The Department of Veterans Affairs wants to pause part of the Mission Act, a measure that expanded veterans' access to community care, over COVID-19 concerns.
Specifically, VA floated a plan to members of Congress this week to slow or limit non-urgent medical referrals to community care providers to prevent further risk of infection, calling it a "strategic pause."
"Completing non-urgent and routine health care appointments to meet access standards puts veterans at risk of contracting COVID-19 and also uses valuable healthcare resources that need to be conserved to respond to COVID-19. This is true for both VA and community healthcare providers," according to communication from VA to Congress obtained by Connecting Vets. "VHA thus proposes a temporary strategic pause in the MISSION Act access standards for 90 days, or until the soonest possible time that routine care may safely resume. Enforcement of the access standards will resume when routine care resumes."
But some lawmakers said they were concerned about the proposal.
Senate Veterans Affairs Chairman Sen. Jerry Moran, R-Kansas, said in a statement to Connecting Vets that he had "serious concerns with VA putting a temporary pause on community care.
"When the VA cannot provide care to veterans, the VA is required under Mission Act to send them to the community," Moran said. "As the VA’s role in the COVID-19 response grows and community-based outpatient clinics are closing to reduce exposure, now more than ever is the time for community care. Veterans should be able to continue accessing community care, which will keep them closer to home, prevent unnecessary exposure at larger VA medical centers and free up VA resources to fight COVID-19. I have requested further information regarding the VA’s proposal and will continue to stay engaged throughout this process to make certain veterans are receiving access to timely care.”
House Veterans Affairs ranking member Rep. Phil Roe, R-Tenn., said he was informed of VA's intentions Tuesday night.
"There is no doubt that we must prevent veterans from being necessarily exposed and ensure that every available resource is directed toward mitigating the deadly impact of this virus," he said in a statement to Connecting Vets. "However, we must also make sure that veterans continue to receive the care that they need and community care is a necessary tool to accomplishing that goal. I hope to receive much more information from Secretary Wilkie and Dr. Stone about how and why VA made this decision and how veterans will continue to be cared for throughout this crisis in VA and in the community.”
VA presented its plan as a means to "enhance veteran safety and prepare ourselves to assist the civilian healthcare system, should surge capabilities be needed." Congressional staff told Connecting Vets that VA officials briefed Veterans Affairs lawmakers on the proposal.
VA officials said they wanted to assure lawmakers that a pause on Mission would not mean veterans would not get needed care, adding that non-urgent care could be handled by phone or telehealth technology such as video calls.
"Referral to the community for emergent or urgent clinical needs will continue when necessary," VA said in its communication to lawmakers. "For non-emergent care, VA has enhanced telehealth capabilities and will be caring for Veterans with routine needs as clinically appropriate to limit veteran risk for COVID-19."
The department plans to review appointments for non-urgent care "on a case-by-case basis, regardless of wait time or drive time eligibility."
Veterans who already have community care appointments "should continue with this care as clinically appropriate and if available," VA said.
It was not immediately clear Wednesday when VA planned to execute its plans.
VA Press Secretary Christina Mandreucci said "these measures will be reassessed continuously and communicated every 30 days to determine whether they need to be extended or adjusted."
VA officials Wednesday afternoon attempted to walk back the use of the word "pause" in its communications with Congress following news reports and reactions from lawmakers.
"VA is not pausing the Mission Act," Mandreucci said, though VA used the specific term in its messages to lawmakers. "The language used to describe the impact of COVID-19 on VA's community care program required refinement to accurately reflect VA's intended approach. VA is working to provide updated guidance to both employees and Congressional staff."
Mandreucci went on to explain VA's intended approach, which, with the exception of no longer using the word "pause" remained the essentially same.
The pause on Mission Act appointments would align with the department's effort to either pause or transition non-urgent appointments to telehealth across the Veterans Health Administration to limit potential infection risk. The changes come as VA works to prioritize urgent care and COVID-19 response and maximize its resources.
VA has taken steps recently to conserve resources and reduce non-virus related health care demands in the event it must activate its fourth mission and serve as a backup healthcare system for America -- not just veterans.
Department medical facilities already ended non-urgent procedures last week to reduce "unnecessary hospitalization and Intensive Care Unit" use and to free up resources "to address COVID-19 if needed."
VA officials told lawmakers the department already was shifting some routine care appointments to phone or telehealth to keep veterans away from hospitals and clinics where they may be at greater risk of contracting the virus.
Sources with knowledge of the VA's disclosure to Congress said there remain concerns about ensuring veterans who already were waiting for referrals to community care don't slip through the cracks or suffer because of any limitations on Mission that might be established by VA.
VA is asking any veterans with symptoms such as fever, cough or shortness of breath to call before they arrive at a hospital or clinic.
VA also produced a guide for veterans on the coronavirus.