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“Breaking Down Barriers: Getting Veterans ACCESS to Lifesaving Care”

House Veterans Affairs Committee, Health Subcommittee Hearing

March 25, 2025 (recording here)

HEARING INFORMATION

Witnesses & Written Testimony (linked) (Panel One):

• Ms. Missy Jarrott: Mother of Navy Veteran Landon Holcomb

• Mr. Michael Urban, LCSW: Army Veteran and Mental Health Advocate

• Dr. Shankar Yalamanchili: Chief Executive Officer, River Region Psychiatry Associates

Witnesses & Written Testimony (linked) (Panel Two):

• Dr. Maria D. Llorente: Acting Undersecretary for Health Office of Integrated Veterans Care, U.S. Department of Veterans Affairs, Veterans Health Administration

• Dr. Ilse Wiechers: Deputy Director Office of Mental Health, U.S. Department of Veterans Affairs, Veterans Health Administration

Keywords mentioned:

• VA funding, mental health care, community care, residential treatment, staffing, Veterans’ ACCESS Act, bureaucracy, providers, substance use disorder (SUD), oversight

IN THEIR WORDS

OPENING STATEMENTS FROM THE SUBCOMMITTEE

• Chairwoman Mariannette Miller-Meeks opened the hearing by reviewing the vast increase in the VA’s budget since 2001, noting that despite a 479% funding increase, veteran suicide rates have remained largely unchanged. She argued that the VA does not have a resource problem but rather an access and process problem, citing persistent delays, inefficiencies, and arbitrary restrictions that prevent veterans from receiving timely mental health care. She supported the Veterans’ ACCESS Act, which aims to remove barriers by expanding veterans’ access to community care when VA services are inadequate or unavailable.

• Ranking Member Julia Brownley expressed concern over how recent workforce cuts and chaotic administrative decisions under the Trump administration were negatively affecting the VA’s ability to provide mental health care. She shared testimony from her district, where VA staffing shortages forced a local Vet Center to reduce services to only group therapy, which is not appropriate for all veterans. The Ranking Member opposed the idea of shifting entirely to community care, citing concerns over high costs, lack of oversight, and quality assurance. She stressed the need to find a balanced approach between community and VA-provided care, particularly for residential rehabilitation treatment.

SUMMARY OF KEY POINTS (PANEL ONE)

• Ms. Missy Jarrott testified about the tragic death of her son, Landon Holcomb, a Navy veteran who was failed by the VA mental health system. Despite reaching out repeatedly for help, Landon experienced long delays, canceled appointments, and was ultimately denied the medication management he desperately needed. After months of emotional deterioration and feeling abandoned by the system, Landon died of an accidental fentanyl overdose while seeking relief from his suffering. Ms. Jarrott called for urgent systemic changes, underscoring the real and immediate consequences of the VA’s failures on veterans and their families.

• Mr. Michael Urban, an Army veteran and licensed clinical social worker, recounted his personal journey through opioid addiction and recovery, illustrating how transformative community-based care was in his own life. He criticized the VA for failing to meet standards of care, citing widespread, systemic barriers to accessing community care across the country. Mr. Urban described examples from various VA facilities where veterans were denied care due to bureaucratic constraints, misinterpretation of access standards, or administrative priorities. He urged for collaboration between VA and community providers to eliminate these barriers and ensure veterans receive timely, effective mental health treatment.

• Dr. Shankar Yalamanchili, a psychiatrist and CEO of River Region Psychiatry, shared a scalable, data-driven care model that has successfully expanded mental health access while reducing costs. He described the VA’s current struggles with long wait times, staffing shortages, and systemic inefficiencies, especially in rural areas. His practice has demonstrated improved outcomes and lower costs through public-private partnerships, which he proposed as a practical solution to close VA care gaps. Dr. Yalamanchili called on the VA to contract with private providers to quickly expand capacity and improve care continuity.

• Ranking Member Brownley questioned Mr. Urban about his role at Banyan Treatment and Recovery, asking if he knew what the VA was being charged for care. Mr. Urban stated that he did not handle billing and could not provide exact figures, though he acknowledged that initial VA reimbursement rates were excessive.

• The Ranking Member pressed on whether the provider had financial incentives to treat veterans. Mr. Urban acknowledged that there were incentives, comparing them to similar motivations in the public sector. Ranking Member Brownley voiced concern that private providers were profit-motivated and not aligned with the VA’s mission of providing ethical, high-quality care. She concluded that Mr. Urban’s consulting role seemed focused on directing veterans toward private providers with questionable motives.

• Rep. Maxine Dexter thanked Ms. Jarrott, offering condolences for her loss. She told Mr. Urban that while his intentions appeared genuine, the lack of a VA fee schedule for residential treatment posed risks of fraud and overcharging. Mr. Urban agreed that rates as high as $6,000 per day were unreasonable. Rep. Dexter asserted that a standard fee schedule was essential before any further expansion of community care. She said that even well-meaning providers might struggle to ensure consistent care without systemic reforms.

• Rep. Buddy Carter praised Ms. Jarrott for her courage and honored the memory of her son, Landon Holcomb. He emphasized that Landon died of fentanyl poisoning, not addiction, and described how VA delays failed to provide him with critical care. Rep. Carter asked her whether she believed Landon would still be alive if he had received timely care in the community. Ms. Jarrott responded affirmatively, describing the timeline leading to his death and expressing disbelief that the VA lacked a structured fee system. She compared VA coverage to the private sector, questioning why veterans lacked access to common services and rights like the “Right to Try.” She highlighted the inconsistency across VA centers and the absence of provider options in her local area.

• Chairwoman Miller-Meeks asked Ms. Jarrott whether anyone at the VA had ever explained the family’s right to access community care or offered alternative treatments. Ms. Jarrott responded that, to her knowledge, no one had.

• The Chairwoman followed up, asking Ms. Jarrott if she believed her son received the highest quality, most effective care through the VA. Ms. Jarrott said that he did not, noting that while care at other VA centers had been acceptable, the inconsistencies between facilities ultimately failed her son.

• Chairwoman Miller-Meeks asked the other witnesses whether no care was better than community care. Mr. Urban and Dr. Yalamanchili both firmly stated that no care was never better than community care.

• The Chairwoman then asked Dr. Yalamanchili how his practice achieved up to 30% in cost savings without compromising care. Dr. Yalamanchili explained that their system tailored care intensity based on patient need and collaborated closely across teams, allowing them to treat more patients efficiently without raising costs.

• The Chairwoman inquired about the most consequential policy failure preventing veterans from accessing timely SUD treatment. Mr. Urban stated that the delays in access to care, especially inconsistent screening and referral timelines across VA facilities, were the cause. Chairwoman Miller-Meeks then asked what clinical standards the VA should adopt. Mr. Urban recommended the American Society of Addiction Medicine (ASAM) criteria, which define appropriate levels of care, staffing, and intensity. Dr. Yalamanchili supported this recommendation. Both witnesses testified that their work was not driven by profit but by a commitment to ensuring veterans receive timely and effective care.

SUMMARY OF KEY POINTS (PANEL TWO)

• Dr. Maria D. Llorente expressed gratitude to the first panel and shared her background as a board-certified psychiatrist with 30 years of experience treating veterans. She acknowledged the challenges in accessing residential treatment for SUD prior to the MISSION Act, especially at facilities without their own programs. She explained that the expansion of community care under the MISSION Act and the 2020 standardization of residential treatment referrals led to significant improvements in timely access and outcomes. Dr. Llorente underscored that while the VA has expanded both its own and community-based residential treatment programs, further updates to access standards are needed. The VA supports the Veterans’ ACCESS Act of 2025 to reduce barriers and improve care delivery.

• Ranking Member Brownley asked how many mental health providers had resigned or taken early retirement since January 20, 2025. Dr. Ilse Wiechers responded that she did not have those numbers and that it was outside her office’s purview.

• Ranking Member Brownley expressed concern that the VA lacked a formal fee schedule for residential treatment providers and asked for an update. Dr. Llorente stated that TriWest implemented a per diem reimbursement policy in December, aligning certain rates with Centers for Medicare & Medicaid Services (CMS) standards, but could not provide detailed information about Optum’s progress.

• The Ranking Member asked whether residential treatment providers could offer emergency stabilization under the COMPACT Act. Dr. Llorente responded that standalone facilities could not, but those connected to hospitals with emergency departments could.

• Ranking Member Brownley inquired whether some community providers were billing the VA for unauthorized residential admissions under the COMPACT Act. Dr. Llorente said that she had no firsthand knowledge, but she acknowledged that such reports may be accurate. She added that the VA refers concerns to the Office of Inspector General (OIG) and third-party administrators for investigation.

• Rep. Dexter reiterated that mental health care shortages exist both inside and outside the VA system and criticized proposals that assume community capacity is sufficient. She pointed out that although inpatient referrals comprised only 13% of behavioral health community care referrals, they made up nearly three-quarters of expenditures. She asked Dr. Llorente if she agreed that veterans should receive high-quality, proven care in all cases. Dr. Llorente agreed and repeated that while the VA delivers excellent care, community care is necessary to fill existing gaps.

• Rep. Dexter mentioned fraud at certain community providers and asked for confirmation that President Trump had fired the VA’s Inspector General (IG) in January. Dr. Llorente confirmed the firing had occurred, but said that the VA continued to collaborate with the IG’s office on audits and investigations.

• Rep. Morrison echoed the importance of evidence-based, high-quality care and asked a series of yes-or-no questions. She asked if the utilization of residential SUD programs had increased over time, to which both witnesses responded yes. She asked if increased capacity had improved access to intensive medical treatment, and Dr. Wiechers confirmed that it had. She asked if staffing and training standards across VA SUD programs were consistent, and Dr. Llorente responded affirmatively. Rep. Morrison concluded by urging continued support for VA-based residential SUD infrastructure.

• Chairwoman Miller-Meeks asked how long a veteran in urgent need of residential care should wait and whether all VA facilities applied the same standards. Dr. Llorente stated that national policy exists but acknowledged variation in implementation, attributing this to unclear policy language, training gaps, or misinterpretation.

• The Chairwoman asked how the VA planned to ensure consistent application of policy. Dr. Llorente said Secretary Doug Collins had initiated a comprehensive review of policies, staffing, and organizational structures to identify and correct inconsistencies.

• Chairwoman Miller-Meeks then asked how the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program (SSG Fox SPGP) helps veterans access care. Dr. Wiechers explained that the program funds community organizations to engage at-risk veterans, helping them connect with the VA and reduce suicide risk. The Chairwoman restated that care access—not just quality—was essential, especially in rural areas, and stated that both VA and community care had a role in addressing the crisis. She warned against blanket criticisms of either care setting.

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