Q&A: CVA Senior Advisor Darin Selnick on what limiting community care means for vets
As the COVID-19 crisis continues, veterans are still looking for answers about their access to the health care they need.
In late March, the Department of Veterans Affairs proposed limiting veterans’ ability to seek care in their communities through the VA MISSION Act. This proposal raised many questions: How should veterans move forward with getting care? What are the implications of limiting access? Is it even legal for the VA to restrict community care?
To fully understand the answers to those questions, we asked an expert – CVA Senior Advisor Darin Selnick.
Selnick has worked in veterans health care policy for years, most recently serving as senior advisor to the VA secretary, where he oversaw implementation of the VA MISSION Act. Selnick’s work has been instrumental in reforming the VA over the last few years.
Q: The Department of Veterans Affairs has issued confusing guidance regarding how it is treating the VA MISSION Act’s access standards and referrals for community care during the coronavirus outbreak. What is the VA’s policy and how is it affecting veterans?
A: The VA’s current policy in terms of community care and following the law and the regulation is to say publicly that they are doing it, but operationally, they’re not doing it.
What we’ve found from reviewing the VA’s policy statements and guidance is that the VA is deciding on a case-by-case basis whether you should get care. If they decide you’re sick enough and the risk of COVID-19 is not strong enough, they will tell you that you can seek an appointment at the hospital or in the community. This puts the VA in charge of a veteran’s care options, not the veteran.
That guidance specifically goes against the law and the regulation in the VA MISSION Act.
Q: Does the VA have the legal authority to limit community care access according to the VA MISSION Act?
A: The authors of the law intentionally included a stipulation that if the VA could not meet its wait time or drive time requirements, it has no choice but to offer veterans care in the community. Veterans don’t have to take that care in the community, or in the case of a pandemic, community care might not be available. But the VA has to offer veterans the choice to at least see if community care was available. Veterans have the right to this choice and there is nothing in the law that gives VA an out — not because of a pandemic or for any other reason.
Q: What are other government health care providers, such as the Department of Defense, doing during this time?
A: No other provider is taking the stance that the VA is. The Tricare Prime program, similar to the VA’s community care program, hasn’t issued guidance to restrict community care. As a matter of fact, Tricare has increased its guidance on the availability of community care by expanding its offerings in telehealth. So, Tricare will now pay for any telehealth appointment that you have in the community through Tricare Prime.
Medicare has also expanded recipients’ ability to get out-of-network care through Medicare Advantage. Additionally, neither Medicaid or the Federal Employees Health Benefits program have issued restrictions. Only the VA has used COVID-19 to restrict your access to the community. That’s what happens when the government is in charge of health care decisions.
Q: Instead of limiting health care options for veterans, what are some policies the VA has adopted or should adopt to ensure veterans are not waiting to receive care?
A: CVA put together some key policy recommendations for the VA that would help veterans. The bottom line is, during this time, the VA should be expanding options for veterans, not restricting them.
A large number of the VA’s community-based outpatient clinics are closed and most appointments at VA facilities have been postponed or canceled except for emergency and urgent care. The only place for many to get the care they need is in the community – particularly in areas without VA facilities. So CVA recommended that the VA preserve veterans’ choice, work with third-party administrators to identify what community care was still available and advise veterans on how to proceed.
If veterans have pressing health needs, such as conditions that need regular monitoring, the VA should make sure they help them find safe providers, inside or outside the VA. Providers are open and taking safety precautions, and the VA should have assisted veterans to get their care safely rather than making bureaucratic decisions about denying care when this pandemic started.
Q: Looking forward, what are the potential mid and long-term consequences of the VA’s decision?
A: The short term and the long term kind of run together. In the short term, veterans are not getting the health care they’ve earned and deserve. Some with chronic conditions could actually see their health worsen. And many veterans who need care but can’t get to it are in pain and experiencing the unintended consequences of disruptions in care.
In the long term, the VA will have a huge backlog of appointments when this crisis is over. The number of completed appointments has already plummeted from 5.22 million in January to 3.85 million in March. Once COVID-19 restrictions have lifted, you’ll have veterans wanting to catch up on their appointments at the VA, causing major delays. That delayed care could be dangerous, and those wait times, as we saw in the Phoenix VA scandal, can be devastating to veterans with chronic or undiagnosed health conditions.