Federal Response to COVID-19: Department of Veterans Affairs
Congressional research reportMay 1, 2020
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Federal Response to COVID-19:
Department of Veterans Affairs
Sidath Viranga Panangala, Coordinator
Specialist in Veterans Policy
Jared S. Sussman, Coordinator
Analyst in Health Policy
Cassandria Dortch
Specialist in Education Policy
Victoria L. Elliott
Analyst in Health Policy
Jonathan M. Gaffney
Legislative Attorney
Libby Perl
Specialist in Housing Policy
Heather M. Salazar
Analyst in Veterans Policy
May 1, 2020
Congressional Research Service
7-....
www.crs.gov
R46340
SUMMARY
Federal Response to COVID-19:
Department of Veterans Affairs
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, the
VHA is 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. These
functions are known as VA’s “Fourth Mission.”
Since the onset of the Coronavirus Disease 2019 (COVID-19) pandemic, Congress has
passed a number of relief measures affecting the VA and its Fourth Mission.
The Families First Coronavirus Response Act (P.L. 116-127), enacted on March 18,
2020, provides $60 million for the VHA in emergency supplemental appropriations.
Among other things, the act also prohibits the VA from charging any copayment or other
cost-sharing payments for COVID-19 testing or medical visits during any period of this
public health emergency.
R46340
May 1, 2020
Sidath Viranga Panangala,
Coordinator
Specialist in Veterans
Policy
-redacted-@crs.loc.gov
Jared S. Sussman,
Coordinator
Analyst in Health Policy
-redacted-@crs.loc.gov
Cassandria Dortch
Specialist in Education
Policy
-redacted-@crs.loc.gov
Victoria L. Elliott
Analyst in Health 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.
P.L. 116-128, enacted on March 21, allows the 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.
The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) (P.L. 116-136), enacted on March 27,
provides a total of $19.6 billion in emergency supplemental appropriations for FY2020 for certain VA accounts, as
well as temporary statutory relief for various VA programs and services during the COVID-19 public health
emergency.
The Student Veteran Coronavirus Response Act of 2020 (P.L. 116-140), enacted on April 28, 2020, is intended
to mitigate the disruption to VA educational benefits, including Vocational Rehabilitation & Employment
(VR&E), when schools, programs of education, and work are suspended or closed from March 1, 2020, to
December 21, 2020.
Congressional Research Service
Federal Response to COVID-19: Department of Veterans Affairs
Contents
Introduction ..................................................................................................................................... 1
Novel Coronavirus (COVID-19) ..................................................................................................... 2
Scope and Limitations of This Report ............................................................................................. 2
Medical Care for Veterans During the COVID-19 Outbreak .......................................................... 3
Health System Capacity ............................................................................................................ 4
Employment Actions Related to the Pandemic Response................................................... 5
Mitigation at VHA Sites of Care ............................................................................................... 6
CLCs and SCI/Ds................................................................................................................ 7
Enhanced Screening at All Sites of Care ............................................................................ 7
Limitations on Community Care ........................................................................................ 8
Guidance for Patients ................................................................................................................ 8
COVID-19 Testing and Treatment ............................................................................................ 9
COVID-19 Diagnostic Testing............................................................................................ 9
COVID-19 Treatment ....................................................................................................... 10
Homelessness and Housing ............................................................................................................ 11
VA General Guidance for Homeless Program Grantees .......................................................... 11
Supportive Services for Veteran Families (SSVF) .................................................................. 12
HUD-VA Supportive Housing program (HUD-VASH) .......................................................... 13
VA Loan Programs .................................................................................................................. 13
Veterans Benefits Administration .................................................................................................. 13
Compensation and Pension Benefits ....................................................................................... 14
Educational Assistance ............................................................................................................ 15
National Cemetery Administration ................................................................................................ 16
Emergency Preparedness (“Fourth Mission”) ............................................................................... 17
Congressional Response ................................................................................................................ 19
Families First Coronavirus Response Act (P.L. 116-127) ....................................................... 19
Supplemental Appropriations and Cost-Sharing ............................................................... 19
P.L. 116-128 ............................................................................................................................ 19
Education Assistance ........................................................................................................ 19
Coronavirus Aid, Relief, and Economic Security Act, “CARES Act” (P.L. 116-136) ............ 20
Emergency Supplemental Appropriations ........................................................................ 20
General CARES Act Provisions Affecting VA Programs and Services ............................ 24
Section 20001. Transfer of Funds ..................................................................................... 24
Section 20002. Monthly Reports ...................................................................................... 24
Section 20003. Public Health Emergency......................................................................... 24
Section 20004. Short-Term Agreements or Contracts with Telecommunications
Providers to Expand Telemental Health Services for Isolated Veterans During A
Public Health Emergency .............................................................................................. 24
Section 20005. Treatment of State Homes During Public Health Emergency.................. 25
Section 20006. Modifications to Veteran Directed Care Program of Department of
Veterans Affairs.............................................................................................................. 25
Section 20007. Provision by Department of Veterans Affairs of Prosthetic
Appliances through Non-Department Providers During Public Health
Emergency ..................................................................................................................... 26
Congressional Research Service
Federal Response to COVID-19: Department of Veterans Affairs
Section 20008. Waiver of Pay Caps for Employees of Department Of Veterans
Affairs During Public Health Emergencies ................................................................... 26
Section 20009. Provision by Department of Veterans Affairs of Personal
Protective Equipment for Home Health Workers .......................................................... 26
Section 20010. Clarification of Treatment of Payments for Purposes of Eligibility
for Veterans Pension and Other Veterans Benefits......................................................... 26
Section 20011. Availability of Telehealth for Case Managers and
Homeless Veterans ......................................................................................................... 27
Section 20012. Funding Limits for Financial Assistance for Supportive Services
for Very Low-Income Veteran Families in Permanent Housing During A Public
Health Emergency.......................................................................................................... 27
Section 20013. Modifications to Comprehensive Service Programs for Homeless
Veterans During A Public Health Emergency ................................................................ 27
Student Veteran Coronavirus Response Act of 2020 (P.L. 116-140)....................................... 27
Section 3. Payment of Work-Study Allowances During Emergency Situations ............... 28
Section 4. Payment of Allowances to Veterans Enrolled in Educational
Institutions Closed for Emergency Situations................................................................ 28
Section 5. Prohibition of Charge to Entitlement of Students Unable to Pursue a
Program of Education Due to an Emergency Situation ................................................. 28
Section 6. Extension of Time Limitations for Use of Entitlement .................................... 28
Section 7. Restoration of Entitlement to Rehabilitation Programs for Veterans
Affected by School Closure or Disapproval .................................................................. 29
Section 8. Extension of Payment of Vocational Rehabilitation Subsistence
Allowances .................................................................................................................... 29
Tables
Table 1. Department of Veterans Affairs, Regular and COVID-19 Appropriations,
FY2020 ....................................................................................................................................... 21
Table A-1. VHA’s Emergency Powers .......................................................................................... 30
Appendixes
Appendix. VHA Emergency Powers ............................................................................................. 30
Contacts
Author Contact Information .......................................................................................................... 32
Congressional Research Service
Federal Response to COVID-19: Department of Veterans Affairs
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
must, by statute, serve as a contingency backup to the Department of Defense (DOD) medical
system during a national security emergency10 and 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 must also 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 The NCA was stablished 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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Federal Response to COVID-19: Department of Veterans Affairs
Novel Coronavirus (COVID-19)13
On December 31, 2019, the World Health Organization (WHO) learned of a cluster of pneumonia
cases in Wuhan City, Hubei Province of China. The WHO has since linked these illnesses to a
disease, called Coronavirus Disease 2019 or COVID-19, caused by a previously unidentified
strain of coronavirus, designated SARS-CoV-2. 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 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. The VHA 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 of This Report
This report provides an overview of VA’s and Congress’s response thus far to the rapidly
evolving COVID-19 pandemic. The report does not provide an exhaustive description of all of
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 Department of Veterans Affairs, Veterans Health Administration,
Office of Emergency Management, COVID-19 Response Plan, Incident-specific Annex to the VHA High Consequence
Infection (HCI) Base Plan, Version 1.6, March 23, 2020, pp. 6-7.
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Federal Response to COVID-19: Department of Veterans Affairs
the department’s activities, and it is based on publicly available information and daily updates
provided from the VA.
The report is organized as follows:
first, it provides details on VHA’s, VBA’s, and NCA’s response activities;
second, it provides details on VA’s emergency preparedness (“Fourth Mission”)
activities to provide support to the overall federal emergency response; and
third, it describes congressional activity related to VA and veterans programs and
services.
The COVID-19 pandemic is a rapidly evolving situation and information changes on a daily, or
often hourly, basis. 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 sites of care, 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, the 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 VA has been providing regular updates to congressional oversight committees
since that time.
The VA has published two public documents that provide valuable information to patients and the
public regarding the response to COVID-19:25 (1) a COVID-19 response plan that provides
operational details for both medical care for veterans, as well as other VHA missions, and (2)
Coronavirus Frequently Asked Questions (FAQ) for patients. The VA COVID-19 response plan is
summarized in more detail in the “Emergency Preparedness (“Fourth Mission”)” section of this
report.
This section describes current health system capacity (including staffing changes), guidance for
patients, mitigation at VHA sites of care (including limitations to community care), and testing
and treatment for COVID-19.
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.accesstocare.va.gov/Healthcare/
COVID19NationalSummary
25 Department of Veterans Affairs, “VA Releases COVID-19 Response Plan,” press release, March 27, 2020,
https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5405.
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Federal Response to COVID-19: Department of Veterans Affairs
Health System Capacity
This subsection reflects point-in-time information provided by the VA to reflect the current
capacity of the system.
As of April 14, 2020, veterans and VHA employees at sites of care spanning the United States
have been diagnosed with COVID-19. The vast majority of COVID-19-positive veterans are
being treated in outpatient settings, with a minority in VA inpatient intensive care unit (ICU) and
acute care settings. The COVID-19 pandemic is a rapidly evolving situation and information
changes on a daily, or often hourly, basis.
In response to the pandemic, the VA increased the number of ICU and acute care beds that are
typically available. As of April 29, 2020, bed capacity across the health system is 12,215, with far
less than half occupied.26 No regional or local level occupancy data have been reported. The VA
started deploying Vet Centers, which provide a range of counseling services, in locations facing
large COVID-19 outbreaks.27
The VA is reporting that the health system has adequate levels of personal protective equipment
(PPE), including N95 respirators.28 Earlier media reports, citing internal VA memoranda, stated
that the VA has a shortage of PPE and hospitals are being directed to decide which employees get
certain supplies.29 The media reports suggested that only employees that work directly with
COVID-19 patients are to be provided N95 respirators.
An April 16, 2020, memorandum to Veterans Integrated Service Networks (VISN) directors from
the VA Deputy Under Secretary for Health for Operations and Management confirmed that the
VA received a significant number of N95 respirators and is working to secure additional
facemasks and surgical masks.30 The memo specified that facilities have enough masks and
respirators to follow CDC-based contingency strategies for supply management.31 The memo
provides system-wide guidance for staff use of respirators and masks.
Staff providing direct care should use N95 respirators. If N95 respirators are in
short supply, staff are directed to use surgical masks for low-risk care on
suspected or confirmed COVID-19 patients.
Staff providing care for patients in specified institutional settings will be
provided with one facemask or surgical mask per day.
It goes on to provide guidance to VISN directors on how to support medical facility directors in
implementing contingency and crisis strategies based on the referenced CDC guidelines. Medical
facility directors have authority to determine allocation and crisis standards of care, in the event
that resources become scarce.32
26 VHA Daily COVID-19 Update, April 29, 2020.
27 As of April 3, 2020, the VA deployed Vet Centers in New York, NY; Pasadena, CA; and Portland, OR. For more
information on Vet Centers, see CRS In Focus IF11378, Veterans Health Administration: Behavioral Health Services.
28 VHA Daily COVID-19 Update, April 29, 2020.
29 Ben Kesling, “Veterans Affairs Hospitals Facing ‘Serious’ Shortage of Protective Gear, Internal Memos Show,” The
Wall Street Journal, April 11, 2020.
30 Department of Veterans Affairs, Deputy Under Secretary for Health for Operations and Management, Update:
Coronavirus (COVID-19) Return to a Contingency strategy for Facemask and N95 Respirator Use, April 16, 2020.
31 For the CDC guidelines for PPE management, see https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/
face-masks.html.
32 Department of Veterans Affairs, Veterans Health Administration, Care Continuity Program, VHA Directive 0320.02,
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Federal Response to COVID-19: Department of Veterans Affairs
The VA is allocating equipment within VISNs, as needed,33 and it has increased pharmaceutical
inventories from 8 days to 10 days and is utilizing certain medications needed for hospitalized
COVID-19 patients as national system-wide resources.34
As described below, the VA has taken a number of actions to ensure that there is adequate staffing
and that safeguards are in place to protect frontline employees. These actions are described in the
next section.
Employment Actions Related to the Pandemic Response
Actions related to employment can be separated into two categories: (1) actions to increase the
capacity of the health system during the pandemic response and (2) actions to protect current
employees from contracting the COVID-19 virus.
Employment Actions to Increase Health System Capacity
The VA submitted a request to the Office of Personnel Management (OPM) and received approval
to waive a requirement that retiree’ salaries be reduced when rehired to reflect the retirement
annuity they already receive, otherwise known as a dual compensation reduction waiver.35 The
VA is asking retired clinicians to register online to join the workforce and to act as surge capacity
if needed.36 The registration form adds the reemployed retirees to VHA’s national provider
database and matches them to opportunities based on their specialties.37
The VA has indicated that it is exploring the use of existing hiring authorities to make 30-day
appointments where a critical need exists, one-year appointments in remote/isolated areas, and
temporary not-to-exceed 120-day appointments.38 VA on-boarded 3,107 new hires in the period
between April 22 and April 28, 2020.39
In addition, activation of the Disaster Emergency Medical Personnel System (DEMPS) allows the
VA to deploy personnel from areas that are less impacted by COVID-19 to reinforce staff levels at
other facilities as needed (e.g., facilities in New York City and New Orleans).40 Under DEMPS,
movement of personnel must be approved by the VISN and the originating medical center’s
director.
Washington, DC, January 22, 2020, p. 5.
33 VISNs are regional administrative units within the VHA. For more information, see CRS In Focus IF10555,
Introduction to Veterans Health Care.
34 VHA Daily COVID-19 Update, April 29, 2020.
35 Office of Personnel Management, “NEWS: OPM Issues Flexibility to the VA to Combat COVID-19,” press release,
March 20, 2020, https://www.opm.gov/news/releases/2020/03/opm-issues-flexibility-to-the-va-to-combat-covid-19/.
Also see CRS In Focus IF11468, Federal Executive Agencies: Hiring Flexibilities for Emergency Situations.
36 Department of Veterans Affairs, “After OPM action, VA invites retired medical personnel back to work,” press
release, March 24, 2020, https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5404.
37 To view the registration form for retirees to rejoin the workforce, see https://jobs.kontactintelligence.com/
VeteranAdmin/Apply?170d70b8b2ff2c02999be209277e8faf.
38 5 C.F.R. § 213.3102(i)(2); 5 C.F.R. § 213.3102(i)(1); and 5 C.F.R. §§ 316 and 330, respectively.
39 VHA Daily COVID-19 Update, April 29, 2020.
40 Ibid.
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Federal Response to COVID-19: Department of Veterans Affairs
Employment Actions to Protect Employees
A number of VHA employees have been diagnosed with COVID-19 or are being monitored for
COVID-19. As of April 29, 2020, over 2,200 employees have been diagnosed with COVID-19
and 20 employees have died from the disease.41 The VA has taken specific actions to protect
employees, which, in turn, increases health system capacity by reducing the need for front-line
employees to take leave during the pandemic.
The VA is following CDC precautions to reduce the likelihood of transmission of COVID-19
among employees.42 According to the VA, staff have been given guidance to remain home if
symptoms develop, to obtain health checks for symptoms associated with COVID-19 while at
work, and to report symptoms through the correct process.43 Employees are also being
encouraged to develop personal and family disaster plans that enable them to continue working.44
Employees are encouraged to telework, if their work can be accomplished remotely.
Sites of care are encouraged to use alternative treatment methods wherever possible, such as
telemedicine and telehealth. To prevent the spread of infection, the VA has dedicated specific
treatment areas for COVID-19 patients.45 This and other mitigation efforts at VHA sites of care
are discussed below.
Mitigation at VHA Sites of Care
The VHA operates care settings with varying levels of patient risk for developing severe
symptoms if COVID-19 is contracted. Each VA medical center is implementing a two-tiered
system to mitigate the potential for spread of the virus, with one zone for active COVID-19 cases
and a passive zone for care unrelated to COVID-19.46 The VA has canceled all elective surgeries
and limited routine appointments to only those with the most critical need.47
This section describes mitigation efforts at community living centers (CLCs; nursing homes) and
spinal cord injury/disorder (SCI/D) centers, which are high-risk settings, separate from other care
settings. The VA has implemented different screening processes and other pandemic responses
depending on the care setting.
On March 26, 2020, the VA Office of Inspector General (OIG) published the results of
inspections of VA facilities for implementing the enhanced screening processes and pandemic
readiness, which took place between March 19 and March 24.48 The findings of those inspections
for each care setting appear in the appropriate sections below.
41 VHA Daily COVID-19 Update, April 29, 2020.
42 For CDC standard and transmission-based precautions, see https://www.cdc.gov/coronavirus/2019-ncov/infection-
control/control-recommendations.html.
43 VHA Daily COVID-19 Update, April 29, 2020.
44
Office of Emergency Management, COVID-19 Response Plan, Veterans Health Administration, March 23, 2020, p.
42, https://www.va.gov/opa/docs/VHA_COVID_19_03232020_vF_1.pdf.
45 Ibid., p. 41.
46 U.S. Department of Veterans Affairs, COVID-19 Guidance for Community Providers, Fact Sheet IB-10-145, March
2020.
47 White House Coronavirus Task Force, Daily Briefing, March 18, 2020.
48 Office of Inspector General, OIG Inspection of Veterans Health Administration’s COVID-19 Screening Processes
and Pandemic Readiness, Department of Veterans Affairs, March 26, 2020, https://www.va.gov/oig/pubs/VAOIG-2002221-120.pdf.
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Federal Response to COVID-19: Department of Veterans Affairs
CLCs and SCI/Ds
On March 10, 2020, the VA announced safeguards to protect nursing home residents and spinal
cord injury patients.49 As of that date, no visitors are allowed at either VA nursing homes or spinal
cord injury/disorder centers. The only exception to this policy is if a veteran is in the last stages of
life, in which case the VA allows visitors in the veteran’s room only. The VA is not accepting any
new admissions to nursing homes and is limiting new admissions to SCI/D centers.
The OIG tested the no-access policy at 54 CLCs and found the majority to be in compliance with
the policy.50 Nine of the 54 CLCs tested were prepared to allow OIG staff to enter, despite the noaccess policy.51
Enhanced Screening at All Sites of Care
The VA implemented enhanced screening procedures at all sites of care to screen for respiratory
illness and COVID-19 exposure. Because each facility determines its own enhanced screening
procedures, those procedures vary at the local level. However, the VA has designed standardized
screening questions for each facility. Screening consists of the following three general questions:
Do you have a fever or worsening cough or shortness of breath or flu-like
symptoms?
Have you or a close contact traveled to an area with widespread or sustained
community transmission of COVID-19 within 14 days of symptom onset?
Have you been in close contact with someone, including health care workers,
confirmed to have COVID-19?
The VA’s COVID-19 response plan provided specific potential questions that sites of care can
implement in different care settings.52 Those screening questions also include screening scenarios
for virtual triage via phone, telehealth, or secure messaging.
If screened individuals are determined to be at risk, staff are instructed to isolate them
immediately. If critically ill, individuals are transferred to the emergency department. If stable,
individuals are sent home with printed instructions to isolate and contact their primary care
providers.53
The OIG evaluated screening procedures at 58 medical centers and 125 community-based
outpatient clinics (CBOC). The OIG found that 41 of 58 (71%) of medical centers’ screening
processes were generally adequate, 16 (28%) had some opportunities for improvement, and one
medical center had inadequate screening procedures.54 The OIG found that the vast majority of
49 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.
50 Office of Inspector General, OIG Inspection of Veterans Health Administration’s COVID-19 Screening Processes
and Pandemic Readiness, Department of Veterans Affairs, March 26, 2020, pp. 11-14, https://www.va.gov/oig/pubs/
VAOIG-20-02221-120.pdf.
51 If no one was checking visitors or if access was granted, OIG staff were instructed to not enter the facility.
52 Office of Emergency Management, COVID-19 Response Plan, Veterans Health Administration, March 23, 2020, pp.
30-38, https://www.va.gov/opa/docs/VHA_COVID_19_03232020_vF_1.pdf.
53 Office of Emergency Management, COVID-19 Response Plan, Veterans Health Administration, March 23, 2020, p.
16, https://www.va.gov/opa/docs/VHA_COVID_19_03232020_vF_1.pdf.
54 Office of Inspector General, OIG Inspection of Veterans Health Administration’s COVID-19 Screening Processes
and Pandemic Readiness, Department of Veterans Affairs, March 26, 2020, p. 5, https://www.va.gov/oig/pubs/
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CBOCs (97%) had screening processes in place. Four CBOCs had no screening process in
place.55
Limitations on Community Care
The VA instituted several changes to community care guidance during the COVID-19 pandemic
response on community care access under the Veterans Community Care Program (VCCP).
Under normal circumstances, veterans generally are eligible for access to medical care from nonVA community providers if they meet certain criteria, including wait time and drive time access
standards and if the veteran elects to receive community care.56
The eligibility criteria are mandated by law, and the VA has no authority to waive them.57
However, as many non-VA providers are postponing or canceling routine care to mitigate the
spread of COVID-19, wait times may be just as long or longer in the community. In addition, the
VA indicated that community providers should not have veterans attend routine appointments inperson except where the urgency of in-person treatment outweighs the risk of contracting
COVID-19.58
VA issued the following guidance to providers:
convert routine in-person appointments to telehealth;59
follow CMS, CDC, state, and local guidance regarding screening, testing, case
reporting, and PPE;
plan for increased high acuity demand;
communicate with local VA medical center regarding any veteran cases or
exposure to COVID-19;
episodes of care ordered through the VA can be extended by 60 days; and
work with the third-party administrators of the community care network (CCN)
to expand enrollment where possible.60
Guidance for Patients
The VA is promoting the Coronavirus FAQ document as the main source of guidance for
veterans.61 This document includes answers to broad questions about COVID-19, VA’s role,
VAOIG-20-02221-120.pdf.
55 Ibid. pp. 10-11.
56 For more information on the VCCP, see CRS Report R45390, VA Maintaining Internal Systems and Strengthening
Integrated Outside Networks Act of 2018 (VA MISSION Act; P.L.115-182).
57 38 U.S.C. § 1703(d); 38 C.F.R. § 17.4010.
58 Letter from Kameron Matthews, Deputy Under Secretary for Health for Community Care, to Community Providers,
April 1, 2020, https://www.va.gov/COMMUNITYCARE/docs/providers/COVID-19_Guidance-Letter.pdf.
59 For more information on VA telehealth, see CRS Report R45834, Department of Veterans Affairs (VA): A Primer on
Telehealth.
60 The CCN is separated into regions. Administration is either accomplished by contract with third-party administrators
or by VA directly, depending on the region.
61 The Coronavirus FAQ is available at https://www.va.gov/coronavirus-veteran-frequently-asked-questions/.
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testing, access to care, mental health, and visiting patients. A fact sheet with similar information is
also available to patients.62
The 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 asked to send a secure message through the VHA
online portal, My HealtheVet, or to schedule a telehealth appointment.63 The VA is experiencing
high call volumes at some facilities and call centers, so it is advising veterans to use online tools
first. However, patients can call their health care providers instead of using the online tools
available from the VA.64
In addition, the 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.
COVID-19 Testing and Treatment65
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.66
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,
the VA has advised providers that to be tested, 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.67 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 copayment requirements.68
The Families First Coronavirus Response Act (P.L. 116-127), enacted on March 18, 2020, does
not allow the VA to charge any copayment or other cost-sharing payments for COVID-19 testing
or medical visits during any period of this public health emergency.69 (For a discussion of P.L.
116-127, see the “Congressional Response” section of this report.)
62 The VA COVID-19 fact sheet is available at https://www.tucson.va.gov/docs/COVID19FactSheetFINAL508.pdf.
63 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.
64 Veterans can call MyVA311 (844-698-2311) to reach their local VA medical center.
65 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.
66 https://www.publichealth.va.gov/n-coronavirus/.
67 38 C.F.R. §17.38.
68 38 C.F.R. § 17.108(e)(14).
69 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 (38 C.F.R. §17.38). Some veterans are required to pay copayments
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COVID-19 Treatment
The VA has not indicated whether it has developed a specific treatment plan for patients
diagnosed with COVID-19. Treatment depends largely on the severity of symptoms that each
patient experiences.
The 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.70
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.71 Eligible veterans needing
urgent care must obtain care through facilities that are part of VA’s contracted network of
community providers.72 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.73 Certain veterans are required to pay copayments for
care obtained at a VA-contracted urgent care facility or walk-in retail health clinic.74
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
for care that is not related to a service-connected disability. However, routine lab tests are exempt from copayments.
(38 C.F.R. §17.108(e)(14)). Prior to enactment of P.L. 116-127, it was unclear whether VA was including COVID-19
testing under this exemption.
70 For more information on copayments for medical care, see CRS Report R42747, Health Care for Veterans: Answers
to Frequently Asked Questions.
71 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).
72 https://vaurgentcarelocator.triwest.com/.
73 U.S. Department of Veterans Affairs, Veteran Community Care – Urgent Care, Fact Sheet, May 2019.
74 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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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.
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 to first pursue all
claims against a third party for payment of such treatment.75
Potential Vaccine Cost-sharing
In the event that a vaccine is approved by FDA and brought to market, it is unclear whether
certain veterans would be charged copayments for administration of the vaccine.76 Under current
regulations, the VA is prohibited from charging copayments for “an outpatient visit solely
consisting of preventive screening and immunizations (e.g., influenza immunization,
pneumococcal immunization).”77
Homelessness and Housing
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.
The VA administers programs to assist veterans experiencing homelessness and also manages
several grant programs for nonprofit and public entities to provide housing and services to
homeless veterans. These include the Homeless Providers Grant and Per Diem program (GPD),
for transitional housing and services; the Supportive Services for Veteran Families program
(SSVF), for short- to medium-term rental assistance and services; and Contract Residential
Services (CRS), for providing housing for veterans participating in VA’s Health Care for
Homeless Veterans program. In addition, the Department of Housing and Urban Development
(HUD), together with VA, administers the HUD-VA Supportive Housing program (HUD-VASH),
through which veterans who are homeless may receive Section 8 vouchers to cover the costs of
permanent housing and VA provides case management services.78
VA General Guidance for Homeless Program Grantees
The VA released guidance on March 13, 2020, for its grantees that administer programs for
veterans who are homeless.79 The guidance suggests grantees take a number of actions:
75 38 U.S.C. §1725. 38 C.F.R. §§17.1000-17.1008.
76 For more information on COVID-19 and vaccination, see CRS Legal Sidebar LSB10427, COVID-19: Legal
Considerations for Bringing a New Vaccine to Market.
77 38 C.F.R. §17.108(e)(11).
78 For more information, see CRS Report RL34024, Veterans and Homelessness.
79 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-19-
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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.80 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’s answers to questions indicate risk of COVID-19, separate them from
other program participants (have an isolation area, if possible), clean surfaces,
and reach out to medical professionals. If isolation is not practical, reach out to
other providers who might be able to isolate.
Supportive Services for Veteran Families (SSVF)
The VA has released additional specific guidance and flexibilities for SSVF providers.
SSVF regulations allow funds to be used for emergency housing, including hotels
and motels; however, this use of funds may occur only when no other housing
options, such as transitional housing through GPD, are available. In response to
COVID-19, however, grantees may use funds for high-risk veterans to live in
hotels and motels instead of congregate settings.81
Due to Public Housing Authority (PHA) closures and remote work, veterans who
have HUD-VASH vouchers, but who have not yet moved into a housing unit,
may face delays in receiving rental assistance. This delay may occur if a PHA
cannot conduct a housing quality standards (HQS) inspection or complete other
administrative tasks that allow move-in to occur. In these cases, SSVF grantees
may use funds to cover rental assistance until a PHA has completed the tasks
allowing the voucher to be used.82
VA_Grantees_3-13-20.pdf.
80 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.
81 U.S. Department of Veterans Affairs, Available SSVF Resources to Place Homeless Veterans at High-Risk of
COVID-19, March 13, 2020, https://www.va.gov/HOMELESS/ssvf/docs/
Available_Supportive_Services_for_Veteran_Families_SSVF_Resources_to_Place_Homeless_Veterans_at_HighRisk_
of_COVID_19.pdf.
82 U.S. Department of Veterans Affairs, HUD-VASH SSVF Referral Packet COVID-19, For use between March 27 and
June 30, 2020, March 2020, https://www.va.gov/HOMELESS/ssvf/docs/
HUD_VASH_SSVF_Referral_Packet_COVID_19.docx.
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HUD-VA Supportive Housing program (HUD-VASH)
For veterans residing in rental housing using HUD-VASH vouchers, HUD has waived certain
requirements pursuant to CARES Act (P.L. 116-136) waiver authority to address situations that
may arise due to COVID-19.83 For example, ordinarily HUD will not approve a unit for Section 8
rental assistance (which includes HUD-VASH vouchers) unless it has passed an HQS inspection.
However, HUD has waived this requirement and will accept an owner certification that there is
“no reasonable basis to have knowledge that life threatening conditions exist in the unit.” PHAs
must conduct inspections of units as soon as reasonably possible, and no later than October 31,
2020. PHAs may also accept alternative inspection results rather than HQS inspections and allow
families to move into units in these cases. For existing tenants, PHAs may change from an annual
unit inspection schedule to a biennial schedule without updating their administrative plan.
If resident income changes due to an inability to work, or other reason, residents should report the
change to their local PHA and rent should be adjusted accordingly. HUD has waived the
requirement that PHAs obtain third-party verification of an income change for these income
recertifications. In addition, as part of the CARES Act (P.L. 116-136), residents receiving Section
8 rental assistance cannot be evicted for nonpayment of rent for 120 days from the date of the
bill’s enactment (March 27, 2020).84
VA Loan Programs
The VA administers both guaranteed and direct loans for veterans through the Veterans Benefits
Administration.85 Prior to enactment of the CARES Act, VA encouraged lenders to establish a
foreclosure moratorium for borrowers with VA loans, but a moratorium was not required.
However, the CARES Act provides for both forbearance (i.e., allowing borrowers to reduce or
suspend mortgage payments) and a foreclosure moratorium for federally backed single-family
mortgages, including guaranteed VA loans. Direct VA loans do not appear to be included in the
CARES Act definition of federally backed mortgage.
Borrowers may request forbearance from their loan servicer for up to 180 days, with another 180day extension, due to financial hardship caused directly or indirectly by COVID-19. The
foreclosure moratorium is in effect for 60 days beginning March 18, 2020. For more information
about these provisions, see CRS Insight IN11334, Mortgage Provisions in the Coronavirus Aid,
Relief, and Economic Security (CARES) Act.
Veterans Benefits Administration
The Veterans Benefits Administration has taken several actions to assure continued delivery of
disability compensation, pensions, and education assistance.
83 U.S. Department of Housing and Urban Development, PIH Notice 2020-05, COVID-19 Statutory and Regulatory
Waivers for the Public Housing, Housing Choice Voucher, Indian Housing Block Grant and Indian Community
Development Block Grant programs, Suspension of Public Housing Assessment System and Section Eight
Management Assessment Program, April 10, 2020, https://www.hud.gov/sites/dfiles/OCHCO/documents/202005pihn.pdf.
84 For more information, see CRS Insight IN11320, CARES Act Eviction Moratorium.
85 For more information, see CRS Report R42504, VA Housing: Guaranteed Loans, Direct Loans, and Specially
Adapted Housing Grants.
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Compensation and Pension Benefits
On March 18, 2020, the Veterans Benefits Administration announced via Facebook and Twitter
that all regional offices would be closed to the public starting March 19.86 The regional offices are
to remain open to ensure the continuity of benefits, however, the offices are longer accepting
walk-ins for claims assistance, scheduled appointments, counseling, or other in-person services.
The VBA is directing veterans who have claims-specific questions or any other questions to use
the Inquiry Routing & Information System (IRIS) or to call 1-800-827-1000.87
In a March 26 interview, VA Under Secretary for Benefits, Dr. Paul Lawrence, assured veterans
and their families that benefits were still being processed thanks in part to the large telework
capability in place for the VBA. Lawrence stated that about 90% of all VBA employees,
approximately 22,500 individuals, are set up and teleworking to retain the continuity of
processing claims.88
Dr. Lawrence also addressed the issue of veterans who need a compensation and pension exam
completed as part of their benefits application. Due to travel restrictions and social distancing
policies, Lawrence explained VBA’s attempt at still providing the exams but without in-person
contact. He stated:
So we’re trying to do more, a lot more through telehealth, You know phone call or a Skype
session or something. We can get these exams done that we’re flexing in new ways. Where
once things were done in person … now they’re being done electronically. 89
Following Dr. Lawrence’s interview, on March 31, the VA issued a press release announcing
changes to several in-person meetings and programs to ensure the safety of both the staff and
veteran/dependent during this time. Some of these changes included
providing educational counseling through online and telephone services;
using teleconferencing and VA Video Connect for case management, general
counseling and connecting veterans to VR&E services;
conducting informal conference hearings by telephone or video conferencing;
providing virtual briefings and individualized counseling for transitioning
servicemembers; and
conducting examinations for disability benefits using tele-compensation and
pension (Tele-C&P) exams. If an in-person examination is required, veterans will
be notified for scheduling.90
However, on April 6, the VBA announced via email that it is “suspending in-person C&P
examinations until further notice and will continue to conduct C&P exams through ACE and TeleC&P, when possible.”91 The email also provided guidance on filing claims and information to
86 This announcement is also included as a banner on the VBA regional offices web page. However, this banner is not
permanent. https://www.benefits.va.gov/benefits/offices.asp
87 https://www.facebook.com/VeteransBenefits/ and https://twitter.com/VAVetBenefits.
88 Interview with Dr. Paul Lawrence, March 26, 2020, Federal News Network, https://federalnewsnetwork.com/
veterans-affairs/2020/03/coronavirus-hits-just-as-vba-was-getting-claims-backlogs-under-control/.
89 Ibid.
90 https://www.blogs.va.gov/VAntage/73202/va-expands-virtual-services-support-veterans-due-covid-19-pandemic/.
91 Email from Veterans Benefits Administration, Monday April 6, 2020, “Your Virtual C&P Examination Alternatives
During the Pandemic.”
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assist veterans with submitting medical documentation without appearing in person. On April 3,
the VA announced that claimants who need an extension in filing their paperwork “can simply
submit [the request] with any late-filed paperwork and veterans do not have to proactively request
an extension in advance.”92
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), Vocational Rehabilitation & Employment (VR&E),
Veteran Employment Through Technology Education Courses (VET TEC), Veterans Work-Study,
Veterans Counseling, and VetSuccess on Campus (VSOC).93 As a result of COVID-19, some
participants’ training and education may be disrupted, and some participants may receive a lower
level of benefits, or none at all. These concerns may directly affect beneficiaries in several ways,
including the following:
Some students may be required to stop out,94 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.
Since mid-March, the VA has sent direct emails to GI Bill participants and school certifying
officials (SCOs) and held webinars for SCOs to explain its authority and payment processing
procedures that are directly relevant to COVID-19 disruptions.95
On March 13, 2020, the VBA Education Service requested that school-certifying officials
“temporarily refrain from making any adjustments to enrollment certifications” if resident courses
transitioned to distance education pending subsequent VA guidance and/or legislative action.96
The VBA Education Service administers VA educational assistance programs. Prior to the
COVID-19 emergency, educational institutions were required to receive approval before
transitioning any courses to a distance learning format for the courses to remain GI Bill-eligible.
92 https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5412.
93 For a description of education benefits other than the Post-9/11 GI Bill, see CRS Report R42785, GI Bills Enacted
Prior to 2008 and Related Veterans’ Educational Assistance Programs: A Primer.
94 A stop-out is a student who interrupts his or her enrollment with a break of more than four months before reenrolling.
95 Emails from VBA Education Service to school-certifying officials and GI Bill participants, March 12, 2020;
Department of Veterans Affairs, VBA Education SCO/SAA Webinar, March 26-27 and 30, 2020; and
https://benefits.va.gov/gibill/.
96 Email from VBA Education Service to school-certifying officials, March 13, 2020.
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GI Bill benefits could not be paid for the pursuit of online courses that had not been previously
approved as online courses. This limitation was alleviated by recently enacted legislation (for a
discussion of P.L. 116-128, see the “Congressional Response” section of this report).
In addition, on April 3, 2020, the VA announced that it was suspending for sixty days the
collection of institutions’ and veterans’ debt, including for debts under the jurisdiction of the
Department of the Treasury.97 Individuals with an existing repayment plan must request a
suspension if they are unable to make payments.98 In 2019, the VA indicated that approximately
25% of GI Bill participants must resolve an overpayment-related debt at some point.99
The VBA Education Service has announced that it is moving away from paper correspondence,
including faxes. In an effort to accomplish this transition, VBA has requested that GI Bill
participants provide or update their email addresses. On-the-job training (OJT) and apprenticeship
training establishments must submit certifications electronically.100
National Cemetery Administration
The National Cemetery Administration has provided information for the survivors and
dependents of veterans who have passed away and are scheduled to be buried in a National
Cemetery during this national emergency. Effective March 23, 2020, the NCA announced that all
“committal services and the rendering of military funeral honors, whether by military personnel
or volunteer organizations, will be discontinued until further notice at VA national cemeteries.”101
VA National Cemeteries will remain open to visitors and for interments, but visitors should
follow their local communities’ restrictions on visitations and travel. In addition, visitors should
be prepared for certain areas of the cemetery typically open to the public to be closed. These areas
include public information centers, visitor centers, and chapels. For direct interments, the NCA is
limiting attendance to immediate family of deceased family members, up to 10 individuals. In
addition, the NCA is to work with families to schedule a committal or memorial service at a later
date.
On Friday, March 27, the NCA informed funeral directors of a change in the floral arrangement
policy, stating that national cemeteries will no longer accept floral arrangements with direct
interments. If families want to place a floral arrangement at the gravesite, they may do so after
4:30 pm on the day of interment or any time after. In addition, the NCA limited floral
arrangements to two per gravesite.
The NCA announced that the National Cemetery Scheduling Office in St. Louis will continue to
provide scheduling services.102 The NCA has set up an “Alerts” web page for the public to check
97 Department of Veterans Affairs, Office of Public and Intergovernmental Affairs, VA extends financial, benefits and
claims relief to Veterans, April 3, 2020; and Department of Veterans Affairs, VBA Education Service, DMC Response
to COVID-19: Treasury Offset Program, Letter, and Payment Processing Concerns, April 9, 2020.
98 Department of Veterans Affairs, Facebook post, The Post-9/11 GI Bill, U.S. Department of Veterans Affairs, April
13, 2020.
99 Leo Shane III, “VA concedes its debt collection systems leave veterans confused, frustrated,” Military Times,
September 19, 2019.
100 Department of Veterans Affairs, VBA Education Service, GI Bill Program Working Towards Paperless
Environment, April 15, 2020.
101 https://www.cem.va.gov/alerts.asp.
102 https://www.facebook.com/NationalCemeteries and https://twitter.com/VANatCemeteries.
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cemetery operating status103and is directing the public to its Facebook and Twitter pages for the
most recent operating information.104
Emergency Preparedness (“Fourth Mission”)
In 1982, the Veterans Administration and Department of Defense 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 a
national emergency.105 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.”106
Among other authorities, the VHA may care for nonveterans, as well as veterans not enrolled in
the VA health care system.107 The VA also has authority to provide certain health services such as
medical counter measures108 to VA employees.109 The authority to care for care for nonveterans,
applies in situations where the President has declared a major disaster or emergency under the
Robert T. Stafford Disaster Relief and Emergency Assistance Act (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.
On March 27, 2020, the VA released its COVID-19 Response Plan.110 The plan defines the VA’s
national level roles and responsibilities:111
103 https://www.cem.va.gov/alerts.asp.
104 https://www.facebook.com/NationalCemeteries and https://twitter.com/VANatCemeteries.
105 38 U.S.C. §811A.
106 U.S. Department of Veterans Affairs, Department of Veterans Affairs FY 2018 - 2024 Strategic Plan, Refreshed
May 31, 2019, May 31, 2019, p. 35.
107 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 the 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.
108 Medical counter measures are: “are life-saving medicines and medical supplies regulated by the U.S. Food and Drug
Administration (FDA) that can be used to diagnose, prevent, protect from, or treat conditions associated with chemical,
biological, radiological, or nuclear (CBRN) threats, emerging infectious diseases, or a natural disaster”
https://www.cdc.gov/cpr/readiness/mcm.html.
109 5 U.S.C. §7901; also see, Appendix A of Department of Veterans Affairs, Veterans Health Administration, AllHazards Emergency Cache Program, VHA Directive 1047, Washington, DC, April 21, 2020, pp. A-1-A-2.
110 Department of Veterans Affairs, “VA Releases COVID-19 Response Plan,” press release, March 27, 2020,
https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5405.
111 Department of Veterans Affairs, Veterans Health Administration, Office of Emergency Management, COVID-19
Response Plan, Incident-specific Annex to the VHA High Consequence Infection (HCI) Base Plan, Version 1.6, March
23, 2020, pp. 6-7.
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VHA will provide [personal protective equipment] PPE fit-testing, medical
screening, and training for [Emergency Support Function #8]112 ESF #8 and other
Federal response personnel.
Provide VHA staff as ESF #8 liaisons to [Federal Emergency Management
Agency] FEMA the Incident Management Assistance Teams deploying to the
state emergency operations center.
Provide VHA planners currently trained to support ESF #8 teams.
VHA provides vaccination services to VA staff and VA beneficiaries in order to
minimize stress on local communities.
VHA furnishes available VA hospital care and medical services to individuals
responding to a major disaster or emergency, including active duty members of
the Armed Forces as well as National Guard and military Reserve members
activated by state or Federal authority for disaster response support.
VHA provides ventilators, medical equipment and supplies, pharmaceuticals, and
acquisition and logistical support through VA National Acquisition Center.
[NCA] provides burial services for eligible veterans and dependents and advises
on methods for interment during national security emergencies.
VHA designates and deploys available medical, surgical, mental health, and other
health service support assets.
VHA provides one representative to the National Response Coordination Center
(NRCC) during the operational period on a 24/7 basis.
According to the 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 followed 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, lifethreating medical conditions are treated before routine medical conditions (see the Appendix).
The Coronavirus Aid, Relief, and Economic Security Act (CARES Act; P.L. 116-136), provided
funding for the Public Health and Social Services Emergency Fund to reimburse the VHA to
respond to COVID-19 and to provide medical care for nonveterans. However, prior to
reimbursing the VHA, the HHS Secretary is required to certify to congressional appropriations
committees that funds available under the Robert T. Stafford Disaster Relief and Emergency
Assistance Act are insufficient and that funds provided under the CARES Act are necessary to
reimburse the VHA for expenses incurred to provide health care to nonveterans.
Generally, if a state, tribal, or territorial government needs resources, it can request assistance
from the federal government through its local HHS regional emergency coordinator (REC),
which is a part of FEMA’s NRCC. The VA cannot receive direct requests for assistance from state
and local governments.113 In addition, the VA does not support providing VA medical personnel to
nondepartment facilities. The VHA has accepted several “fourth mission” assignments from
112 Emergency support functions “are mechanisms for grouping functions most frequently used to provide Federal
support to States and Federal-to-Federal support, both for declared disasters and emergencies under the Stafford Act
and for non-Stafford Act incidents.” Emergency support function #8 pertains to public health and medical services. See
Emergency Support Function Annexes, https://www.fema.gov/media-library/assets/documents/25512.
113 Email from Department of Veterans Affairs, Office of Congressional and Legislative Affairs, March 17, 2020.
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FEMA/HHS. For example, the VHA has responded and provided assistance to New York and
New Jersey. On March 29, VA New York Harbor Healthcare System’s Manhattan and Brooklyn
VA medical centers admitted nonveteran, non-COVID-19 patients, and on April 1, East Orange,
New Jersey VA Medical Center, admitted nonveteran critical and noncritical COVID-19
patients.114 Furthermore, the VHA is providing laboratory services, pharmaceutical and
medication supply through the National Acquisition Center (NAC), and mobile pharmacy units,
among others, as requested by FEMA/HHS.115
Congressional Response
In response to the COVID-19 pandemic, Congress passed several measures to provide the VA
with supplemental appropriations and provided temporary statutory changes to enhance veterans’
benefits and services during this public health emergency.
Families First Coronavirus Response Act (P.L. 116-127)
Supplemental Appropriations and Cost-Sharing
On March 18, 2020, the President signed into law the Families First Coronavirus Response Act
(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, and $30 million for VHA’s medical
community care account (see Table 1).116 These funds are designated as emergency spending and
are to remain available until September 30, 2022. Among other things, the act does not allow the
VA to charge any copayment or other cost-sharing payments for COVID-19 testing or medical
visits during any period of this public health emergency.117
P.L. 116-128
Education Assistance
P.L. 116-128, as enacted on March 21, 2020, allows the VA to continue to provide GI Bill benefits
from March 1, 2020, through December 21, 2020, for courses at educational institutions that are
114 Department of Veterans Affairs, “VA to assist New York City with COVID-19 response,” press release, March 29,
2020, https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5406. Department of Veterans Affairs, “VA New Jersey
Health Care System, East Orange campus, to assist COVID-19 response,” press release, April 1, 2020,
https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5410.
115 A summary VA “Fourth Mission” actions is available at Department of Veterans Affairs, “VA announces ‘Fourth
Mission,’ actions to help America respond to COVID-19,” press release, April 14, 2020, https://www.va.gov/opa/
pressrel/pressrelease.cfm?id=5420.
116 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.
117 “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.
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converted from in-residence to distance learning by reason of an emergency or health-related
situation. P.L. 116-128 further permits the 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 participants covered under this P.L. 116-128 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.
Coronavirus Aid, Relief, and Economic Security Act, “CARES Act”
(P.L. 116-136)
Emergency Supplemental Appropriations
On March 17, 2020, the Administration submitted to Congress a supplemental appropriations
request.118 The Administration sought $16.6 billion for FY2020 for VA’s response to the COVID19 outbreak. This amount included $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 included $2.1 billion for the medical community care account to
provide three months of health care treatment provided in the community in response to COVID19. The 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 emergency supplemental appropriations request included
$100 million for the medical support and compliance account to provide 24-hour
emergency management coordination overtime payments, to cover costs
associated with travel and transport of materials, and to enable VHA’ s Office of
Emergency Management to manage its response to COVID-19;
$175 million for the medical facilities account to upgrade VA medical facilities to
respond to the virus; and
$1.2 billion for the information technology systems account to upgrade telehealth
and related internet technology to deliver more health care services remotely.
On March 27, the President signed into law the CARES Act (P.L. 116-136). Division B of this act
included an emergency supplemental appropriations measure. Title X of Division B provides
supplemental appropriations for FY2020 for certain VA accounts totaling $19.6 billion, and is
designated as emergency spending. Unless otherwise noted below, funds remain available until
September 30, 2021. Funding provided in the CARES Act is broken down as follows (see Table
1):119
VBA, general operating expenses account, $13 million, for enhancing telework
support for VBA staff and for additional cleaning contracts.
VHA, medical services account, $14.4 billion, for increased telehealth services;
purchasing of additional medical equipment and supplies, testing kits, and
118 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.
119 Based on Senate Appropriations Committee, Coronavirus Supplemental Appropriations Summary, available at
https://www.appropriations.senate.gov/download/coronavirus-emergency-supplemental-appropriations-summary.
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personal protective equipment; and to provide additional support to homeless
veterans, among other things.
VHA, medical community care account, $2.1 billion, for increased emergency
room and urgent care usage in the community.
VHA, medical support and compliance account, $100 million, for the provision
of 24-hour emergency management coordination overtime payments, and for
costs associated with travel and transport of materials.
VHA, medical facilities account, $606 million, for the procurement of mobile
treatment facilities, improvements in security, and nonrecurring maintenance
projects.
VA, general administration account, $6.0 million, for maintaining 24-hour
operations of crisis response and continuity of operations plans at VA facilities,
among other things.
VA, information technology systems account, 2.2 billion, for increased telework
capacity, purchasing additional laptops for telework and telehealth-enabled
laptops for VHA providers to work from home, and to increase bandwidth and IT
infrastructure needs, among other things.
VA, Office of Inspector General account, $12.5 million, for increased oversight
of VA’s preparation and response to COVID-19 (funds remain available until
September 30, 2022).
VA, grants for construction of state extended care facilities account, $150
million, to assist state homes to renovate, alter, or repair facilities to respond to
COVID-19.
Table 1. Department of Veterans Affairs, Regular and COVID-19 Appropriations,
FY2020
($ in Thousands)
Program
FY2020 Request
FY2020 Enacted
Veterans Benefits Administration (VBA)
Compensation and pensions
$109,017,152
$109,017,152
—
1,439,931
Subtotal compensation and pensions
109,017,152
110,457,083
Readjustment benefits
14,065,282
14,065,282
Insurance and indemnities
111,340
111,340
Over FY2020 advance
appropriations
17,620
17,620
Subtotal insurance and indemnities
128,960
128,960
Housing programs administrative
expenses
200,377
200,377
Vocational rehabilitation loan
program
58
58
Vocational rehabilitation loan
administrative expenses
402
402
Over FY2020 advance
appropriations
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Program
FY2020 Request
Native American housing loan
program
General operating expenses, VBA
CARES Act (P.L. 116-136)
Subtotal general operating expenses,
VBA
Total, VBA
FY2020 Enacted
1,163
1,186
3,000,000
3,125,000
13,000
13,000
3,013,000
3,138,000
126,426,394
127,991,348
329,000
329,000
—
-1,000
329,000
328,000
51,411,165
51,411,165
National Cemetery Administration (NCA)
NCA
Rescission (P.L. 116-94)
Total NCA
Veterans Health Administration (VHA)
Medical services
Rescission (P.L. 116-94)
Families First Coronavirus
Response Act (P.L. 116-127)
-350,000
—
30,000
CARES Act (P.L. 116-136)
13,100,000
14,432,000
Subtotal medical services
64,511,165
65,523,165
Medical community care
10,758,399
10,758,399
Over FY2020 advance
appropriations
4,521,400
3,906,400
Transfer from Veterans Choice
Fund (VCF) to Community Care
(P.L. 116-94)
—
615,000a
Families First Coronavirus
Response Act (P.L. 116-127)
—
30,000
CARES Act (P.L. 116-136)
2,050,000
2,100,000
Subtotal medical community care
17,329,799
17,409,799
Medical support and compliance
7,239,156
7,239,156
Over FY2020 advance
appropriations
98,800
98,800
Rescission (P.L. 116-94)
—
-10,000
CARES Act (P.L. 116-136)
100,000
100,000
Subtotal medical support and
compliance
7,337,956
7,427,956
Medical facilities
6,141,880
6,141,880
CARES Act (P.L. 116-136)
175,000
606,000
Subtotal medical facilities
6,316,880
6,747,880
762,000
800,000
—
-50,000
Medical and prosthetic research
Rescission (P.L. 116-94)
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Program
Subtotal medical and prosthetic
research
FY2020 Request
FY2020 Enacted
762,000
750,000
Total, VHA (without collections)
96,357,800
97,858,800
Medical Care Collection Fund
(MCCF)
3,729,000
3,729,000
Total, VHA (with collections)
100,086,800
101,587,800
General Administration
369,200
355,911
CARES Act (P.L. 116-136)
7,000
6,000
Subtotal general administration
376,200
361,911
Board of Veterans Appeals
182,000
182,000
—
-8,000
Subtotal Board of Veterans Appeals
182,000
174,000
Information technology
4,343,000
4,371,615
CARES Act (P.L. 116-136)
1,150,000
2,150,000
Subtotal information technology
5,493,000
6,521,615
Electronic Health Records
Modernization (EHRM)
1,603,000
1,500,000
—
-70,000
1,603,000
1,430,000
207,000
210,000
CARES Act (P.L. 116-136)
—
12,500
Subtotal Inspector General
207,000
222,500
Construction, major projects
1,235,200
1,235,200
Construction, minor projects
398,800
398,800
Grants for state extended care
facilities
90,000
90,000
—
150,000
Subtotal grants for state extended care
facilities
90,000
240,000
Grants for state veterans
cemeteries
45,000
45,000
9,630,200
10,629,026
—
-15,949
$232,743,394
$236,791,225
Departmental Administration
Rescission (P.L. 116-94)
Rescission (P.L. 116-94)
Subtotal EHRM
Inspector General
CARES Act (P.L. 116-136)
Total, Departmental Administration
Administrative Rescission
(P.L. 116-94)
Total, Department
of Veterans Affairs (without
collections)
Source: Table prepared by CRS based on the Further Consolidated Appropriations Act, 2020 (P.L. 116-94); the
Families First Coronavirus Response Act (P.L. 116-127); and the Coronavirus Aid, Relief, and Economic Security
Act (P.L. 116-136).
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a.
The Further Consolidated Appropriations Act, 2020 (P.L. 116-94), authorized a mandatory balance transfer
of $615 million from the Veterans Choice Fund (VCF) established by 802(c)(4) of the Veterans Access,
Choice, and Accountability Act of 2014, as amended (38 U.S.C. 1701 note) to the medical community care
account.
General CARES Act Provisions Affecting VA Programs and Services
Section 20001. Transfer of Funds
This section allows the VA to transfer funds between the medical services, medical community
care, medical support and compliance, and medical facilities accounts. The VA can make any
transfer that is less than 2% of the total amount appropriated to an account and may follow after
notifying the congressional appropriations committees. Any transfer that is greater than 2% of the
total amount appropriated to an account or exceeding a cumulative 2% for all of the funds
appropriated to the VA in the CARES Act requires Senate and House Appropriations Committee
approval.
Section 20002. Monthly Reports
This section requires the VA to provide monthly reports to the Senate and House Appropriations
Committees detailing obligations, expenditures, and planned activities for all the funds provided
to the VA in the CARES Act.
Section 20003. Public Health Emergency
This section defines a public health emergency as an emergency with respect to COVID-19
declared by a federal, state, or local authority.
Section 20004. Short-Term Agreements or Contracts with Telecommunications
Providers to Expand Telemental Health Services for Isolated Veterans During
A Public Health Emergency
The VHA provides telehealth services to veteran patients in their communities from any location
in the United States, including U.S. territories, the District of Columbia, and the Commonwealth
of Puerto Rico.120 Section 20004 defines telehealth as “the use of electronic information and
telecommunications technologies to support and promote long-distance clinical health care,
patient and professional health-related education, public health, and health administration.”
Examples of telecommunications technologies include the internet, videoconferencing, streaming
media, and terrestrial and wireless communications. This section allows the VA Secretary to enter
into short-term agreements or contracts with telecommunications companies to expand veteran
patients’ access to telemental health care services.121 The goal of the short-term agreements and
contracts is for the telecommunications companies to provide temporary, complimentary, or
subsidized fixed and mobile broadband services to veteran patients. The Secretary is allowed to
enter into short-term agreements or contracts with telecommunications companies only during the
period of the COVID-19 outbreak. During this period, covered veteran patients can assess VA
telemental health care services through telehealth and the VA Video Connect (VVC) mobile
120 38 U.S.C. §1730C. To learn more about VA telehealth services, see CRS Report R45834, Department of Veterans
Affairs (VA): A Primer on Telehealth.
121 Telemental health care services refers to the delivery of mental health care services via telehealth.
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application, which the act refers to as the VA program that connects veteran patients with their
health care teams using encryption.122 Veteran patients can access the VVC on their mobile
devices, such as laptops and smartphones.
The short-term agreements or contracts with telecommunications companies must address the
telemental health care needs of isolated veterans; therefore, the VA Secretary must prioritize
eligibility to veterans who either have low-incomes, live in unserved and underserved areas,
reside in rural and highly rural areas,123 or are considered by the Secretary as having a higher risk
of committing suicide and mental health care needs while being isolated during the COVID-19
outbreak. The VA, however, may expand eligibility for telemental health care services to veteran
patients who are currently receiving VA care but who are ineligible to receive mental health care
services and other health care services through telehealth and/or the VVC.
Section 20005. Treatment of State Homes During Public Health Emergency
The state veterans’ home program is a federal-state partnership to construct or acquire nursing
home, domiciliary, and adult day health care facilities. VA provides assistance to states in three
ways: First, VA provides states with up to 65% of the cost to construct, acquire, remodel, or
modify state homes. Second, VA provides per diem payments to states for the care of eligible
veterans in state homes. VA may adjust the per diem rates each year.124 A state home is required to
meet all VA standards in order to continue to receive per diem payments. Third, VA is required to
support states financially to assist state homes in the hiring and retention of nurses to reduce
nursing shortages at state veterans’ homes.
This section modifies the treatment of state homes during the public health emergency by (1)
waiving requirements for per diem reimbursements for state homes under the VHA State Home
Per Diem Program and (2) authorizing the Secretary to provide equipment to state homes. The
section waives the occupancy rate requirement under 38 C.F.R. Section 51.40(c), authorizing a
state home to receive per diem payments for veterans who are temporarily absent from nursing
home care regardless of the state home’s occupancy rate. In addition, the section waives the
requirement under 38 C.F.R. Section 51.210(d) that a state home must maintain a certain
percentage of veteran residents. Lastly, the section authorizes the Secretary to provide state
homes with medication, personal protective equipment, medical supplies, and any other
equipment, supplies, and assistance available to VA. The personal protective equipment may be
provided through the All Hazards Emergency Cache in addition to any other source available.
Section 20006. Modifications to Veteran Directed Care Program of Department
of Veterans Affairs
The Veteran Directed Care Program helps isolated veterans who need assistance with activities of
daily living or instrumental activities of daily living, and who are at high risk of nursing home
placement, to live in their own homes. Veterans in this program are provided a budget for services
that can be managed by the veteran or a family caregiver.125
122 To learn more about the VA Video Connect mobile application, see CRS Report R45834, Department of Veterans
Affairs (VA): A Primer on Telehealth.
123 Priority for veteran patients who live in rural and highly rural areas must align with the rural-urban commuting area
(RUCA) codes, which are developed by the U.S. Department of Agriculture (USDA). To learn more about the RUCA
codes, see UDSA, RUCA, https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes/.
124 38 U.S.C. §§ 1741-1745.
125 https://www.va.gov/geriatrics/pages/Veteran-Directed_Care.asp.
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This section modifies the Veterans Directed Care Program during the public health emergency to
require that the Secretary (1) accept telephone or telehealth enrollments and renewals; (2) stop all
suspensions or disenrollments unless requested by a veteran or representative, or the veteran and
provider make a mutual decision; (3) waive paperwork requirements and penalties for late
paperwork; and (4) waive any requirement to stop payments under the program if the veteran or
caregiver is out of state for more than 14 days.
Section 20007. Provision by Department of Veterans Affairs of Prosthetic
Appliances through Non-Department Providers During Public Health
Emergency
In general, VHA prosthetics staff are responsible for providing and fitting prosthetic appliances
that meet the best medical needs of the veteran patient. This provision requires the Secretary to
ensure that eligible veterans receiving or requiring prosthetic appliances and services are able to
obtain them from contracted non-VA providers during this emergency period.
Section 20008. Waiver of Pay Caps for Employees of Department Of Veterans
Affairs During Public Health Emergencies
Under existing regulations, certain VA employees may not receive any combination of premium
pay, including overtime pay, that, when added to their base pay, results in total pay above the
higher of two rates: GS-15, step 10, or the rate payable for Level V of the Executive Schedule on
a biweekly basis. This provision allows the Secretary waive any limitation on pay for any
employee of the VA during a public health emergency for work done in support of the emergency.
The Secretary is required to provide reports on a monthly basis to the Senate and House
Committees on Veterans’ Affairs detailing the waivers.
Section 20009. Provision by Department of Veterans Affairs of Personal
Protective Equipment for Home Health Workers
This section requires the Secretary to provide VA home health workers with personal protective
equipment from the All Hazards Emergency Cache or any other available source.
Section 20010. Clarification of Treatment of Payments for Purposes of
Eligibility for Veterans Pension and Other Veterans Benefits
Under ordinary circumstances, eligibility for a VA pension is, in part, based upon the annual
income of the individual. Generally, “all payments of any kind or from any source (including
salary, retirement or annuity payments, or similar income, which has been waived, irrespective of
whether the waiver was made pursuant to statute, contract, or otherwise) shall be included” when
calculating a veteran’s annual income.126
This provision of the CARES Act excludes the recovery rebate from a veteran’s annual income,
thereby preventing it from counting towards the income limit associated with pension eligibility.
It explicitly states that the rebate “shall not be treated as income or resources for purposes of
determining eligibility for pension under chapter 15 of title 38.” Consequently, the direct
individual payment included in the CARES Act will not affect a veteran’s eligibility for a VA
pension.
126 38 U.S.C. § 1503.
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Section 20011. Availability of Telehealth for Case Managers and
Homeless Veterans
Formerly homeless veterans participating in the HUD-VASH program are assigned VA case
managers to assist with their health and other needs. This section requires the VA to ensure that
telehealth capabilities are available to veterans and case managers participating in HUD-VASH.127
Section 20012. Funding Limits for Financial Assistance for Supportive Services
for Very Low-Income Veteran Families in Permanent Housing During A Public
Health Emergency
The SSVF program, which provides short- to medium-term rental assistance and supportive
services to homeless veterans and their families, is authorized at $380 million through FY2021.
Without legislative authority, the VA cannot obligate additional funding for the program. This
provision removes the SSVF funding limitation in cases of public health emergencies.
Section 20013. Modifications to Comprehensive Service Programs for
Homeless Veterans During A Public Health Emergency
The Homeless Providers Grant and Per Diem (GPD) program provides grants to public entities
and private nonprofit organizations for the capital costs associated with developing facilities to
serve homeless veterans and also makes per diem payments to grantees for the costs of providing
housing and supportive services to homeless veterans. Together, grant and per diem funding is
authorized at approximately $258 million per year. In addition, grant costs are limited to 65% of
the costs of acquisition, construction, expansion, or remodeling of facilities, and per diem
payments are limited to the VA domiciliary care per diem rate, which, for FY2020, is $48.50 per
day. This section allows additional appropriations for the GPD program in cases of public health
emergencies notwithstanding the FY2020 authorization level, and it also allows the Secretary to
waive statutory limitations on grant and per diem payments to grantees.
Generally, VA, under GPD guidance, requires providers to discharge veterans residing in GPD
housing who are absent for more than 14 days. In addition, VA will not make per diem payments
after a veteran has been absent for more than 72 consecutive hours. This section requires the VA
Secretary to waive the discharge requirement and allows the Secretary to reimburse providers for
veterans who have been absent for more than 72 hours.
Student Veteran Coronavirus Response Act of 2020 (P.L. 116-140)
The Student Veteran Coronavirus Response Act of 2020 (P.L. 116-140), as enacted on April 28,
2020, responds to concerns that abrupt and temporary closures or suspensions of educational
institutions, programs of education, and employment could negatively impact the short-term
finances of eligible beneficiaries and their continued pursuit of educational programs. Eligible
beneficiaries include participants in several VA educational assistance programs and Vocational
Rehabilitation and Employment (VR&E).128 The act provides special authorities for the period
127 For more information about telehealth, see CRS Report R45834, Department of Veterans Affairs (VA): A Primer on
Telehealth.
128 For information about VR&E, see CRS Report RL34627, Veterans’ Benefits: The Vocational Rehabilitation and
Employment Program.
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beginning on March 1, 2020, and ending on December 21, 2020, including academic terms
beginning prior to December 21, 2020. Selected sections of the bill are discussed below.
Section 3. Payment of Work-Study Allowances During Emergency Situations
The Veterans Work-Study Program allows GI Bill and VR&E participants to receive additional
financial assistance through the VA in exchange for employment. Provisions in this section permit
Work-Study payments in accordance with an existing Work-Study agreement or at a lesser
amount despite the participant’s inability to perform work by reason of an emergency situation.
These provisions further require the VA to extend an existing agreement for a subsequent period
beginning during the covered period if requested by the Work-Study participant.
Section 4. Payment of Allowances to Veterans Enrolled in Educational
Institutions Closed for Emergency Situations
The VA has authority under 38 U.S.C. Section 3680(a)(2)(A) to pay GI Bill and VR&E
allowances for up to four weeks when an educational institution temporarily closes under an
established policy based on an Executive order of the President or due to an emergency
situation.129 The provisions in this section permit GI Bill and VR&E payments for up to four
weeks, in addition to any payments under 38 U.S.C. Section 3680(a)(2)(A), if an educational
institution closes or the program of education is suspended due to an emergency situation.
Section 5. Prohibition of Charge to Entitlement of Students Unable to Pursue a
Program of Education Due to an Emergency Situation
In general, the GI Bills provide eligible persons a 36-month entitlement to educational assistance.
GI Bill entitlement is restored in the following instances:
for an incomplete course if an individual is unable to receive credit or lost
training time as a result of an educational institution closing;
for an incomplete course if an individual is unable to receive credit or lost
training time because the course or program is disapproved by a subsequently
established or modified policy, regulation, or law; and
for the interim (through the end of the academic term but no more than 120 days)
Post-9/11 GI Bill housing allowance paid following either a closure or
disapproval.
The provisions in this section require that the VA restore entitlement for an incomplete course if
an individual is unable to receive credit or lost training time as a result of a temporary closure of
an educational institution or the temporary termination of a course or program of education by
reason of an emergency situation.
Section 6. Extension of Time Limitations for Use of Entitlement
Many GI Bill participants must use their educational entitlement within a specified time period
beginning upon discharge or release from active duty or eligibility. There are notable exceptions
to the time limitation. For example, Post-9/11 GI Bill participants whose last discharge or release
129 38 U.S.C. §3680(a)(2)(A). The provision 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.
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Federal Response to COVID-19: Department of Veterans Affairs
from active duty was on or after January 1, 2013, are not subject to a time limitation. The
provisions in this section exempt from the time limitation, the period during which an individual
is prevented from pursuing a program of education because the educational institution closed
(temporarily or permanently) under an established policy based on an Executive order of the
President or due to an emergency situation until the individual is able to resume pursuit. The
provisions are applicable to the Montgomery GI Bill-Active Duty (MGIB-AD) 10-year limitation,
the Post-9/11 GI Bill 15-year limitation and age limitation for children using transferred benefits,
the VR&E 12-year limitation and the period of a veteran’s vocational rehabilitation program, and
the Montgomery GI Bill-Selected Reserve (MGIB-SR) limitation.
Section 7. Restoration of Entitlement to Rehabilitation Programs for Veterans
Affected by School Closure or Disapproval
Typically, programs under VR&E are limited to 48 months of entitlement and veterans pursuing
an education program under VR&E must be enrolled to receive a subsistence allowance. For the
covered period, the provisions in this section extend protections from entitlement charges
following school closures that are established for the GI Bills to veterans participating in
education programs under the VR&E program. The provisions further allow the VA to (1)
continue paying subsistence allowances to VR&E participants through the end of the academic
term but no more than 120 days following either a closure or disapproval and (2) prohibits VA
from charging the impacted term against a veteran’s VR&E entitlement if the veteran did not
receive credit for classes.
Section 8. Extension of Payment of Vocational Rehabilitation Subsistence
Allowances
The provisions in this section provide two additional months of subsistence allowance to veterans
who were following a program of employment services under the VR&E program during the
covered period.
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Federal Response to COVID-19: Department of Veterans Affairs
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.
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)).
Sharing Health Care Resources
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Federal Response to COVID-19: Department of Veterans Affairs
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
and, in times of war, instructions
from the Surgeon Generala
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
may 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]).
In General
31 U.S.C. §1344(a)
VA may use government vehicles to
transport employees only 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)).
VA Provider Liability
Transportation of Employees
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.
31
Federal Response to COVID-19: Department of Veterans Affairs
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, Coordinator
Specialist in Veterans Policy
[redacted]@crs.loc.gov , 7-....
Jonathan M. Gaffney
Legislative Attorney
[redacted]@crs.loc.gov
, 7-....
Jared S. Sussman, Coordinator
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-....
Victoria L. Elliott
Analyst in Health Policy
[redacted]@crs.loc.gov
, 7-....
Congressional Research Service
R46340 · VERSION 2 · NEW
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