Department of Veterans Affairs’ Potential Role in Addressing the COVID-19 Outbreak

Department of Veterans Affairs’ Potential

Role in Addressing the COVID-19 Outbreak

Sidath Viranga Panangala

Specialist in Veterans Policy

Jared S. Sussman

Analyst in Health Policy

Cassandria Dortch

Specialist in Education Policy

Jonathan M. Gaffney

Legislative Attorney

Libby Perl

Specialist in Housing Policy

Heather M. Salazar

Analyst in Veterans Policy

March 20, 2020

Congressional Research Service

7-....

www.crs.gov

R46280

SUMMARY

Department of Veterans Affairs’ Potential Role

in Addressing the COVID-19 Outbreak

The Department of Veterans Affairs (VA) provides a range of benefits to eligible veterans and

their dependents. The department carries out its programs nationwide through three

administrations and the Board of Veterans’ Appeals (BVA). The Veterans Health Administration

(VHA) is responsible for health care services and medical and prosthetic research programs. The

Veterans Benefits Administration (VBA) is responsible for, among other things, providing

disability compensation, pensions, and education assistance. The National Cemetery

Administration (NCA) is responsible for maintaining national veterans cemeteries; providing

grants to states for establishing, expanding, or improving state veterans cemeteries; and providing

headstones and markers for the graves of eligible persons, among other things.

With a vast integrated health care delivery system spread across the United States, VHA is also

statutorily required to serve as a contingency backup to the Department of Defense (DOD)

medical system during a national security emergency and to provide support to the National

Disaster Medical System and the Department of Health and Human Services (HHS), as

necessary, in support of national emergencies (also referred to as the “Fourth Mission” of the

VHA).

Based on limited information from VA, this report provides an overview of VA’s response to the

Coronavirus Disease 2019 (COVID-19) pandemic that is affecting communities throughout the

United States. It also discusses recent congressional action as it pertains to the veterans’ benefits

and services, as well as the supplemental appropriations for the department.

R46280

March 20, 2020

Sidath Viranga Panangala

Specialist in Veterans

Policy

-redacted-@crs.loc.gov

Jared S. Sussman

Analyst in Health Policy

-redacted-@crs.loc.gov

Cassandria Dortch

Specialist in Education

Policy

-redacted-@crs.loc.gov

Jonathan M. Gaffney

Legislative Attorney

-redacted-@crs.loc.gov

Libby Perl

Specialist in Housing Policy

-redacted-@crs.loc.gov

Heather M. Salazar

Analyst in Veterans Policy

-redacted-@crs.loc.gov

For a copy of the full report,

please call 7-.... or visit

www.crs.gov.

Congressional Research Service

Department of Veterans Affairs’ Potential Role in Addressing the COVID-19 Outbreak

Contents

Introduction ..................................................................................................................................... 1

Novel Coronavirus (COVID-19) ..................................................................................................... 2

Scope and Limitations ............................................................................................................... 2

Medical Care for Veterans During the COVID-19 Outbreak .......................................................... 3

Guidance for Patients ................................................................................................................ 3

Mitigation at VHA Facilities ..................................................................................................... 3

COVID-19 Testing and Treatment ............................................................................................ 4

COVID-19 Diagnostic Testing............................................................................................ 4

COVID-19 Treatment ......................................................................................................... 5

Homeless Veterans........................................................................................................................... 6

Veterans Benefits Administration (VBA) ........................................................................................ 7

Educational Assistance .............................................................................................................. 7

National Cemetery Administration (NCA) ...................................................................................... 8

Emergency Preparedness (“Fourth Mission”) ................................................................................. 9

Congressional Response ................................................................................................................ 10

Funding and Cost-Sharing....................................................................................................... 10

Education Assistance............................................................................................................... 10

Emergency Supplemental Appropriations Request ................................................................. 10

Tables

Table A-1. VHA’s Emergency Powers .......................................................................................... 12

Appendixes

Appendix. VHA Emergency Powers ............................................................................................. 12

Contacts

Author Contact Information .......................................................................................................... 14

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Department of Veterans Affairs’ Potential Role in Addressing the COVID-19 Outbreak

Introduction

The Department of Veterans Affairs (VA) provides a range of benefits and services to veterans

who meet certain eligibility criteria. These benefits and services include, among other things,

hospital and medical care;1 disability compensation and pensions;2 education;3 vocational

rehabilitation and employment services;4 assistance to homeless veterans;5 home loan

guarantees;6 administration of life insurance, as well as traumatic injury protection insurance for

servicemembers;7 and death benefits that cover burial expenses.8

The department carries out its programs nationwide through three administrations and the Board

of Veterans’ Appeals (BVA). The Veterans Health Administration (VHA) is responsible for health

care services and medical and prosthetic research programs. The Veterans Benefits

Administration (VBA) is responsible for, among other things, providing disability compensation,

pensions, and education assistance. The National Cemetery Administration (NCA)9 is responsible

for maintaining national veterans cemeteries; providing grants to states for establishing,

expanding, or improving state veterans cemeteries; and providing headstones and markers for the

graves of eligible persons, among other things.

In addition to providing health care services to veterans and certain eligible dependents, the VHA

is statutorily required to serve as a contingency backup to the Department of Defense (DOD)

medical system during a national security emergency10 and to provide support to the National

Disaster Medical System and the Department of Health and Human Services (HHS) as necessary

in response to national crises.11 The department is also required to take appropriate actions to

ensure VA medical centers are prepared to protect veteran patients and staff during a public health

emergency. 12

1 For more information on programs, see CRS Report R42747, Health Care for Veterans: Answers to Frequently Asked

Questions.

2 For more information on programs, see CRS Report R44837, Benefits for Service-Disabled Veterans, and CRS Report

RS22804, Veterans’ Benefits: Pension Benefit Programs.

3 For a discussion of education benefits, see CRS Report R42755, The Post-9/11 GI Bill: A Primer.

4 For details on VA’s vocational rehabilitation and employment, see CRS Report RL34627, Veterans’ Benefits: The

Vocational Rehabilitation and Employment Program.

5 For detailed information on homeless veterans programs, see CRS In Focus IF10167, Veterans and Homelessness.

6 For details on the home loan guarantee program, see CRS Report R42504, VA Housing: Guaranteed Loans, Direct

Loans, and Specially Adapted Housing Grants.

7 For more information on insurance programs, see CRS Report R41435, Veterans’ Benefits: Current Life Insurance

Programs.

8 For more information on burial benefits, see CRS Report R41386, Veterans’ Benefits: Burial Benefits and National

Cemeteries.

9 Established by the National Cemeteries Act of 1973 (P.L. 93-43).

10 38 U.S.C. §8111A.

11 38 U.S.C. §1785.

12 38 U.S.C. §8117.

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Novel Coronavirus (COVID-19)13

On December 31, 2019, the World Health Organization (WHO) was informed of a cluster of

pneumonia cases in Wuhan City, Hubei Province of China. Illnesses have since been linked to a

disease caused by a previously unidentified strain of coronavirus, designated Coronavirus Disease

2019, or COVID-19. On January 30, 2020, an Emergency Committee convened by the WHO

Director-General declared the COVID-19 outbreak to be a Public Health Emergency of

International Concern (PHEIC).14 On January 31, the Secretary of Health and Human Services

(HHS) declared a public health emergency under Section 319 of the Public Health Service Act

(42 U.S.C. 247d).15 On March 11, 2020, the WHO characterized the COVID-19 outbreak as a

pandemic.16 Two days later, on March 13, the President declared the COVID-19 outbreak a

national emergency, beginning March 1, 2020.17

The VHA plays a significant role in the domestic response to a pandemic. It is one of the largest

integrated direct health care delivery systems in the nation, caring for more than 7.1 million

patients in FY2020 and providing 123.8 million outpatient visits18 at approximately 1,450 VA

sites of care.19 The VHA employs a workforce of 337,908 full-time equivalent employees (FTEs),

largely composed of health care professionals.20 In addition, the VHA has a statutory mission to

contribute to the overall federal emergency response capabilities.21

Scope and Limitations

This report provides an overview of VA’s response thus far to this rapidly evolving COVID-19

pandemic. It does not provide an exhaustive description of all of the department’s activities, and

it is based on very limited publicly available information from VA. It is organized as follows:

first, it provides details on VHA’s, VBA’s, and NCA’s response activities; second, it provides

13 For more information, see “COVID-19” Hot Topic, at https://www.crs.gov/, and CRS Report R46219, Overview of

U.S. Domestic Response to Coronavirus Disease 2019 (COVID-19).

14 WHO, “Statement on the second meeting of the International Health Regulations (2005) Emergency Committee

regarding the outbreak of novel coronavirus (COVID-19),” January 30, 2020, https://www.who.int/news-room/

statements. The definition of and procedures for a PHEIC are at https://www.who.int/ihr/procedures/pheic/en/. See also

CRS In Focus IF10022, The Global Health Security Agenda (2014-2019) and International Health Regulations (2005).

15 U.S. Department of Health and Human Services (HHS), “Secretary Azar Declares Public Health Emergency for

United States for Coronavirus Disease 2019,” press release, January 31, 2020, https://www.hhs.gov/about/news/2020/

01/31/secretary-azar-declares-public-health-emergency-us-2019-novel-coronavirus.html.

16 WHO, “WHO Director-General’s opening remarks at the media briefing on COVID-19,” March 11, 2020,

https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19.

17 “Proclamation on Declaring a National Emergency Concerning the Novel Coronavirus Disease (COVID-19)

Outbreak,” March 13, 2020, https://www.whitehouse.gov/presidential-actions/proclamation-declaring-nationalemergency-concerning-novel-coronavirus-disease-covid-19-outbreak/, also at U.S. President (Trump), “Declaring a

National Emergency Concerning the Novel Coronavirus Disease (COVID–19) Outbreak,” 85 Federal Register 53,

March 18, 2020.

18 U.S. Department of Veterans Affairs, FY2021 Congressional Submission, Medical Programs and Information

Technology Programs, vol. 2 of 4, February 2020, pp. VHA-19 and VHA-20.

19 Ibid., p. VHA-333. (Sites of care used in this calculation are VA hospitals, community living centers, health care

centers, community-based outpatient clinics [CBOCs], other outpatient service sites, and dialysis centers.)

20 Ibid., p. VHA-15.

21 38 U.S.C. §1785; 38 U.S.C. §8117. Also see U.S. Department of Veterans Affairs, Veterans Health Administration,

Veterans Health Administration Comprehensive Emergency Management Program (CEMP) Procedures, VHA

DIRECTIVE 0320.01, April 6, 2017.

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details on VA’s emergency preparedness (“Fourth Mission”) activities to provide support to the

overall federal emergency response; and lastly, it briefly describes congressional activity as it

pertains to VA and veterans. The Appendix provides a summary of VHA’s emergency

authorities.

Medical Care for Veterans During the

COVID-19 Outbreak

VHA’s provision of medical care to veterans in response to the COVID-19 outbreak includes

implementing mitigation strategies at VHA facilities, as well as testing and treating veterans

diagnosed with or suspected of having COVID-19. (A general description of medical care to

veterans is provided in other CRS reports.22)

In late February 2020, VA provided information to congressional oversight committees on the

number of positive and presumptive positive cases of COVID-19.23 On March 13, 2020, the

department began publishing this information publicly on its website, which it updates on a

regular basis.24 The number of positive diagnoses is likely to grow as testing for COVID-19

becomes more widespread.

VA has reported on the measures it has taken to contain and mitigate further exposure. It has

issued guidance for patients, implemented mitigation strategies at VHA facilities, and begun

testing patients who present symptoms consistent with COVID-19.

Guidance for Patients

VA is advising veterans who may be sick or who are exhibiting flu-like symptoms not to come to

a VA facility. Instead, patients are advised to call their health care providers, even if they already

have a scheduled appointment.25 Alternatively, patients can send a secure message through the

VHA online portal, My HealtheVet, or schedule a telehealth appointment.26

In addition, VA is advising patients to budget additional time for appointments due to enhanced

screening measures at VA facilities. These enhanced screening measures, as well as other

mitigation strategies at VHA facilities, are described below.

Mitigation at VHA Facilities

On March 10, 2020, VA announced safeguards to protect nursing home residents and spinal cord

injury patients.27 As of that date, no visitors are allowed at either VA nursing homes or spinal cord

22 For more information on the provision of health care to veterans, see CRS Report R42747, Health Care for Veterans:

Answers to Frequently Asked Questions.

23

House Committee on Veterans’ Affairs, “House Committee on Veterans’ Affairs Statement on Actions to Protect VA

and Veterans from COVID-19,” press release, March 13, 2020.

24 For the most recent number of VA-related cases, see https://www.publichealth.va.gov/n-coronavirus/.

25 Veterans can call MyVA311 (844-698-2311) to reach their local VA Medical Center.

26 Veterans can access My HealtheVet at https://www.myhealth.va.gov/mhv-portal-web/home. They can access

telehealth services at https://telehealth.va.gov/type/home. For more information on VA telehealth services, see CRS

Report R45834, Department of Veterans Affairs (VA): A Primer on Telehealth.

27 U.S. Department of Veterans Affairs, “VA announces safeguards to protect nursing home and spinal cord injury

patients,” press release, March 10, 2020, https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5400.

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injury/disorder (SCI/D) centers. The only exception to this policy is if a veteran is in the last

stages of life, in which case VA allows visitors in the veteran’s room only. VA is not accepting

any new admissions to nursing homes and is limiting new admissions to SCI/D centers.

VA began implementing enhanced screening procedures at all sites of care to screen for

respiratory illness and COVID-19 exposure. Enhanced screening procedures are determined at the

local level, so they vary at each facility. However, VA has designed standardized screening

questions for each facility.

Each VA medical center is implementing a two-tiered system to mitigate the potential for spread

of the virus, creating a zone for active COVID-19 cases and a passive zone for care unrelated to

COVID-19.28 VA has canceled all elective surgeries and limited routine appointments.29

COVID-19 Testing and Treatment30

This section describes the current VA policy on testing patients for COVID-19 and treatment

following a COVID-19 diagnosis.

COVID-19 Diagnostic Testing

On March 13, 2020, the department began publishing the number of positive cases of COVID-19,

and the number of tests conducted, on its public website, which it updates on a regular basis.31

Individual medical centers have discretion on where to send samples for testing. Samples can be

tested at the Palo Alto VA Medical Center, state public health labs, or private labs.

Individual providers decide whether to test for COVID-19 on a patient-by-patient basis. However,

VA has advised providers that patients must be exhibiting respiratory symptoms and have another

factor, such as recent travel or known exposure to someone who tested positive.

Generally, diagnostic testing is a covered service under VA’s standard medical benefits package,

which is available to all veterans enrolled in the VA health care system.32 Some veterans are

required to pay copayments for care that is not related to a service-connected disability. However,

routine lab tests are exempt from copayments.33 VA has not announced whether cost-sharing for

the COVID-19 diagnostic test is included under the exemption for routine lab tests.

The Families First Coronavirus Response Act (P.L. 116-127), enacted on March 18, 2020, allows

VA to waive any copayment or other cost-sharing requirements charged to veterans for COVID19 testing or medical visits during any period of this public health emergency. VA has not

publicly announced whether cost-sharing for the COVID-19 diagnostic test will be waived for all

veterans who are subject to cost-sharing. (For a discussion of P.L. 116-127, see the

“Congressional Response” section of this report.)

28 U.S. Department of Veterans Affairs, COVID-19 Guidance for Community Providers, Fact Sheet IB-10-145, March

2020.

29 White House Coronavirus Task Force, Daily Briefing, March 18, 2020.

30 For more information on general COVID-19 testing, see CRS Report R46261, Development and Regulation of

Domestic Diagnostic Testing for Novel Coronavirus (COVID-19): Frequently Asked Questions.

31 https://www.publichealth.va.gov/n-coronavirus/.

32 38 C.F.R. §17.38.

33 38 C.F.R. §17.108(e)(11).

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COVID-19 Treatment

VA has not indicated whether it has developed a treatment plan for patients diagnosed with

COVID-19. Treatment depends largely on the severity of symptoms that each patient experiences.

VA is handling coverage and cost of treatment for COVID-19 as it would for any other treatment

for a condition that is not service-connected. Treatment for COVID-19 is a covered benefit under

the VA standard medical benefits package. However, some veterans may have to pay copayments

for both outpatient and inpatient care.34

Normal coverage rules apply for veterans who report to urgent care or walk-in clinics. To be

eligible, a veteran must be enrolled in the VA health care system and must have received VA care

in the past 24 months preceding the episode of urgent or walk-in care.35 Eligible veterans needing

urgent care must obtain care through facilities that are part of VA’s contracted network of

community providers.36 These facilities typically post information indicating that they are part of

VA’s contracted network. If an eligible veteran receives urgent care from a noncontracted

provider or receives services that are not covered under the urgent care benefit, the veteran may

be required to pay the full cost of such care.37 Certain veterans are required to pay copayments for

care obtained at a VA-contracted urgent care facility or walk-in retail health clinic.38

In addition, normal rules apply for veterans who report to non-VA emergency departments. To be

eligible for VA payment or reimbursement, a veteran’s non-VA care must meet the following

criteria:



The emergency care or services were provided in a hospital emergency

department or a similar facility that provides emergency care to the public.



The claim for payment or reimbursement for the initial evaluation and treatment

was for a condition of such a nature that a prudent layperson would have

reasonably expected that delay in seeking immediate medical attention would

have been hazardous to life or health.

A VA or other federal facility or provider was not feasibly available and an

attempt to use them beforehand would not have been considered reasonable by a

prudent layperson.

At the time the emergency care or services were furnished, the veteran was

enrolled in the VA health care system and had received medical services from the

VHA within the 24-month period preceding the furnishing of such emergency

treatment.







The veteran was financially liable to the provider of emergency treatment for that

treatment.

34 For more information on copayments for medical care, see CRS Report R42747, Health Care for Veterans: Answers

to Frequently Asked Questions.

35 A veteran would meet this requirement under any of the following situations: “Care provided in a VA facility, care

authorized by VA performed by a community provider, care reimbursed under VA’s Foreign Medical Program

(38 U.S.C. 1724) or an emergency treatment authority (38 U.S.C. 1725 or 1728) or care furnished by a State Veterans

Home” (U.S. Department of Veterans Affairs, “Urgent Care,” 84 Federal Register 26014, June 5, 2019).

36 https://vaurgentcarelocator.triwest.com/.

37 U.S. Department of Veterans Affairs, Veteran Community Care – Urgent Care, Fact Sheet, May 2019.

38 For more information on copayments for urgent care, see CRS Report R42747, Health Care for Veterans: Answers to

Frequently Asked Questions.

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



The veteran had no coverage under a health plan contract that would fully cancel

the medical liability for the emergency treatment.

If the condition for which the emergency treatment was furnished was caused by

an accident or work-related injury, the veteran is required pursue all claims

against a third party for payment of such treatment first.39

Homeless Veterans

Veterans experiencing homelessness live in conditions that could make them particularly

vulnerable to COVID-19. Those who are unsheltered lack access to sanitary facilities. For those

sleeping in emergency shelters, conditions may be crowded, with short distances between beds,

and there may be limited facilities for washing and keeping clean.

While VA itself administers programs to assist veterans experiencing homelessness, there are

several grants for nonprofit and public entities to provide housing and services to homeless

veterans. These include the Homeless Providers Grant and Per Diem program (transitional

housing and services), the Supportive Services for Veteran Families (short- to medium-term rental

assistance and services), and Contract Residential Services (housing for veterans participating in

VA’s Health Care for Homeless Veterans program).40

VA released guidance on March 13, 2020, for its grantees that administer programs for veterans

who are homeless.41 The guidance suggests grantees take a number of actions:





Develop a response plan, or review an existing plan, and coordinate response

planning with local entities, including health departments, local VA medical

providers, and Continuums of Care.42 Plans should address staff health, potential

staff shortages, and acquisition of food and other supplies, as well as how to

assist veteran clients.

Prevent infection through methods recommended by the CDC, such as frequent

handwashing, wiping down surfaces, and informing clients about prevention

techniques.



In congregate living facilities, such as those provided through VA’s Grant and

Per Diem program, keep beds at least three feet apart (preferably six, if space

permits), sleep head-to-toe, or place barriers between beds, if possible.



Develop questions to ask clients about their health to determine their needs and

how best to serve them. For new clients, interviews should occur prior to entry

into a facility (such as over the phone), if possible, or in a place separate from

other clients.

If a client’ answers to questions indicate risk of COVID-19, separate them from

other program participants (have an isolation area, if possible), clean surfaces,



39 38 U.S.C. §1725. 38 C.F.R. §§17.1000-17.1008.

40 For more information, see CRS Report RL34024, Veterans and Homelessness.

41 U.S. Department of Veterans Affairs, Guidance on the Coronavirus (COVID-19) for VA Grantees Providing

Homeless Services, March 13, 2020, https://www.va.gov/HOMELESS/docs/GPD/providers/GuidanceCOVID-19VA_Grantees_3-13-20.pdf.

42 Continuums of Care are planning boards that coordinate homeless services at the local level. Their role includes

coordinating local service providers to apply for Department of Housing and Urban Development Continuum of Care

program funding.

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and reach out to medical professionals. If isolation is not practical, reach out to

other providers who might be able to isolate.

Veterans Benefits Administration (VBA)

On March 18, 2020, the Veterans Benefits Administration (VBA) announced via Facebook and

Twitter that all regional offices will be closed to the public starting March 19. While the regional

offices are to remain open to ensure the continuity of benefits, the offices are to no longer accept

walk-ins for claims assistance, scheduled appointments, counseling, or other in-person services.

VBA is directing veterans who have claims-specific questions or any questions to use the Inquiry

Routing & Information System (IRIS) or to call 1-800-827-1000.43

A March 16, 2020, Government Executive news article explained that VBA is facing “network

operationality” issues after several regional offices told their employees to telework full time.

VBA headquarters, in Washington, DC, then rescinded the telework directives due to the

information technology issues. VBA is to continue performing tests on the network throughout

the week. According to the article, a VA spokesperson said that regional office directors are to

make decisions on work flexibility based on “the circumstances in their communities” but must

discuss all plans with “central office leadership.”44

Educational Assistance

In FY2020, over 900,000 individuals are expected to receive veterans educational assistance from

the GI Bills (e.g., the Post-9/11 GI Bill), Veteran Employment Through Technology Education

Courses (VET TEC), Veterans Work-Study, Veterans Counseling, and VetSuccess on Campus

(VSOC). As a result of COVID-19, some participants’ training and education may be disrupted,

and some participants may receive a lower level of or no benefits. These concerns may directly

affect beneficiaries in several ways, including the following:













Some students may be required to stop out,45 discontinue working, or take a leave

of absence as a result of their own illness.

Some training establishments, educational institutions, and work-study providers

may close temporarily or permanently.

Some training establishments, educational institutions, and work-study providers

may be required to reduce participants’ hours, enrollment rate, or rate of pursuit.

Some educational institutions may transition some courses to a distance learning

format.

Some educational institutions may require students living on campus to move off

campus.

Individuals receiving benefits in foreign countries may encounter any of the

above circumstances while residing in a foreign country whose COVID-19

situation may differ from that in the United States, or may stop out, discontinue

working, or take a leave of absence and return to the United States.

43 https://www.facebook.com/VeteransBenefits/ and https://twitter.com/VAVetBenefits.

44 Eric Katz, “Mass Telework Causes Operational Strains for Agencies,” March 16, 2020, Government Executive, at

https://www.govexec.com/management/2020/03/mass-telework-causes-operational-strains-agencies/163834/.

45 A stop-out is a student who interrupts his or her enrollment with a break of more than four months before reenrolling.

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A related issue is that, in the past, GI Bill benefits could not be paid for pursuit of online courses

that had not been previously approved as online courses. Given this limitation, VA requested that

school-certifying officials “temporarily refrain from making any adjustments to enrollment

certifications” pending subsequent VA guidance and/or legislative action.46

On March 12, 2020, VA reminded GI Bill participants and school-certifying officials of its ability

to continue paying benefits as participants and institutions react to the COVID-19 emergency. In

particular, VA may continue to pay GI Bill benefits for up to four weeks following the temporary

closure of an educational institution under an established policy based on an executive order of

the President, or due to an emergency situation.47 Other limitations noted in the correspondence

would be alleviated by recently passed legislation (see the “Congressional Response” section of

this report for a discussion of S. 3503).48

National Cemetery Administration (NCA)

The National Cemetery Administration (NCA) has provided limited information for the survivors

and dependents of veterans who have passed away and are scheduled to be buried in National

Cemetery. As of March 18, 2020, NCA has provided some guidance for both families and funeral

directors regarding interments and services for veterans.

For families and visitors. VA National Cemeteries remain open to visitors and for interments,

but visitors should follow their local communities’ restrictions on visitations and travel. For

families who prefer to inter now but hold the committal service at a later date, NCA says it will

work to accommodate those requests. For families who prefer to have the committal service now,

NCA asks them to adhere to CDC recommendations for group gatherings.

For funeral directors. NCA is asking funeral directors to follow the CDC guidelines and

recommendations on group gatherings for families who proceed with full committal services. In

addition, NCA informed organizers that it has discouraged all cemetery personnel from

handshaking and any unnecessary physical contact with family members and funeral organizers.

NCA is to work with the funeral directors and families to accommodate future committal services

for those who decide to postpone.49

NCA has set up an “Alerts” web page for the public to check cemetery operating status50and is

directing the public to its Facebook and Twitter pages for the most recent operating information.51

46 Email from VBA Education Service to school-certifying officials, March 13, 2020.

47 38 U.S.C. §3680(a)(2) might not apply to GI Bill benefits for pursuit of training establishment or correspondence

courses, VET TEC, or work-study. Payments cannot continue into an interval period between enrollment periods.

48 The letter indicated that GI Bill benefits could not be paid for pursuit of online courses that have not been previously

approved as online courses. For courses that transition from in-residence to online during the term, GI Bill benefit

amounts would not change for the remainder of the term; however, for subsequent terms, Post-9/11 GI Bill participants

enrolled exclusively in online education would be eligible for one-half the national average of the housing allowance.

49 Twitter, Facebook, and emails from National Cemetery Administration, “VA National Cemeteries and COVID-19,”

March 11, 13, 17, 2020.

50 https://www.cem.va.gov/alerts.asp.

51 https://www.facebook.com/NationalCemeteries and https://twitter.com/VANatCemeteries.

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Emergency Preparedness (“Fourth Mission”)

In 1982, the Department of Veterans Affairs (VA)-Department of Defense (DOD) Health

Resources Sharing and Emergency Operations Act (P.L. 97-174) was enacted to serve as the

primary health care backup to the military health care system during and immediately following

an outbreak of war or national emergency.52 Since then, Congress has provided additional

authorities to VA to “use its vast infrastructure and resources, geographic reach, deployable

assets, and health care expertise, to make significant contributions to the Federal emergency

response effort in times of emergencies and disasters.”53

Among other authorities, VHA may care for nonveterans, as well as veterans not enrolled in the

VA health care system.54 This applies in situations where the President has declared a major

disaster or emergency under the Robert T. Stafford Disaster Relief and Emergency Assistance Act

(42 U.S.C. §5121 et seq.) (the Stafford Act), or where the HHS Secretary has declared a disaster

or emergency activating the National Disaster Medical System established pursuant to Section

2811(b) of the Public Health Service Act (42 U.S.C. §300hh-11(b)). The President’s March 13,

2020, declaration of a national emergency under Section 501(b) of the Stafford Act allows VA to

use this authority.

According to VA, during declared major disasters and emergencies, service-connected veterans

receive the highest priority for VA care and services, followed by members of the Armed Forces

receiving care under 38 U.S.C. Section 8111A, and then by individuals affected by a disaster or

emergency described in 38 U.S.C. Section 1785 (i.e., individuals requiring care during a declared

disaster or emergency or during activation of the National Disaster Medical System [NDMS]). In

general, care is prioritized based on clinical need—that is, urgent, life-threating medical

conditions are treated before routine medical conditions (see the Appendix).

During a disaster or emergency, VA can support HHS by providing resources to civilian health

care systems.55 Furthermore, VA’s National Acquisition Center can assist with acquisition and

logistical support, such as by providing ventilators, medical equipment and supplies, and

pharmaceuticals. Generally, if a state, tribal, or territorial government needs resources, they can

request assistance from the federal government through their local HHS Regional Emergency

Coordinator (REC). The HHS REC is to then submit a task order to the HHS Secretary’s

52 38 U.S.C. §811A.

53 U.S. Department of Veterans Affairs, Department of Veterans Affairs FY 2018 - 2024 Strategic Plan, Refreshed May

31, 2019, May 31, 2019, p. 35.

54 38 U.S.C. §1785 and 38 C.F.R. §17.86 establish VA authority to provide hospital care and medical services to

nonveterans responding to, involved in, or otherwise affected by a disaster or emergency. These individuals may

include active duty servicemembers, as well as National Guard and Reserve component members activated by state or

federal authority. This authority also allows VA to treat veterans not enrolled in the VA health care system. Unless

another federal agency reimburses VA, individuals could be charged for this care. “[I]ndividuals who receive hospital

care or medical services under this section [38 C.F.R. §17.86] are responsible for the cost of the hospital care or

medical services when charges are mandated by Federal law (including applicable appropriation acts) or when the cost

of care or services is not reimbursed by other-than-VA Federal departments or agencies” (38 C.F.R. §17.86).

55 For example, during Hurricane Katrina, VHA deployed 1,300 volunteers and staff in a series of 14-day rotations to

operate two Federal Medical Stations (FMS) providing medical services to non-VA beneficiaries; operate VHA mobile

medical clinics; and deliver food, water, fuel, and supplies to affected medical facilities, among other activities. See

House Committee on Veterans’ Affairs, Subcommittee on Oversight and Investigations, Emergency Preparedness:

Evaluating the U.S. Department Of Veterans Affairs’ Fourth Mission, 111th Cong., 2nd sess., June 23, 2010

(Washington: GPO, 2010), p. 50.

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Department of Veterans Affairs’ Potential Role in Addressing the COVID-19 Outbreak

Operations Center (SOC) to be fulfilled by HHS, VA, or another federal agency. VA cannot

receive direct requests for assistance from state and local governments.56

Congressional Response

Funding and Cost-Sharing

On March 14, 2020, the House passed the Families First Coronavirus Response Act (H.R. 6201).

The Senate passed the measure on March 18, and the President signed it into law the same day as

P.L. 116-127. The act provides $30 million for VHA’s medical services account to fund health

services and related items pertaining to COVID-19.57 In addition, the act provides $30 million for

VHA’s medical community care account. These funds are available until September 30, 2022.

Among other things, the act allows VA to waive any copayment or other cost-sharing

requirements for COVID-19 testing or medical visits during any period of this public health

emergency.58

Education Assistance

S. 3503, as passed by the Senate on March 16, 2020, and then passed by the House on March 19,

2020, allows VA to continue to provide GI Bill benefits from March 1, 2020, through December

21, 2020, for courses at educational institutions that are converted from in-residence to distance

learning by reason of an emergency or health-related situation.59 S. 3503 further permits VA to

pay the Post-9/11 GI Bill housing allowance as if the courses were not offered through distance

learning throughout the same period. With the exception of those covered under this S. 3503

exemption, Post-9/11 GI Bill participants enrolled exclusively in distance education are eligible

for no more than one-half the national average of the housing allowance.

Emergency Supplemental Appropriations Request60

On March 17, 2020, the Administration submitted to Congress a supplemental appropriations

request. The Administration seeks $16.6 billion for FY2020 for VA’s response to the COVID-19

outbreak. This includes $13.1 billion for the medical services account. According to the request,

this additional amount would provide funding for “healthcare treatment costs, testing kits,

temporary intensive care unit bed conversion and expansion, and personal protective equipment.”

The request also includes $2.1 billion for the medical community care account to provide three

56 Email from Department of Veterans Affairs, Office of Congressional and Legislative Affairs, March 17, 2020.

57 VHA’s annual appropriations consist of five accounts: medical services, medical community care, medical support

and compliance, medical facilities, and medical and prosthetic research accounts. The first four accounts cover the

provision of health care and related services.

58 “Proclamation on Declaring a National Emergency Concerning the Novel Coronavirus Disease (COVID-19)

Outbreak,” March 13, 2020, https://www.whitehouse.gov/presidential-actions/proclamation-declaring-nationalemergency-concerning-novel-coronavirus-disease-covid-19-outbreak/; also at U.S. President (Trump), “Declaring a

National Emergency Concerning the Novel Coronavirus Disease (COVID–19) Outbreak,” 85 Federal Register 53,

March 18, 2020, and U.S. Department of Health and Human Services (HHS), “Secretary Azar Declares Public Health

Emergency for United States for Coronavirus Disease 2019,” press release, January 31, 2020, https://www.hhs.gov/

about/news/2020/01/31/secretary-azar-declares-public-health-emergency-us-2019-novel-coronavirus.html;

https://www.phe.gov/emergency/news/healthactions/phe/Pages/2019-nCoV.aspx.

59 For examples of additional related legislation introduced, see S. 3450, H.R. 6093, H.R. 6194, and H.R. 6212.

60 Letter from Russell T. Vought, Acting Director, Office of Management and Budget, Executive Office of the

President, to the Honorable Michael R. Pence, President of the Senate, March 17, 2020.

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Department of Veterans Affairs’ Potential Role in Addressing the COVID-19 Outbreak

months of health care treatment provided in the community in response to COVID-19. VA

assumes that about 20% of care for eligible veterans will be provided in the community, since

community care facilities would be at full capacity with nonveteran patients. Furthermore, the

request includes $100 million for the medical support and compliance account for the provision

of 24-hour emergency management coordination overtime payments; for costs associated with

travel and transport of materials; and to enable VHA’ s Office of Emergency Management to

manage its response to COVID-19. The emergency supplemental appropriations request also

includes $175 million for the medical facilities account to upgrade VA medical facilities to

respond to the virus. The request also includes $1.2 billion for the information technology

systems account to upgrade telehealth and related internet technology to deliver more health care

services remotely.

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Department of Veterans Affairs’ Potential Role in Addressing the COVID-19 Outbreak

Appendix. VHA Emergency Powers

Table A-1. VHA’s Emergency Powers

An Overview of Governing Legal Authorities and VA Regulations and Policies

Issue

Authority

Description

VA Hospital Care and Treatment

Veterans

38 U.S.C. Chapters 17, 73;

38 C.F.R. §§17.36-17.38

VHA’s primary function “is to

provide a complete medical and

hospital service for the medical care

and treatment of veterans” (38

U.S.C. §7301).

Other VA Beneficiaries

38 U.S.C. §1781;

38 C.F.R. §§17.250-17.251

VA may provide health care to

certain veterans’ spouses, surviving

spouses, and children.

Members of the Armed Forces

38 U.S.C. §8111A;

VHA Directive 0320 (2013)

VA may furnish hospital care and

medical services to members of the

Armed Forces during a time of war

or national emergency.

Non-VA Beneficiaries, Generally

38 U.S.C. §§1784, 1784A

38 C.F.R. §§17.37, 17.43, 17.95,

17.102

VA may provide hospital care or

medical services as a humanitarian

service but must charge for such

care; VA may also provide

treatment for emergency medical

conditions and women in labor.

Non-VA Beneficiaries in a Disaster

or Emergency

38 U.S.C. §1785;

VHA Directive 0320 (2013)

VA may provide hospital care and

medical services to individuals

responding to, involved in, or

otherwise affected by a national

disaster or emergency.

Priorities for Providing Medical

Care

38 U.S.C. §8111A;

38 C.F.R. §17.49

VA must give treatment priority to

veterans with service-connected

disabilities rated 50% or greater and

to veterans needing care for

service-connected disabilities; VA

may then give priority to members

of the Armed Forces.

Sharing Health Care Resources

General Authority

38 U.S.C. §8153;

VHA Directive 1660.01 (2018)

VA has authority to enter into

agreements for the mutual use or

exchange of resources with non-VA

facilities “to secure health-care

resources which otherwise might

not be feasibly available” (38 U.S.C.

§8513(a)(1)).

Department of Defense

38 U.S.C. §8111;

VHA Directive 1660 (2015)

VA and DOD are required to enter

into agreements to share health

care resources to improve “the

access to, and quality and cost

effectiveness of” each department’s

health care services (38 U.S.C.

§8111(a)).

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Department of Veterans Affairs’ Potential Role in Addressing the COVID-19 Outbreak

Issue

Authority

Description

Quarantine and Isolation

General Authority

42 U.S.C. §§264, 266;

42 C.F.R. parts 70, 71;

State, Local, and Tribal law

VA has no specific authority to

involuntarily quarantine or isolate

patients, and instead must rely on

each state’s laws, as well as

instructions from the Centers for

Disease Control and Prevention, in

times of war, the Surgeon General.a

VA Provider Liability

General Liability

28 U.S.C. §§1326(b), 2671-80;

38 U.S.C. §7316

VA health care providers acting

within the scope of their

employment are shielded from

personal liability, but victims of

medical malpractice or other injury

can sue the United States under the

Federal Tort Claims Act (FTCA).b

Declared Emergencies and Major

Disasters under the Stafford Act

42 U.S.C. §5148

Neither the U.S. government nor

VA health care providers are liable

for “any claim based upon the

exercise or performance of or the

failure to exercise or perform a

discretionary function or duty” in

responding to a declared

emergency or major disaster.

(Robert T. Stafford Disaster Relief

and Emergency Assistance Act

§305, 42 U.S.C. §5148 [2018]).

Transportation of Employees

In General

31 U.S.C. §1344(a)

VA may only use government

vehicles to transport employees for

official purposes, which does not

include transportation to or from

an employee’s residence.

During an Emergency

38 U.S.C. §703(f)

If the Secretary determines an

emergency exists, VA may

transport employees between their

places of employment and the

nearest public transportation or, if

public transit is unavailable or

infeasible, their residences, but the

Secretary must “establish

reasonable rates to cover the cost

of the service” (38 U.S.C.

§703(f)(2)).

Credentialing and Privileging Health Care Providers

In General

Congressional Research Service

38 U.S.C. §7402;

VHA Directive 2012-030 (2012)

Health care providers generally

must be fully credentialed prior to

their initial appointments.

13

Department of Veterans Affairs’ Potential Role in Addressing the COVID-19 Outbreak

Expedited and Disaster

Appointments

VHA Directive 2012-030

attachment D

VA provides expedited

credentialing procedures in the best

interest of patient care and in

response to disasters and

emergencies.

VA Disaster Emergency Medical Personnel System

In General

VHA Directive 0320 (2013);

VHA Handbook 0320.03 (2008)

The VA Disaster Emergency

Medical Personnel System (DEMPS)

program allows VA medical

providers to register as volunteers

to respond to domestic disasters

and emergencies by deploying to

affected VA facilities or other

locations as required.

Source: Adapted and updated by CRS from Department of Veterans Affairs, VA Pandemic Influenza Plan app. B2 (2006).

a. Department of Veterans Affairs, VA Pandemic Influenza Plan app. B-2 (2006). For an overview of the federal

government’s quarantine authority, see Legal Authorities for Isolation and Quarantine, Centers for Disease

Control and Prevention, https://www.cdc.gov/quarantine/aboutlawsregulationsquarantineisolation.html (last

visited March 18, 2020).

b. For more information on the FTCA, see CRS Report R45732, The Federal Tort Claims Act (FTCA): A Legal

Overview, by Kevin M. Lewis.

Author Contact Information

Sidath Viranga Panangala

Specialist in Veterans Policy

[redacted]@crs.loc.gov , 7-....

Jonathan M. Gaffney

Legislative Attorney

[redacted]@crs.loc.gov

, 7-....

Jared S. Sussman

Analyst in Health Policy

[redacted]@crs.loc.gov, 7-....

Libby Perl

Specialist in Housing Policy

[redacted]@crs.loc.gov

, 7-....

Cassandria Dortch

Specialist in Education Policy

[redacted]@crs.loc.gov

, 7-....

Heather M. Salazar

Analyst in Veterans Policy

[redacted]@crs.loc.gov

, 7-....

Congressional Research Service

R46280 · VERSION 2 · NEW

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