The following is an update from national Veterans Affairs and Rehabilitation Division director Chanin Nuntavong.

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Health Policy 

Meeting

• May 4 – Director and Deputy Director met with TriWest (Donna Hoffmeier and Chet Edwards) regarding status of CCN and Covid 19 efforts
  • • Issues discussed included
    • How operations are currently running amid the Covid 19
      • Volume of referrals has dropped
        • 70% for specialty care
        • 50% for mental health
        • 1100 people furloughed due to drop in numbers
          • Plan is to bring them back if able
    • Routine care is still on hold
      • • For now, blanket policy across VA to maintain urgent only care
        • VA may start to reopen non urgent care as states allow
      • 95% of urgent care facilities remain open some with reduced hours
      • Providers in network remain with TriWest
  • VA has said they will extend the time limit for authorization of referrals but is pending approval

• May 5 – Director and Deputy Director met with Deputy Director meeting with Optum Serve (Ed Weinberg) regarding status of CCN and Covid 19 efforts
  • Issues discussed included
    • How operations are currently running amid Covid 19
      • Have seen a decrease in patients being seen in the community
        • Pandemic has forced evolution of how they serve the community (i.e. telehealth)
        • Although there is uncertainty, they are stable for now
      • VA had two messages for returning to normal operations
        • Safety first
        • Community care referrals will continue but must be thoughtful in their approach
          • Measured risk
          • Numbers are still down 30-40%
        • No concerns of providers dropping out of network – using this time to strengthen relationships with new providers
      • Telehealth
        • What does it look like
          • Intake is generally face to face if possible
          • Tele health for subsequent appointments
        • Reports on numbers are not available because they are based on claims data that is not in for a few months after treatment
  • Optum Serve is in the process of starting a veteran advocate portal for Congress and VSOs to provide key updates, fact sheets, key providers, and any new change

• May 7 – Deputy Director attended Office of Community Care VSO Meeting (Dr. Upton, Assistant Deputy Under Secretary for Health for Community Care)
  • Community care is starting to return to “normal”
    • Guidance is to focus on the veteran
      • Services will be available
      • Veteran has the right to choose to be seen or not
      • In office and telehealth available
    • Scoring system will be in place for thoughtful guidance to veteran and for providers
    • There was a dip in referrals at the end of March but number are beginning to rise
  • Telehealth – Hard to gauge numbers as claims take a few months to populate
  • Community care deployment
    • Region 2 opened in March
    • Region 3 will open in June
    • Region 4 (Eastern Colorado and Montana) will open in June
  • How will veterans know it is safe to return to providers offices?
    • Communication and collaboration with VA, VSOs, and the Government

• May 7 – Deputy Director attended VA Vacancy Crisis meeting with Veterans Healthcare Policy Institute (Brett Copeland) guest speakers; journalists Suzanne Gordon and Jasper Craven
  • Reasons for large number of vacancies in the VA
    • Brain drain at top administrative positions
    • Pressure and lack of support by political administration
    • Mass public firings of healthcare staff within the VA
    • Saw ¼ drop in funding to VA due to Privatization
      • VA Choice Act
      • Mission Act
    • Linda Ward Smith – VA nurse and President of AFGE Local 1224
      • VA wasn’t prepared properly

• Early stages of Covid 19 pulled outpatient staff to work inpatient critical care without proper training
• VA was already short staffed on all levels from medical staff to support staff

• High anxiety of staff pulled to Covid 19 teams – need for bodies overtook need of providers and staff
  • Some had underlying conditions
  • No services for complex needs
    • Childcare
    • Homeschooling
  • Some were exposed to Covid and not reported
  • Underqualified with minimal training
• Secretary Wilke reported 9000 new hires in the last 4 weeks
  • Only approximately 2000 were medical providers, the rest were support staff
  • Used relaxed standards in order to bring employees on
  • This staff is not permanent, some are 120 day temp
  • The need was 50,000 employees before the pandemic so 9000 is not covering the current and future need for medical providers and support staff in the VA

System Worth Saving (SWS) – Changes in red

	Preparation	Completed Site Visit	Writing Draft	Chairman Edits	Facility Edits	Final Edits	Website	Published
VA Medical Center, Martinsburg, WV	X	X	P
VA Illiana Health Care System, Danville, IL	X	X	X	X	P
Washington DC VA Medical Center, Washington, DC	X	X	X	X	X	X
Lexington VA Health Care System, Lexington, KY	X	X	X	X	X	X	P
W.G. (Bill) Hefner VA Medical Center, Salisbury, NC	X	X	X
Central Alabama Veterans Health Care, Montgomery, AL	X	X	X

X= Complete               P= in Process

• Health Policy Coordinator(s) continued to analyze SWS’s In-facility and Mail-Out Question Bank for the MISSION Act of

 

 

Claims Services

 

National Memorial Day Observance to be modified

• The Military District of Washington reports that the National Memorial Day Observance will be modified this year in response to the ongoing COVID-19

 

• There will be no public ceremony in the memorial amphitheater. A private wreath-laying ceremony will be held, with a limited number of guests invited by the Office of the Secretary of Defense. The decision was made with the health and safety of America’s veterans and the public in

 

• Any forthcoming information will be shared by DoD and Arlington National Cemetery through their communication

 

Cancellation of BVA In-person Hearings extended through June 1

• In keeping with VA’s primary mission to care for our veterans, the Board of Veterans’ Appeals (BVA) has suspended all video and Central Office hearings through June 1,

 

• However, the BVA and U.S. Court of Appeals for Veterans Claims remain open and are processing

 

• The BVA is requesting that VSOs contact veterans scheduled for Board hearings during the month of The appellants should be offered the options of 1) rescheduling an in- person hearing, 2) arranging for a virtual hearing, or 3) withdrawing from the hearing altogether.

 

• To date, the Board has successfully held more than 640 virtual hearings and has the capacity to hold 250 per There are many openings on the virtual hearing docket for Veterans and their representatives considering this option.

 

• More information on virtual Board hearings can be found here.

 

Upcoming Memorial Day ceremonies

• With Memorial Day less than a month away, the National Cemetery Administration reports “it is too early to know whether large events can be held safely in late May.” The American Legion’s liaison at NCA reported April 29 that plans for Memorial Day ceremonies “are being flushed out right now” and Legion leadership would be advised “as soon as we know for ”

 

• The NCA continues to monitor guidance from the Centers for Disease and Control, as well as state and local officials, to inform its decision on Memorial Day activities. Regardless of whether a cemetery holds a public ceremony, VA national cemeteries will observe Memorial Day in some

 

BVA – Indianapolis & Washington, D.C. Board Units (combined)

• Legacy Appeals 1765
• Board Unit Inventory (AMA Appeals) 1777

o Pending  125 Days+                                                                 310

• Informal Hearing Presentations (IHP) prepared 321
• Memos generated 14
• Phone inquiries 152
• Decision Reviews (formerly Quality Reviews) 283
• Individual Training 25 hours
• Team Training 5 hours
• Hearings 0
• Board Dispositions 258
  • Appeals granted 91 (35.3%)
  • Remanded 107 (41.5%)
  • Denied 49 (19%)

o Other                                                                                       11 (4.3%)

 

Senior Veterans Disability Claims Specialists

 

–     Compensation & Pension Claims	17
–     Discharge Upgrades	3
–     Other Issues	5
–     Contacts	52

 

 

Veterans Benefits

 

Meetings

• May 6 – Veteran Benefit Coordinators participated in a meeting with the secretary of the VA Robert Wilke. Veteran Affairs are conducting its “4th Mission” by sending VA employees, who want to volunteer, to nursing homes. They have been able to provide a bridge between the state and federal government by doing so. Thus far they have sent employees to 38 states and 8 veterans’ homes. Additionally, some VAMC’s have taken in civilians with COVID-19. 14 teams have been deployed to Florida, and other states employees have been sent are Delaware and Idaho. VA has also supplied 3500 pieces of equipment. A list of the changes the VA is making are listed

• Hired 9,300 employees overall, 2100 of which are nurses. VA was able to do this by streamlining the onboarding process and eliminating bureaucratic
• VA is moving forward with telehealth by providing IPADS/Tablets for Veterans in facilities that cannot have
• Working on suicide prevention efforts. Before COVID-19, there were 40,000 encounters. Since COVID-19, the encounters have increased to 154,000.
• Working with President Trump’s task force to determine the timing to return to “normal operations”, meaning everyday healthcare (primary care appointments, routing appointments, surgeries, )
• As of the call, there are 2700 veterans with active COVID cases in the country. 4700 veterans have returned to normal activity, meaning they have completed the 14-day quarantine. 566 Veterans have been lost due to COVID-19.
• BVA are still holding Board hearings through video conferencing on either a cell phone, IPAD or computer. Video conferences have been conducted from the veteran’s own

 

• May 8 – Veteran Benefit Coordinators participated in weekly meeting with Bergmann & Moore to discuss summer DSO
  • Discussed IT issues with Department Service Officer school and how to streamline procedures to include trouble shooting any technical issues during the training
  • Discussed first draft of survey questions to be submitted to DSO’s to determine what better ways National can support Department Service Officers in the field
  • Continued Reviewing the draft agenda for the TAL DSO Virtual Course set for August 2020