VA Secretary press conference, Monday, February 26, 2024,

Terrence Hayes (VA Press Secretary):  Good morning ladies and gentlemen. Thank you for joining us for this month’s press conference. We know that it’s an early start. So, we thank you for joining us. To our teammates online as well, thank you. I know we have some new faces included, so I’m very interested in meeting some of you, either in person or virtually. So, with that, we’ll go ahead and get started, and I’ll throw it over to Secretary Denis McDonough. Mr. Secretary.

Denis McDonough (VA Secretary):   All right. Good morning, everybody. When you say you look forward to meeting some of them, don’t you want to meet all of them?

Terrence Hayes (VA Press Secretary):  Well, I think I know most of them. Some of them I don’t.

Denis McDonough (VA Secretary):   Okay. It just came across like maybe you didn’t want to meet everybody [laughter] so, I don’t want to be like. Anyway, Terrence, thank you so much. And good morning, everyone. I understand this is the largest press conference we’ve had, so I’m glad to see that. Or actually mostly just worried about that. So welcome to the new team. And welcome back to the team that’s been with us throughout. In just a moment, our Undersecretary for Health, Dr. Shereef Elnahal will tell you about another historic expansion of VA healthcare for Veterans.

So, before he does that, let me hit two items quickly. First, on Friday–sorry, Thursday and Friday last week at our San Antonio Northwest VA Healthcare Clinic, we held another outreach event that we’re calling the One VA Experience. Right there, one stop, Vets could file new claims. They could complete claims, check the status of pending claims, enroll in VA healthcare, and learn about other benefits they may be missing, like home loans and education benefits. We invited around 50,000 local Vets to join us, some of whom aren’t currently getting any VA care or any VA benefits. Altogether during that two days, we served 500 Veterans, family members, caregivers, and survivors. 38 of those Vets enrolled in VA healthcare, 30 made appointments to be seen at one of our Vet centers. 288 filed new or supplemental claims. And one Vet and his spouse told us that this was the best service they have, quote, ever received with filing a claim for benefits. That’s what the One VA Experience is about, meeting Vets where they are and serving them as well as they have served us. Making sure our programs fit into their lives rather than insisting that they change their lives to fit into VA programs. As I said last month, we’re going to keep fighting like hell to reach Vets. In fact, reach even more Vets to continue building trust with them, to fit their lives–fit us into their lives, rather than making them change their life to come to us.

Second item, starting April 20th, as part of our digital GI Bill Modernization Initiative, VA will no longer send Veterans or family members benefits payments to more than one bank account. We’re making this change to help protect Vets and families from fraud and to ensure that we’re able to pay Veterans on time, every time, without error. This will require–this change will require all Veterans and beneficiaries who receive GI Bill payments and other payments across multiple accounts to select one account by April 20. This shift will impact about 50,000 of the 800,000 total GI Bill beneficiaries. Let me just say that one more time. This shift will impact nearly 50,000 of the 800,000 total GI Bill beneficiaries. Fortunately, we have the contact information for these Vets, and we’re aggressively reaching out to them through text message, phone, and email on a weekly basis through April 20th. They’ll continue to receive text messages and emails until they’ve updated their information in VA.gov. We’re also working with schools, VSOs, and other relevant parties to make sure Veterans meet this deadline. The easiest way for these Vets to make this change is to log on to VA.gov/change-deposit–I’m sorry. VA.gov/change-direct-deposit. VA.gov/change-direct-deposit. Importantly, no Veteran will miss a benefits payment of any type, even if they do not switch their accounts on time. For any student Veteran who does not consolidate their bank account for benefits by April 20th, VA will consolidate them on their behalf, electing their non-education benefit pay account as their primary bank account. We will ensure that every single Vet has access to the benefits they’ve earned and deserve, and that no Veteran loses education benefits as a result of these changes. Now, beginning March 5th, we’re making millions of Veterans eligible for VA healthcare years earlier than called for by the PACT Act. Joining us from Los Angeles this morning, three hours earlier there, Dr. Shereef Elnahal will give you details on this important new VA healthcare eligibility for Vets. Shereef, thanks for getting up early out there. Over to you, brother.

Dr. Shereef Elnahal (Under Secretary for Health): Good morning, everyone, and thank you very much, sir. So, as the secretary just said, we are bringing as many Veterans as possible into our care because VA is, in fact, proven to be the best, most affordable healthcare option for Veterans in the United States. And that’s why beginning March 5th, we’re making new groups of Veterans eligible for VA care earlier, years earlier than called for by the PACT Act as the president already directed in his Veterans Day speech just last year. The three groups are as follows: Number one, Veterans who were exposed to toxins or other hazards during their military service. Number two, Veterans who were assigned to certain duty stations in Southwest Asia or parts of Africa. And number three, Veterans who deployed in support of certain operations after 9/11. Here’s what that means for Veterans across the country. If you served in Vietnam, the Gulf war, Iraq, or Afghanistan, you can now enroll. If you deployed to any combat zone after 9/11 at all, you can enroll. And if you deployed in support of the global war on terror, you can also enroll. And even if you never deployed but were exposed to toxins or hazards while training or serving on active duty here at home by working with chemicals, pesticides, lead, asbestos, certain paints, nuclear weapons, x-rays, and more, you can enroll, too. Here’s the bottom line. All Veterans exposed to toxins and other hazards at home or abroad are eligible to enroll in VA care beginning on March 5th. This is the biggest expansion of VA care eligibility in generations, and we want you to apply as soon as possible. It’s quick and easy to enroll. You don’t need to be sick or file a claim to become eligible for this care. All you have to do is show that you served in one of these locations or operations or participated in one of the activities that could have exposed you to toxins or hazards. And even if you don’t think you need this care today, you might need it tomorrow or the next day or 30 years from now. Remember that when you enroll in VA healthcare, that enrollment means access to care for life, which is why this expansion on March 5th is so important. So please don’t miss this opportunity to enroll for VA healthcare. Affordable, excellent healthcare is waiting for you. Go to VA.gov/PACT and get the care that you’ve earned and deserved. And I promise we will do everything in our power to serve you as well as you’ve served us. Back to you, Mr. Secretary.

Terrence Hayes (VA Press Secretary):  Well, thank you, Dr. Elnahal. I know it’s bright and early out there out in the west coast. Probably warmer out there as well, so

Denis McDonough (VA Secretary):   60 here today.

Terrence Hayes (VA Press Secretary):  It’s 60 here? Oh, wow. I might actually go outside and run then. All right. We’ll go ahead and start the question and answer period. So, hey, questions? Any questions from the press? I won’t start with Leo this time. I’ll go to David. Good morning, David.

David Elfin (cyberFEDS):  Good morning, Terrence.

Terrence Hayes (VA Press Secretary):  Hopefully your mother’s doing well.

David Elfin (cyberFEDS):  Thank you. Good morning, Mr. Secretary. Saturday at 12:01 a.m. is the shutdown deadline governing VA. I wonder what your congressional liaison people are telling you that you can tell us. How concerned are you about what’s coming and how prepared are you, and if it happens what happens to the VA then?

Denis McDonough (VA Secretary):   Yeah. Dave, thanks so much. And I’m sorry to hear that your mom’s not well. So let me add my well wishes to Terrence’s. We are prepared. We just got a brief this morning from assistant secretary for the Office of Enterprise Integration, Guy Kiyokawa. He’s been working with our leads across the enterprise off and on for these last six months as we’ve confronted the various timelines. So, we are ready. But let me just be clear that in case of a shutdown, there would be no impact on Veteran healthcare. Burials would continue at VA national cemeteries. VA would continue to process and deliver benefits to Veterans, including compensation, pension, education, and housing benefits. And the board will continue to process appeals. However, we would not be able to conduct most outreach to Veterans. Our public facing regional offices would be closed and many regular operations like career counseling, transition assistance, and cemetery ground maintenance would not be available. I’m particularly mindful about the importance of outreach in light of the two things that we’ve just discussed. First, from Dr. Elnahal, where under a new statute, the PACT Act, millions of Veterans are now eligible for VA healthcare. We want to be able to reach them to ensure they avail themselves of what they have earned. Secondly, I also talked about a change in how we pay education benefits, and we are using every minute of every day between now and April 20th to affect that transition seamlessly. If, however, a shutdown impacts our ability to conduct our outreach to Veterans as it would, I’m concerned about that, and that’s why I’ve been arguing–that’s among the reasons I’ve been arguing for months that we need a full year appropriation from Congress. So, I hope that responds to the question, David.

David Elfin (cyberFEDS):   Follow-up, Secretary. First of all, you haven’t been through this as Secretary. You’ve been through it in the Obama White House, probably, I’m imagining. But what do you tell staff because I’m assuming they won’t be paid during a shutdown? And what level of optimism do you have we’re going to avoid this?

Denis McDonough (VA Secretary):   Yeah. Look, on the second part, I’m not going to kind of handicap the outcomes here. I think we’re working really hard to be ready. We’re working really hard to inform our negotiators in the White House, and so we’re going to keep doing that in the hopes that we get an agreement. In terms of our team, I’ve said time and again that the goodness in VA is our providers, our workers, our teammates in the field, and the most important thing we can do is be entirely transparent with them about what to expect and what we’re planning for. We’re continuing to do that. And then we’re obviously going out of our way to make sure that we are underscoring to them the massive importance that they have to the VA mission. Nothing happens in this important mission, this sacred obligation, as the president calls it, without our workforce. And so, we’re staying close to them, keeping them updated, and we’re being 100% transparent with them.

David Elfin (cyberFEDS):   Thank you.

Denis McDonough (VA Secretary):   Thank you.

Terrence Hayes (VA Press Secretary):  We’ll go to Ellen. Good morning. Ellen.

Ellen Milhiser (Congressional Synopsis):   Good morning, Terrence. Good morning, Secretary. Good morning, Dr. Elnahal. Back to some budget issues. With the potential cut in federal spending if they do a full year CR, it’s a 1% cut and just the pressure to control spending. You all are expanding VA healthcare, how do you think that’s going to play out in the FY ‘25 budget processes?

Denis McDonough (VA Secretary):   Ellen, thanks so much. We’ll have ample opportunity to talk to you about the FY ‘25 budget later next month, and we’ll obviously avail ourselves of that opportunity and make sure that we’re responding to your questions then. So, I’m not going to front run that question now. And then, as you say, that there is the risk that if there’s not an agreement, I think by April 30th, then there would be a 1% across the board cut. Similarly, I’m not going to rush to that conclusion. We’re working very hard this week to make sure that we are informing our negotiators what we’re experiencing, that we’re talking with our employees about what we’re experiencing, talking with VSOs, with the Hill, with you all today and otherwise about what we’re experiencing. And I think that that’s the most prudent path. The last thing is, I’ve been struck since I’ve worked at VA that there’s never been an answer to a question other than that everybody wants more VA. And I think Section 103 of the PACT Act is a good example of that. And so, when we are taking the steps we are taking, we are trying to respond to that instinct, which is, I think, true among Republicans and Democrats, that we get greater access at VA. And so, I have every confidence that we’ll do that well. And as we need additional resources, if we need additional resources there, we’ll conduct ourselves the way we have to date, transparently, candidly, and working with OMB and with the Hill to get what our Vets have earned. So, I hope that responds to the question.

Ellen Milhiser (Congressional Synopsis):   It did. Shifting slightly. Dr. Elnahal, the military health system is very focused on bringing complex care back into their MTFs as part of expanding medical readiness for their staff. Are they working with you to–I know you just announced a partnership with Pensacola. Is there any speed up on more of those partnerships?

Dr. Shereef Elnahal (Under Secretary for Health):  Thank you, Ellen, for the question. We’re really excited about the partnerships we’ve been able to build with DoD, both Assistant Secretary Martinez Lopez for Health Affairs and General Talita Crossland, who runs the Defense Health Agency. In fact, I was just in Fort Campbell on Friday and had a chance to announce a new VA clinic on that base that will now see Veterans. 3000 Veterans are going to have their care immediately transferred. We’ve been seeing patients for some number of days now. We had the ribbon cutting. Those officials were there with me. But we have Army staff, VA staff working together on that base to expand care options for Veterans while also contributing to the readiness mission actively that our active duty clinicians need to prepare for. And so, the Pensacola partnership is another great example of that. We have now a longer list of projects that we hope to execute just over the next coming months that opens more VA options for care in partnership with the DoD. And so, this, I think, is a demonstration of us making use of every option we have to expand our space and our clinical footprint to be able to meet the rising demand that will come from Section 103 acceleration and really an unprecedented demand for VA healthcare, as we just demonstrated last year with a record number of appointments delivered. So that partnership with DoD, Ellen, is a key part of our strategy to expand care to Vets.

Ellen Milhiser (Congressional Synopsis):   Thank you so much.

Denis McDonough (VA Secretary):   Hey, Ellen, I might just pile on here, at the risk of saying something dumb, since you just heard from the smartest guy in the VA, I just want to shout out Al Montoya. I know he spent some time with many of you last week. Dr. Elnahal and Mr. Montoya are doing an amazing job working with our network directors who are constantly innovating on new partnerships to provide more access to care. And we’ve talked about this in this room over the course of the last several–I guess maybe more than a year, about our hope that we can accelerate those partnerships with VA–sorry, with DoD. I mentioned Tinker Air Force Base, I mentioned Fort Sill after my visit to Oklahoma. I was just in California not long ago, and I know that VA Sacramento is staffing functionally the MTF on Travis Air Force Base. These are win-win opportunities for us and for Veterans and for active duty personnel and family members that also, incidentally, save the taxpayers money over time. So, I just want to publicly commend Dr. Elnahal, Mr. Montoya, and our network directors. Chief among them, you know, David Isaacs I want to shout out. Skye McDougall, I want to shout out Wendell Jones, I want to shout out. Paul Cruz, I want to shout out. These are professionals who are every day looking for innovative new ways to increase access to care. I hope in the coming months to be able to talk about an expanded program with the United States Department of Agriculture, where VA works with USDA funded facilities in rural settings to increase access closer to home for rural Veterans. But this is the kind of work that Dr. Shereef and Al and our network directors are making happen every day. And I’m so impressed by them and so grateful to them for it.

Ellen Milhiser (Congressional Synopsis):   At the risk of being really obnoxious, Terrence, one fast question. With the VA people working in DoD facilities, which are all using the Cerner EHR, do you think this will accelerate y’all going back to rolling out the Cerner system?

Denis McDonough (VA Secretary):   We–the Oracle Cerner system is currently functioning in reset mode, where our commitment is to not expand beyond the five sites except in the Lovell Federal Healthcare center in Chicago, about which we’ll make a decision here in the next couple of weeks until we’ve proven that that system works. So, we’re looking at all available data. We’re talking directly to our awesome providers in places like Spokane, Roseburg, White City, Columbus, and we’re going to continue that rollout when it’s proven to work.

Ellen Milhiser (Congressional Synopsis):   Thank you.

Terrence Hayes (VA Press Secretary):  Leo.

Leo Shane (Military Times):  Thank you for doing this, Mr. Secretary. Last Thursday, you signed a memo in response to the Transgender American Veterans Association petition regarding the gender confirmation surgeries. You said at the time–you said in the memo that you want further study to know the impact, the number of folks who might be involved, especially in light of the PACT Act. This was announced in summer 2021, well before the PACT Act. I wonder at this point what information you’re still looking for. We’re coming up on three years. Is this just a way to keep pushing this into the future and not making a final decision?

Denis McDonough (VA Secretary):   Yeah. Well, thanks very much for that question, Leo. You know, I’ve said before that transgender Vets deserve world class healthcare and benefits, and gender affirming care should be available to any Vet who needs it. VA remains committed to providing care to transgender Vets, but we’re not ready at this point to initiate rulemaking addressing the specific regulatory changes proposed in the petition. VA has moved methodically, and I have talked about this for months now, in its consideration of this important potential change in coverage, because it must be implemented in a manner that’s been thoroughly considered and ensures that the services made available to Vets meet VA’s rigorous standards for consistent, high quality healthcare nationwide. So, we’ll continue that consideration and analysis on this important issue.

As part of that, as your question suggests, I have asked Veterans health administration to produce estimates and collect data concerning the population of Veterans who will become newly eligible for hospital care, including mental health services and counseling, medical services, and nursing home care for any illness under recent major expansions of VA care. And so, while you’re right, Leo, that I made my initial announcement in the summer of ‘21, the president signed the PACT Act in 2022, and we’ve only in the course of the last five or six months made the decision to accelerate eligibility for all classes of Veterans envisioned in Section 103 of the PACT Act. So, these are all new developments under the PACT Act since it was signed. And among the things we’re asking Dr. Elnahal and his team to get me regulatory impact analysis on are questions about how many trans Veterans we anticipate enrolling under the expanded Section 103, and then what kind of services those trans Veterans will need so that we’re ready for that.

Let me just say one last thing here, which is that–two last things. While we’re making further analysis–considering this for further analysis, VA will continue to provide all other types of gender affirming care to Veterans. That includes medical care, support groups, mental health services, and more. And to all LGBTQ plus Veterans, and to all Veterans, I just want to be 100% clear that VA is 100% committed to providing you world class care in a safe, welcoming, and discrimination free environment. Every Veteran and every VA employee should feel respected and treated with dignity at VA. I’ll say this again. Every Veteran and every VA employee should feel respected and treated with dignity at VA. President Biden charged me on day one that our job is to fight like hell for all Veterans. Not some–all Veterans. That’s the policy and the standard to which I hold myself accountable, and I simply will not settle for less. I hope that responds to your question.

Leo Shane (Military Times):  Do you have a timeline for when you expect that review by Dr. Elnahal to be finished?

Denis McDonough (VA Secretary):   We’ve given him several months to do that, and so I’ll be prepared to dig into it when I get it.

Leo Shane (Military Times):   Okay. Thank you.

Denis McDonough (VA Secretary):   Thank you.

Terrence Hayes (VA Press Secretary):  We’ll go to Lucy. Good morning, Lucy.

Lucy Bustamante (NBC Philadelphia):   Thank you, Mr. Secretary. Two quick questions. One, obviously, the Veterans are going to expect to enroll, and hopefully it means free care. At what point does the VA determine whether this enrollment invitation equals to free care given their exposure? And then the second question is regarding your congressional hearing just last week, three and a half hours. Any regrets that these two men, Mr. Johnson, Mr. Davis, that they were not fired instead of allowed to retire and given severances? Thank you, sir.

Denis McDonough (VA Secretary):  Thanks so much. I don’t have anything new to add to the record after the hearing last week, other than to maybe one more time, underscore, as I just did to Leo, which is that every Veteran and every VA employee must feel respected and treated with dignity at VA. That’s the standard we hold. Secondly, Shereef, maybe you can comment on this, but the processes by which we determine questions like copays and other issues around access to VA healthcare are well established. Those are among the things that we’ll talk to Veterans about when they enroll. Let me just say there’s some Veterans who may be thinking, geez, I don’t really need VA healthcare. I’ve got better options or additional options now. To them, I say, hey, you may not need us today, but you might need us next month or next year or next decade. And once you’re in, you’re in for life. So please take advantage of this new option for increased eligibility for Veterans in the categories that Shereef briefed us about. But Shereef, anything that you want to add to the first part of Lucy’s question?

Dr. Shereef Elnahal (Under Secretary for Health):  Thank you, sir. I think you summarized it very well. Just one addition. So, the Section 103 of the PACT Act offers the opportunity not only for new Veterans to enroll into the system, but for Veterans who were previously in what we call lower priority groups because of variables like service-connection, income, et cetera. There are ways for even our existing Veterans enrolled in VA healthcare to potentially increase their priority group to a higher level in a manner that ultimately reduces what we call their cost sharing. So, copayments, et cetera. And one key element of Section 103 acceleration, the provision within the law, calls for conditions and treatments for those conditions that are related to toxic exposures to be exempt from copays. And so, there are multiple mechanisms by which Veterans may see, again, even if they’re already enrolled, an ultimately lower cost burden because of this. And so, we’re really excited about being able to do that for our existing base and, of course, for the many new Veterans who will become eligible for VA healthcare for the first time.

Terrence Hayes (VA Press Secretary):  Okay, who’s next? Patricia.

Patricia Kime (Military.com):   Thank you for doing this. I appreciate it. In September, Undersecretary for Benefits, Joshua Jacobs, said that they were going to review the rulemaking process or the rating scale to see if they could do anything about the 0% disability payments. Can I get an update on that and where that sits?

Denis McDonough (VA Secretary):  Why don’t we have Josh give you that update? I don’t have anything with me here, and I don’t know if his monthly has already happened or is about to happen, but we’ll make sure that he’s ready for that question.

Patricia Kime (Military.com):  Okay. That’s like the number one topic in my inbox is hypertension and 0% disability.

Denis McDonough (VA Secretary):  Yeah. Let us get–I want you to not be hypertensive about that. So let us make sure that we help get that addressed. I just also want the record to show that Lucy asked two questions, but Ellen today asked four. So [crosstalk]

Patricia Kime (Military.com):  I’m gonna ask another one. The travel kiosk, like new travel system, that kind of thing. I’m still hearing a lot of complaints from Veterans about it. And apparently there is a 30-day, like you have to file within 30 days that maybe wasn’t as publicized because I’m hearing that Veterans aren’t able to have them processed or even submit a claim before the 30 days and are having to pay out of pocket.

Denis McDonough (VA Secretary):  I hear a lot of concerns about the travel system, too. Shereef, do you want to take this one?

Dr. Shereef Elnahal (Under Secretary for Health):  Just that we’re looking at this issue from top to bottom to really just make this process easier and better for Veterans. And we’re really trying to take a user center design to the different options that Veterans have to be able to file their beneficiary travel claims. So that work will take a couple of months at least to get to ground on what we have to act on first. But as the Secretary said, I’ve also been hearing a lot about this, and we just have to make that process easier. Right now, it is not easy enough for too many Veterans to be able to file their claim on time and get reimbursed for what they’re eligible for. So, we are working on that very closely.

Patricia Kime (Military.com):  Is this an IT-related system? I mean, is it because of the BTSS or whatever it’s called, not functioning like it should?

Denis McDonough (VA Secretary):  No, I think there’s two things. So, one, just on the 30 days, let us take that, and Terrence will make sure that he gets back to you on that specific question. I had not heard that there’s a 30 day suspense on it. So let us take that. The second thing is what we’re trying to do is I think the program of record that Shereef is now reviewing was an effort to try to make it more Veteran friendly by moving away from the kiosks. But I think there’s many Veterans who actually thought it was more Veteran friendly to maintain the kiosks, even though we do see big uptake on the use of the app based, phone based travel reimbursement system, which we thought–I think the program of record envisioned replacing the kiosks, which the existing kiosk system requires the Veteran to go file a particular receipt at the kiosk and then be reimbursed later. We thought, I think probably, perhaps wrongly, but Shereef will find this out in his review, that this was going to be more Veteran centric. But we’re working through that question top to bottom.

Patricia Kime (Military.com):  Okay. Any data you have on that, I’d love. Appreciate it.

Denis McDonough (VA Secretary):  Definitely.

Patricia Kime (Military.com):  Okay. Thank you.

Terrence Hayes (VA Press Secretary):  Thank you, Patricia. We’ll go to Orion. Good morning, Orion.

Orion Donovan-Smith (The Spokesman Review):  Thank you, Terrence. Good morning. I’m sorry I couldn’t be there in person. Mr. Secretary, I’d like to follow up on something you just said a few minutes ago about the level federal healthcare center go-live with the Oracle Cerner EHR. Sounds like that decision, the go-live date is a little less than two weeks away. But am I correct in understanding that you’re still going to make a decision as to whether or not to go forward on that date? Could you just tell me–maybe this is more for Dr. Elnahal, but tell me what’s going into that decision?

Denis McDonough (VA Secretary):  Yeah. I think we–I think it’d be great. We can get you either with–if Shereef wants to take an hour, we can get you with Deputy Secretary Bradsher to talk about that decision. So, there’s–I’m sure there’s a range of things going into it. I’m tracking most closely that there’s been a series of updates which we call blocks, and in those blocks are various sections. So, we’re watching how those perform right now. Dep Sec was recently in Chicago to take a deep look at that. So, I don’t want to speak for her because I’m sure I’ll get it wrong. But that’s among–the performance of those updates are among the issues that we’re resolving. But Shereef, anything you want to add to that?

Dr. Shereef Elnahal (Under Secretary for Health):  Absolutely. So, a number of things still being tested now, including the functionality related to pharmaceuticals and being able to prescribe out of our pharmacy components much more easily. And so, these are updates that we had been working on with Oracle Cerner for some time, and we’re undergoing testing there and really looking at a holistic set of metrics and inputs. I will say something that the Deputy Secretary has said multiple times, and I very much agree with her. We want to make sure this is ready, and if it’s ready, we will go live. And if it’s not, we will do what it takes to get ready to go live. And so, I know that date is coming up, but our teams are working every single day, and the Dep Sec really has her eyes on this very closely.

Orion Donovan-Smith (The Spokesman Review):  Thank you. I’d appreciate a chance to talk with the Deputy Secretary to understand that thinking a little bit better. Just a quick follow-up. I’m sure Veterans can appreciate the care and the caution that you’re all showing with this decision that obviously affect a lot of folks. What is that fact that this is still in question? What does that say about what Veterans and providers at the five sites are dealing with still?

Denis McDonough (VA Secretary):  Look, we’re restless for excellence at VA, and that’s as true for our current care, well established care, as it is for new updates to that care, including new technological updates. And so, I hope what Veterans believe about this is that we’re really digging into this to get it right. And a key part to getting it right is hearing from our providers. On getting some time with Dep Sec, I want to make sure that I’m not promising something to you right now as an exclusive or something, Orion. We’ll make sure that as we get to that decision that she’s in a position to explain that to you guys. So, I just don’t want you to think that she’s going to call you this afternoon or something. We’ll work that through with you.

Orion Donovan-Smith (The Spokesman Review):  Fair enough. Thank you.

Terrence Hayes (VA Press Secretary):  Thank you, Orion. We’ll go to Eric.

Eric Katz (GovExec):  Thanks a lot. So, a few of us here have reported that there’s some sort of restrictions on hiring happening at VHA medical centers throughout the country. Can you–that can be in the form of a freeze or an FTE cap or even, as I understand it, not backfilling vacancies or even rescinding, in some cases, offers that have gone out. Can you update us on the nature of that? What are these VISN and medical center directors hearing from you? And secondly, to what extent, as we presumably get FY ‘24 full year approps, can that pressure be made more severe or alleviated?

Denis McDonough (VA Secretary):  Yeah. Thanks so much. Shereef, you wanna take–I have a couple of things to say about this, but you want to take first swipe at this?

Dr. Shereef Elnahal (Under Secretary for Health):  Thank you, sir, happy to. So, we are in this place for a couple of reasons. The first is that we hired many, many more people last year than even we were expecting because we had a strong mandate to be able to bring new healthcare workers on board to be able to meet the increased demand that we expected to see because of the historic developments around the PACT Act with new benefits and care eligibility. That includes a new wave of Veterans we hope to see with the Section 103 announcement as of March 5th that we talked about earlier. So, we exceeded our hiring goals. We hired more than 61,000 people into the system for the first time, a record in VA history. We also saw a lower turnover rate. In fact, we had a lower loss rate of employees for all reasons, by about 20% than we had seen in the immediate previous years. And I think that’s due to a couple of things. Number one, we exercised and used the new PACT Act hiring and retention authorities, to a very large extent. And Congress put that in the bill, and we asked for those authorities because we wanted to better retain and recruit the best healthcare talent out there. I think the second reason is because we’ve really focused on the work environment for our employees, both through our cultural initiatives like high reliability, which really lifts up the voices of the front line, but also our efforts to reduce burnout. And so, I think part of it’s our programming, part of it’s our use of these authorities. And the end result is that we well exceeded our hiring goals last year, which is a good thing. It means that we are at the end strength that we need to be able to serve Veterans. And so, just like any organization does, you have to have an FTE level that’s able to meet the mission and is supported by the budget. And so that’s what we’re doing this year. We’re making sure that we make use of all of those healthcare workers, especially the new ones we brought on board, to see the maximum number of Veterans and deliver the care that we need. And we think we’ll be able to do that. Just want to be clear about a couple of things. Number one, we’re not under a hiring freeze. And number two, we will continue to strategically hire in areas where we know Veteran care demand will be and in geographic areas where we know Veteran growth is the most. So, I’ve tried to make that clear to all of our medical centers, clinics, and healthcare workers. We will need to hire fewer staff this year. And again, that is because of the excellent hiring year we just had. So, what we’re doing is just taking sensible steps where we can to be able to meet the Veteran care mission most importantly, but also live responsibly within what we expect our budget to be over the next couple of years. And I wouldn’t differentiate at all what we’re doing from any organization that has a mission, FTE, and a budget. Ultimately, though, I think we have the end strength overall across the system, and we’re providing maximum flexibility to our hospitals and clinics to do what they need to do to execute on that mission.

Denis McDonough (VA Secretary):  Awesome. Shereef, I think you hit all the points I wanted to hit. And let me just accentuate two points that Dr. Elnahal made. One is that I think we did do a good job and Shereef led this effort. So let me publicly commend him for that and his team, people like Jessica Bonjorni and the HR professionals in the field at our VISNs did a really good job hiring last year. As importantly, they did a really good job of retaining providers. And that will obviously inform our decision later this year about how we execute on year two of the five years that we have for these special employment tools that came with the PACT Act. Secondly, we have areas that it’s super high growth, right. You’ve heard us talk about that in here a lot. Texas, Florida, Georgia, North Carolina, South Carolina, Nevada, Arizona, California, Washington state, Colorado. These are very high growth places. And where we need people there we have authority and we’ll make sure that we have the budget authority to hire them. And that’s what Shereef just said, including, by the way, we have to think really hard about how we hire them. I was just in South Carolina last week or maybe the week before for a great visit. But what we’re experiencing throughout that VISN 7, is that it’s really difficult to hire mental health professionals to work in person because psychologists and psychiatrists have so many options that are fully remote outside the VA system. So, we have to think really hard. Not only do we have the authority to hire those people, but how do we hire them? How do we remain competitive there? And that goes to questions like, do we insist that they be in person? Right. And so, we’re taking that look strategically at this as well. Last point. I thought Al Montoya made a really good point last week, Shereef, at the VA executive board, what do we call it — execution board, something like that. That sounds a little dark. But the VaEB, two weeks ago on these budget questions, he said, look, let’s keep in mind that later this year we’ll open the Fredericksburg, VA clinic. And by VA, I mean both Virginia and Veterans Affairs, biggest CBOC in the country. That requires us to hire thousands of people to work there. That’s built into the plan, right. So, the idea that we have a hiring freeze is not correct, right. The idea that we are looking carefully at hiring is correct. And that’s, as you’ve heard me talk about in here a lot, a function both of where we are in relation to the pandemic and where this labor market is and where the labor market is specifically for healthcare providers in the country. And it’s a reflection of a tighter fiscal picture as well. And I just remind everybody, David’s first question. We’re five months into the fiscal year. We’re operating under last year’s number outside of VHA, and by the way, in big portions of VHA. So, we’re already in a constrained fiscal environment, and we’re eyes wide open about that. And we’ll be 100% transparent with you guys about that.

Eric Katz (GovExec):  Just to follow up. So, I understand there’s no top-down hiring freeze, but if there are restrictions at certain facilities or in certain areas, Dr. Elnahal mentioned that we’re at the end strength, or you’re at the end strength that you need to be. Will that continue to be the case in those places if vacancies aren’t being filled?

Denis McDonough (VA Secretary):  I’m not sure–I think we’re answering your question. I don’t think we’re trying to hide anything from you here. Where we’re not hiring or where–it’s not because we haven’t been able to hire, it’s because we don’t have a need. And why would we not have a need? Well, we just had a great year hiring, right. But we’ll continue to make those cases led by our network directors, led by our VAMC directors. We’re watching very carefully execution on our budget this year, and I think that is as it should be as a general matter, but it is as it should be, maybe particularly when we’ve now entered the kind of a very dynamic labor market and we’ve entered a tighter fiscal picture, as the best evidence of that is exactly what David was asking about. I don’t know, Shereef, do you want to add to this?

Dr. Shereef Elnahal (Under Secretary for Health):  I think what we’re trying to do is make sure that medical center directors and network directors in our system ask the most important questions. Secretary said, what is the need when it comes to personnel, to deliver the most critical Veteran services and where they identify those needs, they will be able to continue to hire into those positions. Where we no longer have a need or when we have the end strength we need in particular functions, medical centers can make adjustments. They can decide not to hire, and in some cases, in the middle of a hiring process, they may have made that decision with information that they didn’t have at the beginning of that process. What I’m trying to do is still empower, as we always have been, our operational units in the field. Medical centers, nursing homes, clinics to hire where they think they need to when it comes to Veteran care demand, that’s the most important thing that we can ask them to do. And we have the latitude, we’ve given everybody the latitude to continue doing that.

Eric Katz (GovExec):  Thank you.

Terrence Hayes (VA Press Secretary):   We’ll go to Lisa. Good morning, Lisa.

Lisa Rein (The Washington Post):  Good morning. Can you guys hear me?

Terrence Hayes (VA Press Secretary):   We can. We can. Hopefully you’re feeling a little bit better.

Lisa Rein (The Washington Post):  Thanks. Let’s hope so. Actually, this is just a quick follow up on the conversation we’ve just been having, which is about VBA. So, is it safe to assume there is a slowdown, given the fiscal picture at VBA as well? And how will that affect the claims processing picture and the backlog?
Denis McDonough (VA Secretary):  Yeah, it is not safe to assume that. And I’m sorry you’re not feeling well either. I just got over a nasty cold, so I hope you feel better quickly.

Lisa Rein (The Washington Post):  It’s February.

Denis McDonough (VA Secretary):  Yeah, right. I don’t think it’s safe to assume that, Lisa. And so, if I inferred that–if you inferred that from what I said, you may have inferred something I did not mean to imply. However, if we’re in a yearlong CR, you know, we may have to make some determinations about that, right. But again, those are the questions I’m trying to avoid answering today because I’m hoping that we just get a resolution and agreement, and we’re working really hard to do that. There’s not been a slowdown in hiring. In fact, one of the things that has allowed us to reduce the backlog at VBA by 30,000 claims since the last time we met in this room is the coming online of thousands of additional trained VA examiners, RVSRs. And so, I’m really proud of the team over there. Josh, of course, but also the whole team, Mike Fru, Willie Clark, our regional office directors. I’m really proud of the team over there. Now, again, if this current picture continues, we may have to take a look at that, Lisa. But that’s not been the case yet.

Lisa Rein (The Washington Post):   Okay. All right. That’s it. Thank you.

Terrence Hayes (VA Press Secretary):  Thank you, Lisa. We’ll go to Jory.

Jory Heckman (Federal News Network):  Hi. Thanks again for doing this. Following up on the hiring piece of things. I heard everything you just told Eric about this, but we did see a memo recently, I guess, earlier this month, giving guidance to VA facilities about rescinding, in some cases, tentative job offers, in some cases, final job offers. And I wanted to hear from you a little bit more about how VA found itself in that position so suddenly. You know if they were in a position where they were making job offers, and then all of a sudden they’re in a situation where they’re pulling those back and what are you guys doing to, I guess, let them down gently?

Denis McDonough (VA Secretary):  Yeah. So, Shereef, do you want to take a first shot at this?

Dr. Shereef Elnahal (Under Secretary for Health):  Sorry. Happy to take it. So, one factor here that is a reality that’s related to this is how long it remains that it takes for us to hire new people on board. And unfortunately, that process still requires a couple of months. We’ve made some progress in reducing that, but part of the issue is that a lot of hires had been in the queue for that extended period of time. And as we’ve been reviewing our budget execution month to month, we realized that, number one, we had the end strength we need overall as a system, and number two, that our medical center directors and VISN directors determined that they were at the FTE level they needed for critical services potentially earlier than they had thought. And so, in those cases, especially when the job offer was still tentative, medical centers did have to make some rescissions on that. The guidance that we put out, though, was pretty clear that if we have a final job offer, if our candidates made moves within their lives, selling their homes, making arrangements to move to a new location to begin work, et cetera, we did not want them to pull back on those offers for a lot of reasons. And so that guidance was clear that even withdrawing a tentative job offer is to be used as a tool of last resort. And for final job offers, we do not support rescinding any of those. But nonetheless, I think the dynamic you’re talking about is, again, just the number of days it takes to hire an onboard, which we’re working on. And so, I think because of that dynamic, some of these withdrawals occurred.

Jory Heckman (Federal News Network):   All right. Do you have a sense of what that time to hire, time to fill is looking like now, and where you’re looking to get it to?

Dr. Shereef Elnahal (Under Secretary for Health):   We’re still over 120 days on average across the system, and it’s a highly variable region by region. So, some of our networks are well below that at this point, and we’re making some progress, but that’s the timeframe we’re talking about. Still over 100 days.

Jory Heckman (Federal News Network):  All right, Mr. Secretary, I wanted to circle back to your remarks, the last one of these that we did back in January. You said one of the tools at your disposal is kind of managing this through attrition, that as people leave deciding whether or not to fill specific positions or not, obviously not a bad problem to have that you guys did really well on hiring last year and that people are staying at a higher rate. But is there a specific goal in mind? Are there metrics that you guys are following in terms of that attrition side of things?

Denis McDonough (VA Secretary):  No, I don’t have a specific number in mind, Jory. I think in terms of specific tools, we just put out the tenth workforce dashboard on Friday under the PACT Act. We thought that that’s a really important window for you all and for Veterans and for VSOs and for the Hill to rely on that as a tool that we’re putting out there very regularly across a range of indicators in the workforce as it relates to PACT. But even there, we don’t publish a retention or attrition number. So that’s going to be something that we work through. But I don’t have a specific number for you.

Jory Heckman (Federal News Network):  Okay. Thank you.

Terrence Hayes (VA Press Secretary):  Did you have a question, Melissa? Thank you for your patience.

Melissa Burke (The Detroit News):  No problem. This is a bit of a follow up to Eric and Jory. I wanted to just clarify one thing. Detroit VAMC, they have told me that or sources there have said that they’re looking at an $83 million cut and they have some positions that are vacant that they haven’t been able to hire since about November. And I just wanted to clarify, this budget reduction, is it related just to the hiring or are there other areas of budget and operation beyond personnel that you guys are also looking at tweaking just to live within these constraints that you’re talking about?

Denis McDonough (VA Secretary):  Yeah, that sounds like–and we’ll go to Shereef in a second here, but maybe he has more data on that than I do. I’m not aware of a reduction for the Detroit VAMC. So, we’ll make sure that we reach out and make sure that we understand what the sources are telling you there, and then we’ll come back to you to talk about it. But again, we’re right now operating under our advanced appropriation for this year, and obviously that’s an important number. What Congress does on things like how much carryover they rescind, for example, will be something we’re looking at very closely. If we do get a final FY ‘24, we’re five months into the FY ’24–if we get into FY ‘24 numbers. And then, of course, we have the budget agreement levels for FY ‘25, and we’ll talk about those in the next couple of weeks. I’m not sure what your sources are pointing to, but let us get smart on that and we’ll make sure we spend some time with you. Shereef do you want to add anything to this?

Dr. Shereef Elnahal (Under Secretary for Health):  Happy to sir. So just sort of big clarifying point here. We believe we have the funding we need across VHA and the healthcare system to be able to meet Veteran care needs and support our base of FTE. So, I just want to make that crystal clear up front. What sometimes our medical centers and networks do is project out into the out-months and to the out-years what the budget would look like if we had certain scenarios take place, including inaction on things around budget execution that we know we need to take action on. So, what that is, is a management tool. It is not reflective of any real budget shortfall. And I know that’s nuanced and a bit in the weeds, but I just want to make crystal clear that we are not in a budget shortfall. We have the funding we need to be able to execute on the Veteran care mission and various leaders throughout the system make projections on different scenarios to be able to manage to that. But I’m not concerned about a funding issue at this point.

Melissa Burke (The Detroit News):  Thank you.

Terrence Hayes (VA Press Secretary):  We’ll go to Dan. Good morning, Dan.

Dan Sagalyn (PBS NewsHour):  Thanks for calling me. I’m sorry if I’m late. And forgive me if someone has asked this question. I understand that the VA is in the process of coming up with a code for constricted bronchiolitis and that it’s in the hands of the lawyers. Can you give us an update on that, when you expect it to be in existence? Is it going to be a code just for constrictive bronchiolitis or deployment related respiratory disease as defined by the consensus statement in March 2023? And just what will the disability rating be for it, or will it depend on severity?

Denis McDonough (VA Secretary):  Yeah. Thanks, Dan. I don’t have that at my fingertips. So, let us follow up–make sure that Terrence follows up with you after the press conference to get you exactly what you need there.

Dan Sagalyn (PBS NewsHour):  Can I ask–Dr. Elnahal, can you comment on this? I understand you’ve been talking about this.

Dr. Shereef Elnahal (Under Secretary for Health):   Yeah. So, as the Secretary said, the commitment we have is to do everything we can for Veterans with conditions like constrictive bronchiolitis to get them the care and benefits that they need. And so, I don’t want to speak ahead of rulemaking, especially rulemaking that VBA is thinking about, but we are trying to canvass every option that we can in our planning and thinking when it comes to policy to better serve Veterans with constrictive bronchiolitis.

Denis McDonough (VA Secretary):  Go ahead, Dan, if you want to follow up.

Dan Sagalyn (PBS NewsHour):  No, I mean–so this is in the hands of lawyers, so you don’t want to talk about it because you guys are internally deliberating about it?

Denis McDonough (VA Secretary):  No, that’s not what we said. Nobody said–you said it’s in the hands of lawyers.

Dan Sagalyn (PBS NewsHour):  I know, but I’ve been told that. That’s what Dr. Elnahal had said.

Denis McDonough (VA Secretary):  No, that’s not what he said.

Dan Sagalyn (PBS NewsHour):  No, not now, but in another conversation with other people.

Denis McDonough (VA Secretary):  Okay. All right, look, you asked a question. I told you we’d get you an answer. And we’ll make sure Terrence follows up with you.

Dan Sagalyn (PBS NewsHour):  Okay. Thank you, sir.

Denis McDonough (VA Secretary):  Okay.

Terrence Hayes (VA Press Secretary):  We’ll go back to Lucy. You there, Lucy? Lucy? Going once, going twice. Any other questions from folks in the room here? I’ll follow back up with Lucy after this. Any other additional questions? All right. I think that does it, sir. Again, thanks, everybody, for coming to the department at this early timeframe. Thank you, Dr. Elnahal, for getting up early as well, to share the news on the Section 108 and the PACT Act and how this–excuse me, 103, and how this is really going to impact millions of Veterans across the country. Truly important announcement there, and I truly hope that Veterans do take full advantage of that. Thank you again, Mr. Secretary, as well. And we’ll see you again next month everybody. Take care.

Denis McDonough (VA Secretary):  Thank you. Thanks, Shereef. Thanks everybody. Appreciate you guys.