For lack of a better answer, I'm posting my solution here.  The 'Save As' functionality appears to be inaccessible without using SendKeys...which of course is less than optimal given that a user can easily defeat the purpose by actively working on their desktop while the process is running.  Regardless, this process is initiated by calling the Download() procedure, passing the browser, the filename, and whether or not they'd care to replace the file if it exists already.  If no filename is passed the default 'Save' functionality is called and the default file name will save in the default folder.  This data has been accumulated and adapted from various sources both here at StackOverflow and elsewhere and should be a somewhat effective solution in MS Access.  
Option Explicit
Declare PtrSafe Function FindWindowEx Lib "user32" Alias "FindWindowExA" (ByVal hWnd1 As LongPtr, ByVal hWnd2 As LongPtr, ByVal lpsz1 As String, ByVal lpsz2 As String) As LongPtr
Declare PtrSafe Sub Sleep Lib "kernel32" _
    (ByVal dwMilliseconds As Long)
Declare PtrSafe Function FindWindow Lib "user32" Alias "FindWindowA" _
    (ByVal lpClassName As String, ByVal lpWindowName As String) As LongPtr
Declare PtrSafe Function SetForegroundWindow Lib "user32" _
    (ByVal hWnd As LongPtr) As Long
Declare PtrSafe Function SendMessage Lib "user32" Alias "SendMessageA" _
    (ByVal hWnd As LongPtr, ByVal wMsg As Long, ByVal wParam As Long, lParam As Any) As Long
Declare PtrSafe Function PostMessage Lib "user32" Alias "PostMessageA" _
    (ByVal hWnd As LongPtr, ByVal wMsg As Long, ByVal wParam As Long, lParam As Any) As Long
Public Const BM_CLICK = &HF5
Public Const WM_GETTEXT = &HD
Public Const WM_GETTEXTLENGTH = &HE
Public Sub Download(ByRef oBrowser As InternetExplorer, _
                     ByRef sFilename As String, _
                     ByRef bReplace As Boolean)
    If sFilename = "" Then
        Call Save(oBrowser)
    Else
        Call SaveAs(oBrowser, sFilename, bReplace)
    End If
End Sub
'https://stackoverflow.com/questions/26038165/automate-saveas-dialouge-for-ie9-vba
Public Sub Save(ByRef oBrowser As InternetExplorer)
    Dim AutomationObj As IUIAutomation
    Dim WindowElement As IUIAutomationElement
    Dim Button As IUIAutomationElement
    Dim hWnd As LongPtr
    Set AutomationObj = New CUIAutomation
    hWnd = oBrowser.hWnd
    hWnd = FindWindowEx(hWnd, 0, "Frame Notification Bar", vbNullString)
    If hWnd = 0 Then Exit Sub
    Set WindowElement = AutomationObj.ElementFromHandle(ByVal hWnd)
    Dim iCnd As IUIAutomationCondition
    Set iCnd = AutomationObj.CreatePropertyCondition(UIA_NamePropertyId, "Save")
    Set Button = WindowElement.FindFirst(TreeScope_Subtree, iCnd)
    Dim InvokePattern As IUIAutomationInvokePattern
    Set InvokePattern = Button.GetCurrentPattern(UIA_InvokePatternId)
    InvokePattern.Invoke
End Sub
Sub SaveAs(ByRef oBrowser As InternetExplorer, _
                     sFilename As String, _
                     bReplace As Boolean)
    'https://msdn.microsoft.com/en-us/library/system.windows.automation.condition.truecondition(v=vs.110).aspx?cs-save-lang=1&cs-lang=vb#code-snippet-1
    Dim AllElements As IUIAutomationElementArray
    Dim Element As IUIAutomationElement
    Dim InvokePattern As IUIAutomationInvokePattern
    Dim iCnd As IUIAutomationCondition
    Dim AutomationObj As IUIAutomation
    Dim FrameElement As IUIAutomationElement
    Dim bFileExists As Boolean
    Dim hWnd As LongPtr
    'create the automation object
    Set AutomationObj = New CUIAutomation
    WaitSeconds 3
    'get handle from the browser
    hWnd = oBrowser.hWnd
    'get the handle to the Frame Notification Bar
    hWnd = FindWindowEx(hWnd, 0, "Frame Notification Bar", vbNullString)
    If hWnd = 0 Then Exit Sub
    'obtain the element from the handle
    Set FrameElement = AutomationObj.ElementFromHandle(ByVal hWnd)
    'Get split buttons elements
    Set iCnd = AutomationObj.CreatePropertyCondition(UIA_ControlTypePropertyId, UIA_SplitButtonControlTypeId)
    Set AllElements = FrameElement.FindAll(TreeScope_Subtree, iCnd)
    'There should be only 2 split buttons only
    If AllElements.length = 2 Then
        'Get the second split button which when clicked shows the other three Save, Save As, Save and Open
        Set Element = AllElements.GetElement(1)
        'click the second spin button to display Save, Save as, Save and open options
        Set InvokePattern = Element.GetCurrentPattern(UIA_InvokePatternId)
        InvokePattern.Invoke
        'Tab across from default Open to Save, down twice to click Save as
        'Displays Save as window
        SendKeys "{TAB}"
        SendKeys "{DOWN}"
        SendKeys "{ENTER}"
        'Enter Data into the save as window
        Call SaveAsFilename(sFilename)
        bFileExists = SaveAsSave
        If bFileExists Then
            Call File_Already_Exists(bReplace)
        End If
    End If
End Sub
Private Sub SaveAsFilename(filename As String)
    Dim hWnd As LongPtr
    Dim Timeout As Date
    Dim fullfilename As String
    Dim AutomationObj As IUIAutomation
    Dim WindowElement As IUIAutomationElement
    'Find the Save As window, waiting a maximum of 10 seconds for it to appear
    Timeout = Now + TimeValue("00:00:10")
    Do
        hWnd = FindWindow("#32770", "Save As")
        DoEvents
        Sleep 200
    Loop Until hWnd Or Now > Timeout
    If hWnd Then
        SetForegroundWindow hWnd
        'create the automation object
        Set AutomationObj = New CUIAutomation
        'obtain the element from the handle
        Set WindowElement = AutomationObj.ElementFromHandle(ByVal hWnd)
        'Set the filename into the filename control only when one is provided, else use the default filename
        If filename <> "" Then Call SaveAsSetFilename(filename, AutomationObj, WindowElement)
    End If
End Sub
'Set the filename to the Save As Dialog
Private Sub SaveAsSetFilename(ByRef sFilename As String, ByRef AutomationObj As IUIAutomation, _
                                ByRef WindowElement As IUIAutomationElement)
    Dim Element As IUIAutomationElement
    Dim ElementArray As IUIAutomationElementArray
    Dim iCnd As IUIAutomationCondition
    'Set the filename control
    Set iCnd = AutomationObj.CreatePropertyCondition(UIA_AutomationIdPropertyId, "FileNameControlHost")
    Set ElementArray = WindowElement.FindAll(TreeScope_Subtree, iCnd)
    If ElementArray.length <> 0 Then
        Set Element = ElementArray.GetElement(0)
        'should check that it is enabled
        'Update the element
        Element.SetFocus
        ' Delete existing content in the control and insert new content.
        SendKeys "^{HOME}" ' Move to start of control
        SendKeys "^+{END}" ' Select everything
        SendKeys "{DEL}" ' Delete selection
        SendKeys sFilename
    End If
End Sub
'Get the window text
Private Function Get_Window_Text(hWnd As LongPtr) As String
    'Returns the text in the specified window
    Dim Buffer As String
    Dim length As Long
    Dim result As Long
    SetForegroundWindow hWnd
    length = SendMessage(hWnd, WM_GETTEXTLENGTH, 0, 0)
    Buffer = Space(length + 1) '+1 for the null terminator
    result = SendMessage(hWnd, WM_GETTEXT, Len(Buffer), ByVal Buffer)
    Get_Window_Text = Left(Buffer, length)
End Function
'Click Save on the Save As Dialog
Private Function SaveAsSave() As Boolean
    'Click the Save button in the Save As dialogue, returning True if the ' already exists'
    'window appears, otherwise False
    Dim hWndButton As LongPtr
    Dim hWndSaveAs As LongPtr
    Dim hWndConfirmSaveAs As LongPtr
    Dim Timeout As Date
    'Find the Save As window, waiting a maximum of 10 seconds for it to appear
    Timeout = Now + TimeValue("00:00:10")
    Do
        hWndSaveAs = FindWindow("#32770", "Save As")
        DoEvents
        Sleep 200
    Loop Until hWndSaveAs Or Now > Timeout
    If hWndSaveAs Then
        SetForegroundWindow hWndSaveAs
        'Get the child Save button
        hWndButton = FindWindowEx(hWndSaveAs, 0, "Button", "&Save")
    End If
    If hWndButton Then
        'Click the Save button
        Sleep 100
        SetForegroundWindow hWndButton
        PostMessage hWndButton, BM_CLICK, 0, 0
    End If
    'Set function return value depending on whether or not the ' already exists' popup window exists
    Sleep 500
    hWndConfirmSaveAs = FindWindow("#32770", "Confirm Save As")
    If hWndConfirmSaveAs Then
        SaveAsSave = True
    Else
        SaveAsSave = False
    End If
End Function
'Addresses the case when saving the file when it already exists.
'The file can be overwritten if Replace boolean is set to True
Private Sub File_Already_Exists(Replace As Boolean)
    'Click Yes or No in the ' already exists. Do you want to replace it?' window
    Dim hWndSaveAs As LongPtr
    Dim hWndConfirmSaveAs As LongPtr
    Dim AutomationObj As IUIAutomation
    Dim WindowElement As IUIAutomationElement
    Dim Element As IUIAutomationElement
    Dim iCnd As IUIAutomationCondition
    Dim InvokePattern As IUIAutomationInvokePattern
    hWndConfirmSaveAs = FindWindow("#32770", "Confirm Save As")
    Set AutomationObj = New CUIAutomation
    Set WindowElement = AutomationObj.ElementFromHandle(ByVal hWndConfirmSaveAs)
    If hWndConfirmSaveAs Then
        If Replace Then
            Set iCnd = AutomationObj.CreatePropertyCondition(UIA_NamePropertyId, "Yes")
        Else
            Set iCnd = AutomationObj.CreatePropertyCondition(UIA_NamePropertyId, "No")
        End If
        Set Element = WindowElement.FindFirst(TreeScope_Subtree, iCnd)
        Set InvokePattern = Element.GetCurrentPattern(UIA_InvokePatternId)
        InvokePattern.Invoke
    End If
End Sub
Public Sub WaitSeconds(intSeconds As Integer)
  On Error GoTo Errorh
  Dim datTime As Date
  datTime = DateAdd("s", intSeconds, Now)
  Do
    Sleep 100
    DoEvents
  Loop Until Now >= datTime
exitsub:
  Exit Sub
Errorh:
  MsgBox "Error: " & Err.Number & ". " & Err.Description, , "WaitSeconds"
  Resume exitsub
End Sub
References:
SaveasDialog
True Condition
Faidootdoot