In the Driver’s Seat

The Veterans Mobility Safety Act (VMSA), also known as H.R. 3471, was signed
into law in December.

It was a triumphant moment for the National Mobility Equipment Dealers
Association (NMEDA), which had made the VMSA concept, and then gaining
support for the formal bill, a major focal point for years.

“From our first meeting with Veterans Affairs (VA) in 2010 to the time the
bill passed and was officially signed into law on Dec. 15 was about six and a
half years,” says Amy Schoppman, government affairs director for NMEDA.
“This bill is a win for NMEDA members, it’s a win for the mobility equipment
industry, it’s a win for veterans, and it’s a win for the American tax payer.”

So with the passage of the bill now in the association’s rear-view mirror,
what’s next on NMEDA’s agenda?

Making VMSA a Reality

Well, for starters…the VMSA.

To understand the work that still needs to happen on that
front, and why, it’s best to start with exactly what the VMSA
mandates.

“The meat of the legislation is now that the Veterans Mobility
Safety Act is law, the VA is required to establish quality and safety
standards for automobile adaptive equipment and installations
within their AAE [Automobile Adaptive Equipment] program,”
Schoppman says.

“There currently are no such enforceable standards, and
[members of VA] are operating with a handbook that was last
updated in the year 2000. So you can imagine the advances in
technology that have been made: Now you can modify all sorts
of vehicles, whereas in 2000, it was pretty much limited to the
minivan, and it was sort of the old, clunky, raised-roof kind of
deal. That’s not the situation we are presented with today. There
are a lot of options for individuals who would like to pursue the
independence of driving despite some sort of mobility limitation
that they might have.”

The lack of an up-to-date policy handbook in itself is a practical
concern, Schoppman adds. “The idea of the VA just updating that
handbook to come into concert with the technical and consumer
reality of today, I think is a good thing. But in addition to that, part
of the [VMSA] requirement is that the handbook include standards
for equipment and standards for installation. The absence of
those standards has really diminished the quality of VA healthcare
generally, and it has also raised some pretty serious safety concerns
for veterans and their families, as well as the general driving public:
lifts falling off of vehicles, malfunctioning hand controls, vehicle
fires resulting from poor electrical wiring because the technician
hadn’t completed any sort of basic electrical training.

“That’s not good for anyone. And I think the American public
would agree that not only do our veterans deserve a higher
standard of care, but our tax dollars should be spent on quality
equipment and safe workmanship. The Veterans Mobility Safety
Act is what we think will get us to that point. The regulations
that are developed will lead to increased safety and quality of VA
healthcare within the auto adaptive equipment program, as well
as common-sense stewardship of tax payer funds.”

Schoppman says pursuing legislation was not NMEDA’s first
choice, and that in meetings, VA representatives did acknowledge
that the agency’s handbook needed updating and that quality
standards made sense. Unfortunately, those actions were not
among the agency’s priorities, and therefore the industry saw no
movement forward for years.

Thus, H.R. 3471.

“We actually tried for five years to come to a non-legislative
solution, working with VA prosthetics directly, and NMEDA and
its representatives would meet with them annually,” Schoppman
said. “You learn over time that some things need to be legislated,
and this was one of them.”

Developing Those Quality Standards

VA will need to develop quality standards, according to VMSA
mandate, and one of the questions Schoppman was asked by
members of Congress and their staffers was whether the bill was
really just an effort by NMEDA to force VA to purchase adapted
vehicles from NMEDA dealers.

“I think we cleared that up pretty quickly by letting them
know that the answer was no,” Schoppman said. “If that were
what we were trying to do, we would have required that VA adopt
NMEDA QAP [Quality Assurance Program], which we never
suggested that they do. Quite frankly, the QAP standard, which is
really the gold standard for the industry, would likely be too high
for a government agency to apply nationally.”

Schoppman said a major factor for NMEDA was making sure
veterans in more remote areas would retain access to adapted
vehicles after the VMSA passed.

“We’ve always kept in our minds the concern for veterans
living in rural areas,” she says. “If the only provider within
50 miles of a veteran in Louisiana is not a NMEDA provider,
we don’t want the veteran to go without. So the VA-developed
standards will almost certainly be lower than the NMEDA QAP
standard. [The VA version] is going to be a minimum standard in place of the previous regime, which was no standard. It was sort
of a wild west: Send them to the cheapest bidder with no regard
for training, facilities, experience, expertise, abilities.

“Now there will be certain requirements in place, but it’s
not going to be to the level of NMEDA QAP. A benefit for our
members is if you are NMEDA QAP, you will meet or exceed
whatever standard is eventually developed by VA. The only
providers who will run into any sort of trouble adhering to the
yet-to-be-developed standards are ones who don’t have appropriate
facilities or choose not to train their employees in basic
electric [work], or don’t use what is largely considered to be
appropriate equipment, things of that nature.”

While NMEDA won’t be supplying verbatim the quality standards
that VA uses, Schoppman says the association definitely
wants to be among those supporting the development process.

“We’re a little uncertain of what the timeline is going to be, but
sometime in 2017, VA will release a proposed rule as mandated by
the VMSA,” she says. “And that will include the quality standards
for the equipment, the safety standards for the installations.
There were also included standards for employees at VA who are
helping to run and administer the program. There’s a requirement
for an annual report. So there are a lot of details that still
need to be worked out.”

NMEDA anticipates that VA will call a “stakeholders’ meeting”
that could include “vehicle modification experts, veterans groups,
adaptive technology professionals, rehab representatives, perhaps
disability or aging groups, and of course ADED [Association
for Driver Rehabilitation Specialists] on behalf of the CDRS
[Certified Driver Rehabilitation Specialist] community.”

After that, VA is expected to develop and release a proposed
rule, to be followed by one or more comment periods and possible
revisions before the final rule is released.

Schoppman described this portion of the process as “more
detailed, less political work.” But even while working directly
with Congress — Schoppman and her NMEDA colleagues visited
the Capitol Hill offices of all 535 members of Congress in 2016 —
she noted that the idea of automobile adaptive standards for VA
earned bipartisan support.

“I think our co-sponsors were pretty much split down the
middle, 50/50,” she says. “But I think also generally, no matter
how hard someone or some organization might try to make
it, this is not a partisan issue. Accessibility and access to safe,
quality vehicle modifications doesn’t appeal to Democrats more
than Republicans or vice versa. I think most reasonable people
agree that these sorts of services should be available to people,
you should use quality equipment, the installation should be safe,
and if the federal government is using tax payer funds to operate
a program specifically for automotive adaptive equipment, there
should be standards for that.”

2017 Federal & State Agendas

Another major issue for NMEDA and its membership also concerns
VA — namely, getting paid in a timely manner for automotive work done for Veterans Affairs, which is an ongoing challenge.

“Our [past] president Sam Cook testified in June 2015 before
the House Veterans Affairs Committee on how it negatively
impacted mobility equipment dealers,” Schoppman says. “Many
of our members are small businesses, and when they have half
a million dollars in invoices that are past due, they need to keep
their lights on, they need to be able to pay their employees. It’s
extremely important that VA pay on time, and when they don’t,
folks inevitably begin to shy away from doing work for them. If
it weren’t for the end user, the veteran, who really is benefiting,
I think some of our members would have stopped doing work
for VA altogether, based on their inability to pay. That is not the
case, but it’s a chief frustration.”

Currently, NMEDA is working with VA prosthetics staff on
behalf of dealer members who hold outstanding VA invoices.

“I have to say VA has been doing a great job,” Schoppman says.
“We put together our spreadsheet, separate it by vehicle, we organize
it by VA, eliminate duplicates, submit only those 90 days past
due, and that’s every three months. And once the next quarter
rolls around, the ones that were submitted before have almost 100
percent been taken care of.”

On the state level, Schoppman expects to continue educating
vocational rehab offices that don’t currently recommend or
prefer NMEDA QAP dealers, because, she explains, vocational
rehab offices that elect to work with less qualified adaptive automotive
dealers can experience poorer outcomes that later need
to be fixed.

“A lift is not something that you can just pick one out that you
like, spot weld it onto a car and you’re on your way,” Schoppman
notes. “There is a somewhat complex calculation that goes into
determining what is the appropriate equipment for the individual’s
needs and for the vehicle that they have and for what it will
be carrying. Power chairs can be several hundred pounds, lifts
themselves can be several hundred pounds, and to trust a safe,
appropriate application of that to a vehicle that can handle it
without negatively impacting the driveability, etc., is something
that [unqualified individuals] should not be doing.”

Spreading the Word

Although H.R. 3471 is now law, the need to educate at both the
federal and state levels continues. Fortunately, Schoppman says
that after H.R. 3471, members of Congress and their staffs are
much more aware of the automobile adaptive industry and the
critical work it does on behalf of people with disabilities.

When she and her colleagues visited Capitol Hill,
Schoppman says, “I can’t tell you how many times staff in
Congressional offices were left almost speechless because they
had no idea that this sort of work was taking place. And why
would you, unless you have used it or a family member or
close friend or loved one uses a modified vehicle? You almost
wouldn’t think that it’s out there.

“What we wanted to do in educating was not say, ‘Help us pass
this bill.’ It was ‘This is the industry, this is what we do, what are
your questions?’ And they almost always had about a dozen.

“I think the profile and understanding of this sort of work has
certainly increased on Capitol Hill as part of that.”