A senator and several House lawmakers are calling for answers from the Department of Veterans Affairs on its progress expanding community care options for vets, including VA's March plan for a "strategic pause" of care referrals during the pandemic.
The Mission Act, signed into law two years ago and launched last year as the Choice Act expired and frequently touted by the president, aimed to expand opportunities for veterans to receive health care from private providers closer to home, while VA picked up the bill.
Sen. Joni Ernst, R-Iowa, a 23-year veteran of the Army Reserve and Iowa National Guard, sent a letter to VA Secretary Robert Wilkie this week asking him to provide an update on Mission's implementation at the agency.
"It is vital to ensure this landmark legislation is being properly implemented and that veterans are able to utilize and benefit from provisions under the bill," she wrote.
Ernst said Mission was intended to "increase access to health care in VA facilities and in the community, reduce wait times, expand benefits for caregivers and improve the VA's ability to recruit and retain quality medical professionals."
In March, VA floated a plan to members of Congress to slow or limit non-urgent medical referrals to community care providers to prevent further spread of the coronavirus, 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 in March. "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."
Lawmakers at the time expressed concerns about the plan, though VA presented it as a means to "enhance veteran safety" and prepare for COVID-19 response.
Other Republican lawmakers, this time in the House, are calling for answers from VA on the Mission Act pause.
In a letter also sent to Wilkie on Monday, a group of House Republicans led by House Freedom Caucus Chairman Andy Biggs, R-Ariz., asked for any policy or guidance issued by the department that could limit healthcare options for veterans to be retracted as many parts of the country begin to reopen. Reps. Chip Roy of Texas, Gregory Steube of Florida and Ralph Abraham of Louisiana also signed the letter.
“As the various states begin to free their economies from draconian coronavirus restrictions, it is critical for (VA) to immediately overturn any related bureaucratic actions that threaten our veterans' health care freedom,” the letter reads. "We are concerned with reports that (VA) has issued new guidance that is limiting access to health care choices for veterans ... in contravention of the VA MISSION Act of 2018."
VA officials in March attempted to walk back the department's use of the word "pause" in its communications with lawmakers following news reports.
"VA is not pausing the Mission Act," VA Press Secretary Christina Noel said at the time, 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."
Noel went on to explain VA's intended approach, which, with the exception of no longer using the word "pause" remained the essentially same.
Sources with knowledge of VA's disclosure to Congress in March said at the time there were concerns about ensuring veterans who already were waiting for referrals to community care at the time of the "strategic pause" don't slip through the cracks or suffer because of any limitations the department may have placed on Mission.
The pause on Mission Act appointments aligned 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 came as VA works to prioritize urgent care and COVID-19 response and maximize its resources.
Now, VA has begun resuming normal operations at some of its facilities nationwide, though COVID-19 cases are surging again, including in areas VA planned to begin reopening more services. Cases at VA also are continuing to increase. Active COVID-19 cases have increased more than 201 percent among VA patients since June 3.
Initially, VA said its pause of the Mission Act would last about 90 days, with officials reviewing that decision every 30 days. The end of those 90 days was June 23.
Ernst asked for an update provided to her office, including a briefing on the status of implementing Mission, "as well as how programs are being utilized and how both access and quality of care have improved for our veterans over the past two years."
The House lawmakers wanted to know if any veterans have been limited or denied referrals who otherwise would have been eligible and whether those vets were told they can appeal as well as what legal authority VA had to limit Mission and who made those decisions.
Lawmakers said they wanted to know whether VA has denied veterans care because of "lack of willing community providers to deliver care" or because the department decided not to sign off on those referrals.
It was not immediately clear on Monday whether any plans to pause Mission were still in place from March. VA officials did not immediately return requests for comment.
"The current coronavirus outbreak is certainly unprecedented and the VA is facing significant hurdles in ensuring veterans can safely access care, however, it is vitally important that the VA follow the law and not arbitrarily limit or deny health care options for veterans," the House lawmakers wrote.