Delivery of VA Telehealth Services During COVID-19

Delivery of VA Telehealth Services During COVID-19

May 20, 2020
Delivery of VA Telehealth Services During COVID-19
Introduction
Lejeune Families Act of 2012 (P.L. 112-154), among other
The Veterans Health Administration (VHA) of the
things, allows the VA Secretary to waive veteran patients’
Department of Veterans Affairs (VA) is responsible for
copays for telehealth. As of April 6, 2020, veterans do not
providing health care benefits to eligible veterans. In
have to pay copays during the pandemic (https://go.usa.gov/
FY2020, about 9.3 million veterans were enrolled in VA
xvF6j).
health care (https://go.usa.gov/xvFTz). Of those enrolled in
the VHA, approximately 7.1 million of them received
Overview of VA Telehealth
health care services. During the Coronavirus Disease 2019
In FY2020, the VA obligated $1.06 billion to its Telehealth
(COVID-19) pandemic, both routine and urgent in-person
Program, which is about a 4% increase from the FY2019
health care services are either being postponed or shifted to
level of $1.02 billion (https://go.usa.gov/xvJCr). In
telehealth by the VHA for those veterans who (1) do not
FY2019, the VA provided 2.6 million telehealth episodes of
have COVID-19 diagnoses, (2) are not exhibiting
care to more than 900,000 veterans, of whom 44% were
symptoms of the disease, and (3) are not at high risk of
rural veterans. Veterans can access more than 50 different
being affected by the disease. (To learn more about VA’s
health care specialties via telehealth including primary care,
response to COVID-19, see CRS Report R46340, Federal
mental health, rehabilitation, dermatology, and sleep
Response to COVID-19: Department of Veterans Affairs.)
medicine. Veterans who seek individual, group, marriage
Telehealth generally refers to health care providers’ use of
and family counseling can access those through telehealth.
information and communication technology to provide a
health care service. This In Focus provides an overview of
The VHA provides telehealth services to veteran patients in
veterans’ access to VA telehealth services and discusses
their communities from any location in the United States,
two funding activities that aim to assist veterans with
including U.S. territories and the District of Columbia. The
obtaining telehealth-related infrastructure during the
VA MISSION Act (P.L. 115-182) authorizes this provision
pandemic.
of telehealth delivery. However, the VA has not yet
implemented telehealth in all VA medical facilities such as
Eligible Veterans
Vet Centers. Of the 1,200 VHA facilities, telehealth
Veterans who are eligible for VA health care are eligible to
services are available at 900 sites of care. The VA has
access telehealth services through the VA. (To learn more
instructed all of its facilities to attempt to transpire their
about VA eligibility, see CRS Report R42747, Health Care
activities through telehealth in order to achieve the goal of
for Veterans: Answers to Frequently Asked Questions.) In
meeting the health care needs of ambulatory veteran
addition, during covered disasters and emergencies, the
patients. On May 12, 2020, the VA announced that veterans
Department of Veterans Affairs Emergency Preparedness
who need same-day urgent care for minor illnesses or
Act of 2002 (P.L. 107-287, as amended), among other
injuries during the pandemic may access those services via
things, allows the VA to provide health care services to
telehealth (phone or video-based visits) from VA providers
veterans without regard to whether they are enrolled in VA
and in-network community clinic providers
care. Section 1785 of title 38 of U.S.C. defines covered
(https://go.usa.gov/xvFA5).
disasters and emergencies as those that are declared by the

VA Telehealth Modalities
U.S. President under the Robert T. Stafford Disaster
A telehealth modality refers to the mode in which a
Relief and Emergency Assistance Act (P.L. 100-707, as
telehealth visit transpires. Veterans can access VA
amended) or
telehealth services via three telehealth modalities: (1) home
 Secretary of the Department of Health and Human
telehealth, (2) store-and-forward telehealth, and (3) clinical
Services under Section 2812 of the Public Health
video telehealth.
Service Act.
Therefore, the VA may provide health care services to
Home telehealth (HT) modality allows a VA provider
veterans who are not currently enrolled in VA care during
who is not located in the same location as a veteran patient
the COVID-19 pandemic. Eligible veterans either must be
to provide the patient with daily case management services
responding to, involved in, or otherwise affected by the
for his or her chronic medical conditions, such as chronic
disaster or emergency to be eligible for care under this
heart disease or diabetes.
provision of law.
Store-and-forward telehealth (SFT) modality facilitates
VA Telehealth Copayment Requirements
the interpretation of patients’ clinical information by
A telehealth copayment (copay) refers to the out-of-pocket
allowing a VA provider who is not located in the same
costs that a veteran patient pays for a telehealth encounter.
location as a veteran patient to assist another VA provider
The Honoring America’s Veterans and Caring for Camp
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Delivery of VA Telehealth Services During COVID-19
who is located in the same location and has provided in-
136, as amended) and the Connected Care Pilot Program.
person care to the veteran patient.
This is not a comprehensive list.
Clinical video telehealth (CVT) modality allows a VA
CARES Act
provider who is not located in the same location as a
Section 20004 of the CARES Act, among other things,
veteran patient to view, diagnose, monitor, and treat
allows the VA Secretary to enter into short-term agreements
medical conditions of the veteran patient in real-time. The
or contracts with telecommunications companies to expand
CVT modality functions by allowing the VA provider and
isolated veteran patients’ access to telemental health care
the veteran patient to see each other via an interactive live
services. Examples of telecommunications technologies
video technology. Telehealth episodes of care via the CVT
include the internet, videoconferencing, streaming media,
modality transpire between different VA sites of care, such
and terrestrial and wireless communications. The VA
as from a VA medical center to a veteran patient’s home or
Secretary must prioritize eligibility to veterans who either
from a veteran patient’s home to a VA provider’s home
have low-incomes, live in unserved and underserved areas,
office.
reside in rural and highly rural areas, or are considered by
the Secretary as having a higher risk of committing suicide
VA Mobile Health (VA Mobile)
and mental health care needs while being isolated during
VA Mobile allows veterans to access certain health services
the COVID-19 pandemic. The VA, however, may expand
and electronic protected health information via VA mobile
eligibility for mental health care services via telehealth to
applications (mobile apps), which are software programs
veteran patients who are currently receiving VA care but
that run on certain operating systems of mobile devices
who are ineligible to receive mental health care services
(e.g., smartphones and tablets) and computers that transmit
and other health care services through telehealth.
data over the internet that veterans can access as telehealth
applications. Veterans can access VA mobile apps on
Connected Care Pilot Program
cellular and mobile devices that operate using either a web-
The Connected Care Pilot Program is a three-year program
based platform, an iOS platform, or an Android operating
that provides funding to nonprofit and public health care
platform. VA mobile apps are located in the virtual VA
provider sites located in rural and nonrural areas
App Store (https://mobile.va.gov/). Two main VA mobile
(https://go.usa.gov/xv79v). Eligible health care providers,
apps of interest are VA Video Connect (VVC) and COVID
codified in Section 254(h)(7)(B) of the Communications
Coach.
Act of 1934; as amended, may use program funds to
purchase infrastructure for themselves and their patients,
The VVC allows a veteran patient to connect via live video
particularly eligible veterans and eligible low-income
with a VA provider regardless of where the veteran or
individuals. An eligible veteran is a person, regardless of
provider is located. Veterans with Sprint, T-Mobile,
income level, who is eligible to receive VA care. The pilot
TracFone, or Verizon as wireless carriers can access the
program subsidizes (up to 85% of) qualifying costs of
VVC without incurring any data charges
providing connected care services, including patient
(https://go.usa.gov/xv6JS).
broadband internet service. Pilot projects are to primarily
focus on, among other issues, public health epidemics. The
The COVID Coach educates and reminds veterans of
program was established during the COVID-19 pandemic.
coping skills for self-care during the pandemic. The app
aims to encourage self-care and overall mental health by
According to the Federal Communications Commission
allowing veterans to track their moods and measure their
(FCC), which administers the pilot program, connected
growth towards meeting their personal goals.
care services refer to “a subset of telehealth that uses
broadband Internet access service-enabled technologies to
VA Appointments and Medication Refills
deliver remote medical, diagnostic, patient-centered, and
Veterans can change their existing in-person scheduled VA
treatment-related services directly to patients outside of
appointments to telehealth visits. To do so, veterans can
traditional brick and mortar medical facilities—including
send a message to their health care providers through My
specifically to patients at their mobile location or
HealtheVet and use the VA appointment self-scheduler
residence.” The FCC is an independent federal regulatory
tool. For virtual appointments, VA providers will send
agency charged with regulating interstate and international
veterans a link to the VVC mobile app. Veterans can
communications by radio, television, wire, satellite, and
request medication refills through the VA’s Rx Refill
cable. The agency is making available $100 million over a
mobile app, My HealtheVet, and by phone. Medication
three-year period from the general Universal Service Fund
refills that require veterans to undergo an in-person
monies to administer and fund the Connected Care Pilot
evaluation can be renewed via telehealth (phone or video-
Program. The FCC is using P.L. 104-104 as the authority to
based visit).
administer the program. (To learn more about this program,
see CRS In Focus IF11553, FCC COVID-19 Telehealth
Two Funding Activities for
Program and Connected Care Pilot Program: Funding to
Telehealth Infrastructure
Assist Health Care Providers and Patients.)
Two funding activities aim to expand veterans’ access to
the infrastructure they need to access telehealth services
Reintroduction of In-Person VA Care
during the COVID-19 pandemic: the Coronavirus Aid,
On May 18, 2020, select VA medical facilities began
Relief, and Economic Security (CARES) Act (P.L. 116-
reintroducing in-person care in phases (https://go.usa.gov/
xvugK).
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Delivery of VA Telehealth Services During COVID-19

IF11554
Victoria L. Elliott, Analyst in Health Policy

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