible for community care baseball mat Now, if you need specialty care, say orthopedics or cardiology appointment If we cannot get you in in Portland within 20 - eight days then you are also eligible for community care. Now, one thing that they have also implemented with the mission Act is the drive time standard. So this has been really really a wonderful addition because we have a lot of veterans that travel distances to get to the Portland. So this is something that's It's a drive time standard so for primary care and mental health we have a standardized tool called the decision support tool and it's automated tool that will put in the address of where the veteran lives and where the services are available at the if that is outside the 30 minute drive time for primary care mental health then you are eligible for care in the community and if it's greater than 60 minutes for specialty care you're eligible for care in the community So those are access standards the next time I wanna talk about is the same as it wasn't a choice program So if you need a service that he doesn't provide mammography is a great example. You need a mammogram. We don't provide that service. You are eligible for care in the community The next one is best medical interest in what I really really like and I would say our versus in community care really like about this one is the continuity of care benefit that we have not had in the past so with the choice Program. It was a little bit more rigid many of you are probably familiar with Salem Hospital So say you have a bad fall and break their leg You go to the hospital for orthopedic care So in the past if we had access to the Portland D then we had to bring you back to the Portland for follow up care Now that was not appealing to our veterans were breaking up their care Our providers weren't comfortable taking over other providers care and our program in the community Frankly didn't like it as well either because they wanted to treat you if they saw you in the right So now there's a continuity of care peace to this best medical interest so you go see your provider, you call your providers. They gave it to the other. I had this happen over the weekend Can I go back to that surgeon or that doctor that treated me that provider your primary care provider can put in a request to community care and the best medical interest for your continuity of care So that's a wonderful addition that I wanted to highlight because it's been a big frustration The past So another one is grandfathered eligibility so for our veterans who are 40 miles under the choice program there's a grandfather eligibility so you will be eligible for community care services through June of 2020 and that was because we didn't want to have any abrupt stop or districted care come June So that's kind of grandfather program to make sure that there's time to transition all the care to the appropriate entity The other two one is still in works its quality care so it's a Cannot provide quality services for you for particular needs that you may have then you're eligible for care in the community Those quality standards are still being worked on. So we're waiting you know further guidance but that's something that's coming and then if there's no full service being your state that doesn't apply here but my Alaska they don't have a full-service being state of Alaska So those veterans are all eligible for care in the community so as you can see From the choice program, it's really expanded the whole veterans And I just wanted to add on the dry side I just wanna make sure that you're aware of the way they kept calculate the drive time in the city which is a district decision support tool as they take a rolling average over the previous 30 days to calculate how you know if you meet the drivetime standard or not So this means that one month you may be qualified if you live right on the boundary of the 30 minute or 60 minute drive, it could mean that you meet the drive time for this month but. Next you may not because whenever construction program process was going on the freeway it improve traffic. So I just has it. That's one big change. I know it's confusing and if you have questions, we will definitely answer but that's something I really wanna make sure everybody's aware and I don't want you to be excited with us. So please, if you have questions, write it on the index card and we will be more than happy to walk through it. Okay the next thing I wanna talk about this urgent care benefit and so this is something that Very excited about and so if you need to be seen by urgent care provider the way you qualify is if you receive services through the VA in the last 20 - four months. Okay and so if you meet that qualification, you can seek care at any urgent care facility that is in network with our third party administrator which happens to be try West and so it's very important that you go to an urgent care facility as in our network Urgent care facility rides for a prescription You can now go to a pharmacy that is in network with Tri West and we did and I know Pat can expand on this but we did sign up with Express scripts so we have about a hundred and 15 pharmacies in our network which is great news so you can walk into one of those pharmacies and get your prescription filled for 14 days so that is wonderful Virgin hair I know there are some challenges out there it has not gonna be getting us not on smooth but is what we really need to hear about is when you go to an urgent care facility and they're not aware of a mission app or that they're treating veterans that you let someone at the bingo so they can get word to Rachel and myself because they were working closely with Tri West We're also calling these centers and making sure they understand what the mission act and including pharmacy so if you have any Like that personally, please see Rachel and myself afterwards so that we can troubleshoot with our partners at Tri West Lots of questions last but not the least this representative management staff here in our region relationships that they saw a little more seamlessly maybe they have in the past market dynamics suggesting some opportunities that might advise that Thanks sir again I am passively the the tried several of the medical centers in the Western part of the United States I am a veteran myself army medical services for officer for 20 - one years and change. we I share this responsibility with doors who's also a Navy veteran retirement Tribe very interested in program works for everybody just by some of the challenges that type of thing but I wanna go ahead and basically just sort of lay out a little bit of background in terms of what Tri West is why we're here at our responsibilities are with respect to support of the VA and the mission Act and then a couple of an individual specific items Go ahead to basically just make all aware of try waste is has been in existence since 1990 - six. we originally designed to go ahead to manage the Tricare program for the Department of Defense and we did that for about 16 years on that contract ended we organized in a response of solicitations from the to manage the patient Center Community Care C three program which was the first generation if you will Go ahead into sort of standardize the community process after we started at a program in January 2014, it was in April of 2014 of the long lines at the Phoenix VA and that type of thing prompted the the choice program to his program was signed in August 2014 and and the S to go ahead and take on that program as well We could have started in November of 2014 Doing instead we work through the choice program and now we're going into the mission Act and supporting the in this regard as well during the time that the mission Act is in place try was will be the manager if you will of the program until such time as the community care network contracts are awarded Community Care Network is the next evolution of the program and we For just even on that contract for this particular part of the country that's just do some kind of that in the near future but during that time and until such time as the new contractor whether it's try West or some other entity Wednesday at contract and starts the C Span program try moving managing of the community care of in the network portion of the community care our network at this point in time and we all respond For the entire United States so we have over A million locations. We have over 900000 providers currently in the network is one of the largest managed care networks in the country and we we think we've done a pretty good job in terms of pulling together quality individuals into the network but we're constantly monitoring that to make sure that that the quality remains is this highest as possible with with the onset of the mission Act ah five years for teaching me wealth manage memories of using ah our network ah subscribe the cnt program ah kids and ah and we are also responsible for setting up and managing your card ah the required what has been the change it's not just matter of walking together we care center and very interested in so we developments because most of them are there requirement in the contract to make sure that the the services that are provided our quality for certain quality and needs some of the of the Requirements there in the in the contract for example urging care Center must be a Medicare participating provider they also must be able to build a certain women if they if they don't meet those criteria then they're eligible for being into the network and so try Western possibility to make sure that all of those requirements are met before they can they can come in and just to give you an example of some of the challenges We had I'll point out the area of the San Luis Valley in Colorado and Bailey in Colorado. There are three large health care providers all of whom offer urgent care type services but they are not Medicare participating or they don't they don't build according to the district, the requirements of the contract and so consequently we had the present time. We have situation in San Luis Valley in Colorado where It is not available even though there are providers in the community that are interested in doing so this is this is an issue that we're working through We've identified this issue and up to the leadership and they're in the process of going ahead and basically wanna find the contract so that we can go ahead and incorporate some of these people but when I look at the timing of bringing the urgent care centers into the network these are some of the issues that we're having to work through and which are impacting you know whether you have one or two or 10 urgent care centers in your area in particular there's just a couple of administrative process issues that I like to go ahead and talk about if in fact you've been referred out into emergent care or excuse me for community care and you had a trial West authorization if you get a bill it's a mistake don't hang on to the bill go ahead and make sure that you come back into our West. Let us know about it We have a Department that's responsible for fixing those within about 40 - eight to 70 - two hours. if as long as we know that that Believer and then you say well okay so now it's gonna impact my credit well as long as you get the information quickly, we can go ahead and we can get it adjusted. It will affect your credit and and you should not be paying it though the what we find is that it now 10 nine out of 10 cases building problems have nothing to do with you everything to do with the provider provider is building correctly for whatever reason so a mistake sometimes they haven't read the instructions whatever we can usually success very pretty quickly and because of the fact that try West used to manage the tri care program and we get a lot of confusion between try try West and then also accessibility now the thing that I wanted to mention just briefly and then we'll take questions is the telephone number for access to the information about the mission action that type of thing We'll be changing you're probably used to using the eight 666068 198 number sometimes it's September probably that telephone number will be turned off because the choice program doesn't exist anymore it will be using the Pvc free number which is a 5572228 three eight so put it put please put that on right here in yourselves on put a contact in there often times thousand rupee eighty-five seconds you to to eight okay That we have we wanna go ahead and and have you make a contact in your cellphone or whatever but with that particular number one of the reasons that we end up having to return referrals offense because we can't get a hold of the veteran we find that because it's an eight 55 number that comes up on caller I d because of the way the telephone system is set up when I have six number of my House I don't answer the phone I'm sure Either you're being referred out and you see an eight 55 number, please ask for phone trying to get hold Number one more time, eight 5572228 three, eight And I think we'll take it so aa thank you next aa make sure my my tapi aa aa ini aa ya That's a great question so what I wanted to touch on is the average amount of urgent care visits that humans attend in a year is too and so because of our veteran population, they did an analysis and determined that three would be the acceptable number and then on four their vehicle pay and there's a couple of reasons behind that one of them is if we have veterans that are currently enrolled in the healthcare system right for to be eligible for the urgent care benefit And you're using it more often than kind of a pinch when you need it there's probably an underlying chronic condition going on that really should be addressed quite primary care provider they don't want the urgent care benefits to turn into an alternative to primary care. It's just kind of when you need it. So that was the reason for the amount of visits per year and it resets every calendar year A lot of questions here is it true that you have to or can go to Lebanon for urgent care So let me know in a community hospital in Pat. You maybe able to correct me if I'm wrong up is one of the in network providers for Tri West So currently there are not I know there's a couple that are listed in Salem but we're still working out some kinks and I've actually spoken to some of you about some of the issues we've encountered in Salem So we're working through that right now. It will be 11 will be the closest one that's fully functioning and if you have any issues with them, please let us know the second question is are there any in Salem right now The answer is we're trying to set Yet four as of the scoring number four facilities and urgent care centers in Salem I've got the list here but I pulled up on my phone so maybe we go ahead. Take another question and then slam about the the grandfather feature a choice and the version here So the grandfather is for those veterans who met the 40 Maya criteria for the choice program. So if you before June six if your address and you live greater than 40 miles from any qualifying facility regardless, if they provide the care you need at that facility or not thank you are consider eligible for the 40 mile program so that means that the time you could call Tribe Fest and just opt in for whatever care you needed So they took that group of veterans and didn't wanna just you know, stop it They created grandfather eligibility criteria so that if you previously all my people still qualify for that and as Rachel mentioned that program will be ending in June 2020 and that by determine if you need other eligibility criteria and then as far as the copay for the urgent care as second part it has a priority group you're in so priority group So if you're a priority groups one through five and the first three visits to the urgent care facility you do not have to pay anything after those three visits is when you pay that $30 copay From six, if the reason you're being seen is related to any combat experience, special authority or exposure then again, you do not eat a copay till after the third visit priority Room seven to eight You have to pay $30 copay regardless of how many times you go Out with a one eligibility system and ants veterans getting health care. What's the vision of mine That one source bringing all the community care together under one roof so this may be a leading to the fact that choice program is very disjointed. We had the choice program. We have our local not care community program and if you're outsourcing the community, you didn't know if you were the choice program or our traditional program and each had a different process so that okay so setting up a one You go in one place and they can everything How to be a big picture that this business Oregon the it's The eligibility program into the state of Oregon A lot get that Thank you for bringing it up Sweet off your care now The cars that are currently in the network West Salem Clinic the water quick hair on a water as well Total health community clinic Northwest human services in North. The health community Clinic is request services in an urgent care Oregon doc in Silverton I would mention that that we try waste is identified 20 -, two additional urgent care clinics in Oregon that that are targeted for us to review with respect to that mentioned the Medicare participation and the billing issues and stuff like that so go ahead and we can add those there are about 90 - 500 or in care clients in the United States as of this morning to our West has about 6000 of them in the network and we're working to go ahead and continue Yes Yeah. Think about the moment We're not we're not finish with the Salem you know recruitment and that's everything but it does it does take some time to go ahead and work through some issues with with some visa facility Care Alright, I've had two tours in Vietnam on a rural area on the post lifting travel to the hospital for most care how can you help us do this part of itself a little bit. We can actually go to the Seahawks over there as you guys know sure we have with clinic of access in Newport Lincoln City and a story up So if you're anywhere close to them, we have primary care access for specialty care services You would need criteria for the mission Act To Portland a lot of people have an established relationship with a provider in Portland and they wanna continue to come to Portland and we certainly can support that but if you're on the Coast is more than an hour especially care, you will be eligible for the mission What if you were in Bandon broke away Emergency emergencies. If you're having a chest pain, you hurt yourself, you should always go to the closest yard but I know you're a veteran and they will They will contact us and let us know that you're there but yeah for for emergency, don't risk your health That's not safe if you are walking around See anything for that initial contact the criteria for paint or emergency room. Have not change with Mission Act and they're they're very dependent on on how quickly to be able to notify injured service connection and that connection Yes These are it's a good questions folks will be a a healthcare system. Honor zoom a health in South Salem and also in Portland great University care instead of the emergency room as their relationship with I don't think we have a contract with Zoom yet but we but Tri West is working with them to get the network I know they're very popular in Portland Market and we are looking at them. We have provided we have provided try West with A lot of facilities that we would like them to reach out and contract with it's just a matter of of getting there Is there a reason? It's so hard to get a hearing testing test scheduled Portland should have hearing Aids covered It's our cover if you're having trouble getting in again if we can get you in within within 30 days for a lot of snow, we can fuck get your provider in the community a lot of a lot of like to use the for their hearing Aids and further issues that's the number one service connection that we have a lot of people like used to be because we we don't have any generic hearing Aids arch capture all Cadillacs and a lot of people Like the top notch service that we use we have a whole United Portland is dedicated to research and hearing loss and we have a lot of really state of the art and cutting edge stuff so you can't get in ask to go to the community if you wanna go to the community but we do have good programs there and the last time I looked it was pretty good What are the expectations for using telehealth and providing the services where we with that So I know I wanna make sure I'm understanding the question but as far as tell help yes, we are offering that especially mental health area dermatology primary care and there I know there are plans to expand that as far as how that fits in with the mission at yes, we can offer you telehealth if we have a passion for that specialty but if you deny if you don't want to help that doesn't mean you will call it my permission Come a little bit about this new mental health providers fall on community care mission at and us every the have a community care coordinator Yes every has to community care for dinner we are very fortunate to have Rachel and Tiffany and I have a team of about a hundred people total working right So lots of good resources and mental health is covered with division three one for ice cream for cataract surgery or who have to be of market if you are if your religion and we care absolutely we will end product you can get and if you have also provided of communication a provide Excuse me the the providers are actually the same providers that we've been using for the choice program and also for C three we we're continuing to add to the network if someone wants to to be a mission act provider if you will they have to be quote unquote certified which basically means they have to meet quality of criteria a certification intake usually Three days 34 days, whatever once they are certified than a contract in process which is which is more involved but but we can put them into the network that quickly and if in fact the Provider has been a provider overtime than their C three kinda drive will continue to be enforced during the mission can you expand on how the mission act no longer requires my permission to build my health insurance and specifically what is a sensitive diagnosis So if you have other health insurance through your work or something like that that vehicle is always been able to fill your insurance what we typically do as we pay the bills in here and then we And that is so that we can continue to provide more services and the it just it is not to be penalizing you anyway but it is if there isn't another pair, we do try to get them to pay The list of sensitive diagnosis, our art ever evolving but typically sometimes mental health diagnosis or some infectious diseases fall into a sensitive diagnosis So as a sensitive diagnosis is much more something that is is for us If we are referring you to the community to see a mental health provider and you have a substance abuse issue we need to let them know so that they know how to treat me just like if you had a drug allergy, we would let them know you know don't give the seller so Diagnoses are things that we we we find something and say you know this isn't something that we want to be talking about in general terms, it's not like your high blood pressure cholesterol It is something that we want to make sure that we protect for you us clinically For me Questions, why is the not fully funded that would be used to your congressman? I thought we had done that but if it's not your mind, I'd like to chat with you afterwards that would be very helpful for me This is one area of the budget that we try to pre fund frankly because as you know Congress is not already got our budget work done on time and when I first talked to Congress, we try to advance take a lot of medical health benefits so that you guys and gals will not get caught up in our own inadequacies United States Congress admission act. Others were trying to build on that. Make sure it despite the controversy Is a very diverse great country You guys are called Middle of at the end of the day but please meet up with me afterwards on any of my staff to tell you that the papers care you need to let me know because We have a benefit you've earned the benefit and we will figure out a way to pay for a good question here. The US it happens with a lot of agencies what's being done to fill all the agencies all the vacancies for providers and he stand a little bit on the sale on C back from that we've been dealing with for years You're hoping this will sure so the mission act does give us a lot more power for using things like student loan repayments to to get providers to move to the area I think sales I like it here but it has been a disc proved to be a very very difficult area recruited we have one by the staff We have two providers starting in August August September But if you are, if you brought the transfer list, they will contact you if you're getting care in the community once we get those providers will bring people back in they will contact you. Bring back in We have two starting in August. We have two more than we think accepted. It will be coming in early in the fall and then how many are you gonna do it I've got two coming this week and we've got four or five Yeah. So six more interviews going and they have authorization to to hire all that Meet criteria we we want to make sure we're hiring good doctors that are providing high-quality care and and want to be at the Department. So we are We are very fortunate that by the end of the calendar year we will be fully staffed there and we will get everyone that wants to be at the sale clinic back I know that there's some people in this market. It's right to request them further care or they have a a primary care provider Some people like to do work but by the end of the calendar year we are very confident just last recruiting on some of the new tools that we have to make positions more attractive It seems to be working and if you have questions going forward here please contact my office We work closely with our wine and his folks cuz this again top priority for us. get this fix for gosh sakes. It's been a long time. I appreciate your attention to issue interesting question. How would it be initiated affect my health care coverage in Grand Ron Don't think it will impact it at all if you are receiving care at the Grand that will continue if the Grand Ron is just getting through one of the EU agreements that we can have with tribal health there there will be no change in how those that over back to the vacancy question our purple proportionally up to 40 - 4000 C for healthcare providers or for providers how we're gonna build I don't have 40018 so you know I I think that there are a lot of efforts going on nationally end within within the States to try to figure out how we're going to have the primary care providers specifically and specialist in mortgage where people are living there are new programs that are being offered at the many of the medical schools a lot of work at nurse practitioners and having them help with the primary care issues and there are things in the mission Act that help us get more people into residency programs so that we can train more doctors and I'm very probably 80 percent of the doctors in this country receives some part of their training to be a hospital because of because of the rich population, we have a veterans and types of care that you're asking for it comment I guess hopefully for all of us up here, thank you for supporting this research and be a funding prevalence in service men and women is a serious and great for the sport that research it before. I'm defense and I age DC frankly helpful before Thank you And over 60 - five and on Medicare supplement. so I go anywhere offer treatment. I have 50 percent disabled supplement possibly $200 a month. I can the pay that $200 per month and I will sign up for the as you see the Not sure I see that company you guys appreciate the spirit with which way health care with large. if you have the best place for folks actually get the energy I think that's the question. I just reaffirm things does the mission Act cover the cost of travel For example, I get surgery just you through the mission Act Will they cover my transportation costs So if your travel eligible currently and you're used to getting your travel paper than yes, there hasn't been a change in the eligibility for the mission Act itself what we're dealing with right now is because we have so many veterans getting care in so many different locations. It's a little bit more difficult to claim travel submit for clap travel and the amount of claims that have been submitted is increasing So we're hoping with a mission act and having better ability to be closer to home. It will be a little bit easier and would have to travel so far but the Bottom line is that the travel eligibility yourself is not changed with mission and I would hope that if you are better than Salem and you need surgery you gotta drive better parking our facility and Most of the servants at Www train at the chance us but let's try to do your surgery right there Don't drive by us to go somewhere else Medicare requires a Co payment for emergency if you have Medicare will be a health assistant that Co payment if you're man this is this is a problem that has been going on for a long time if you show up in the emergency room and you tell them you're a veteran they are not supposed to fill your Medicare until after they talk to the once they have build Medicare in many facilities. Do this because they know that Medicare How to build Medicare if Medicare pays first and you have a Co payment I can't pay your coping if one of those things that that's codified in what I can use the money to Congress gets us to pay for that. I can't pay for copayments or deductibles by another insurance and that is that is challenge I encourage all of you just Sure that you tell them to talk to the person Papers that Once Medicare pays that it falls into that category as deductible or copay and I'm not allowed to pay those Group eight I haven't had a pay Co pay for Elsa providers the Bay $50 per visit for Eye specialty gear will discontinue yes If you you have Co payments based on your service connection that will not change that that part of the benefit was not funded by the do doing a choice of the provider to go to in the community Yes As long as you select someone that network and that's something that our staff will work with you if there's a provider or community that you have a relationship with water that you know that doctor so and so did your brother's hip and you would like him to New York If he's not in the network that we can reach out to try to us that they can help get that provider I guess the last question year great questions and I learn a lot frankly as dental is now care covered under the mission app if you are eligible for dental care at the VA and we can't get you in to the Bank A lot of money but the eligibility criteria has not changed so if you previously were not eligible for dental services because you don't have a service connection that is not it still you're not eligible We have our own network. I think I signed Well, I wanna thank everybody for showing up and the quality of the questions speaks to the quality of the community in my opinion and really appreciate the input and feedback from our panel this year, let's get different around the support Questions feel free. I said they're more than willing to answer that you've help inform the role of the mission Act by the questions you ask and help us refine that going forward so will be quite a scare for access the intention, the Choice Act So again, thank you everybody for coming. have a great day and let's make this work