[Federal Register Volume 87, Number 145 (Friday, July 29, 2022)]
[Notices]
[Pages 45853-45855]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-16325]


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DEPARTMENT OF VETERANS AFFAIRS


Notice of Request for Information on the Department of Veterans 
Affairs Ophthalmology Technician Standard of Practice

AGENCY: Department of Veterans Affairs.

ACTION: Request for information.

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SUMMARY: The Department of Veterans Affairs (VA) is requesting 
information to assist in developing a national standard of practice for 
VA Ophthalmology

[[Page 45854]]

Technicians. VA seeks comments on various topics to help inform VA's 
development of this national standard of practice.

DATES: Comments must be received on or before September 27, 2022.

ADDRESSES: Comments may be submitted through www.regulations.gov. 
Comments received will be available at www.regulations.gov for public 
viewing, inspection or copies.

FOR FURTHER INFORMATION CONTACT: Ethan Kalett, Office of Regulations, 
Appeals and Policy (10BRAP), Veterans Health Administration, Department 
of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420, or by 
phone at 202-461-0500. This is not a toll-free number.

SUPPLEMENTARY INFORMATION:

Authority

    Chapters 73 and 74 of 38 U.S.C. and 38 U.S.C. 303 authorize the 
Secretary to regulate the professional activities of VA health care 
professions to make certain that VA's health care system provides safe 
and effective health care by qualified health care professionals to 
ensure the well-being of those Veterans who have borne the battle.
    On November 12, 2020, VA published an interim final rule confirming 
that VA health care professionals may practice their health care 
profession consistent with the scope and requirements of their VA 
employment, notwithstanding any State license, registration, 
certification, or other requirements that unduly interfere with their 
practice. 38 CFR 17.419; 85 FR 71838. Specifically, this rulemaking 
confirmed VA's current practice of allowing VA health care 
professionals to deliver health care services in a State other than the 
health care professional's State of licensure, registration, 
certification, or other State requirement, thereby enhancing 
beneficiaries' access to critical VA health care services. The 
rulemaking also confirmed VA's authority to establish national 
standards of practice for health care professionals which would 
standardize a health care professional's practice in all VA medical 
facilities.
    The rulemaking explained that a national standard of practice 
describes the tasks and duties that a VA health care professional 
practicing in the health care profession may perform and may be 
permitted to undertake. Having a national standard of practice means 
that individuals from the same VA health care profession may provide 
the same type of tasks and duties regardless of the VA medical facility 
where they are located or the State license, registration, 
certification, or other State requirement they hold. We emphasized in 
the rulemaking and reiterate that VA will determine, on an individual 
basis, that a health care professional has the necessary education, 
training and skills to perform the tasks and duties detailed in the 
national standard of practice and will only be able to perform such 
tasks and duties after they have been incorporated into the 
individual's privileges, scope of practice, or functional statement. 
The rulemaking explicitly did not create any such national standards 
and directed that all national standards of practice would be 
subsequently created via policy.

Need for National Standards of Practice

    As the Nation's largest integrated health care system, it is 
critical that VA develops national standards of practice to ensure 
beneficiaries receive the same high-quality care regardless of where 
they enter the system and to ensure that VA health care professionals 
can efficiently meet the needs of beneficiaries when practicing within 
the scope of their VA employment. National standards are designed to 
increase beneficiaries' access to safe and effective health care, 
thereby improving health outcomes. The importance of this initiative 
has been underscored by the COVID-19 pandemic. With an increased need 
for mobility in our workforce, including through VA's Disaster 
Emergency Medical Personnel System, creating a uniform standard of 
practice better supports VA health care professionals who already 
frequently practice across State lines. In addition, the development of 
national standards of practice aligns with VA's long-term deployment of 
a new electronic health record (EHR). National standards of practice 
are critical for optimal EHR implementation to enable the specific 
roles for each health care profession in EHR to be consistent across 
the Veterans Health Administration (VHA) and to support increased 
interoperability between VA and the Department of Defense (DoD). DoD 
has historically standardized practice for certain health care 
professionals, and VHA closely partnered with DoD to learn from their 
experience.

Process To Develop National Standards of Practice

    Consistent with 38 CFR 17.419, VA is developing national standards 
of practice via policy. There will be one overarching national standard 
of practice directive that will generally describe VHA's policy and 
have each individual national standard of practice as an appendix to 
the directive. The directive and all appendices will be accessible on 
VHA Publications website at: https://vaww.va.gov/vhapublications/ 
(internal) and https://www.va.gov/vhapublications/ (external) once 
published.
    To develop these national standards, VA is using a robust, 
interactive process that is consistent with the guidance outlined in 
Executive Order (E.O.) 13132 to preempt State law. The process includes 
consultation with internal and external stakeholders, including State 
licensing boards, VA employees, professional associations, Veterans 
Service Organizations, labor partners and others. For each identified 
VA occupation, a workgroup comprised of health care professionals 
conducts State variance research to identify internal best practices 
that may not be authorized under every State license, certification, or 
registration, but would enhance the practice and efficiency of the 
profession throughout the agency. The workgroup may consult with 
internal stakeholders at any point throughout the process. If a best 
practice is identified that is not currently authorized by every State, 
the workgroup determines what education, training and skills are 
required to perform such task or duty. The workgroup then drafts a 
proposed VA national standard of practice using the data gathered 
during the State variance research and incorporates internal 
stakeholder feedback to date.
    The proposed national standard of practice is internally reviewed, 
to include by an interdisciplinary workgroup consisting of 
representatives from Quality Management; Field Chief of Staff; Academic 
Affiliates; Associate Director Patient Care Services; Ethics; Workforce 
Management and Consulting; Surgery; Credentialing and Privileging; 
Field Chief Medical Office; and EHR Modernization.
    Externally, the proposed national standard of practice is provided 
to our partners in DoD. In addition, VA labor partners are engaged 
informally as part of a pre-decisional collaboration. Consistent with 
E.O. 13132, a letter is sent to each State board and certifying 
organization that includes the proposed national standard and an 
opportunity to further discuss the national standard with VA. After the 
States have received notification, the proposed national standard of 
practice is published to the Federal Register for 60 days to obtain 
feedback from the public, including professional associations and 
unions. At the same time, the proposed national standard is published 
on an internal VA site to obtain feedback from VA employees. Feedback 
from State boards,

[[Page 45855]]

professional associations, unions, VA employees and any other person or 
organization who informally provides comments via the Federal Register 
will be reviewed. VA will make appropriate revisions in light of the 
comments, including those that present evidence-based practice and 
alternatives that help VA meet our mission and goals, and that are 
better for Veterans or VA health care professionals. We will publish a 
collective response to all comments at https://www.va.gov/standardsofpractice.
    After the national standard of practice is finalized, approved and 
published in VHA policy, VA will implement the tasks and duties 
authorized by that national standard of practice. Any tasks or duties 
included in the national standard will be incorporated into an 
individual health care professional's privileges, scope of practice, or 
functional statement following any training and education necessary for 
the health care professional to perform those functions. Implementation 
of the national standard of practice may be phased in across all 
medical facilities, with limited exemptions for health care 
professionals as needed.

National Standard for Ophthalmology Technicians

    The proposed format for national standards of practice when there 
is a national certifying body is as follows. The first paragraph is 
general information about the profession and what the health care 
professionals can do. The second paragraph references the education, 
certification, license, registration, or other requirements needed to 
practice this profession at VA and confirms that this profession 
follows the standard of practice set by the certifying body. A final 
statement confirms that as of the date of the workgroup's research into 
requirements, all individuals in this profession follow the same 
standard of practice.
    We note that proposed standards of practice do not contain an 
exhaustive list of every task this profession can perform. Rather, it 
is designed to highlight whether there are any areas of variance in how 
this profession can practice across States and how this profession will 
be able to practice within VA notwithstanding their State license, 
certification, registration, and other requirements.
    VA qualification standards require Ophthalmology Technicians to 
have an active, current, full and unrestricted national certification 
from the Joint Commission on Allied Health Personnel in Ophthalmology 
(JCAHPO). VA reviewed whether there are any alternative registrations, 
certifications, or State requirements that could be required for an 
Ophthalmology Technician and found that there were none. VA proposes to 
adopt a standard of practice consistent with the national 
certification; therefore, VA Ophthalmology Technicians will continue to 
follow the same standard as set by their national certification. The 
standard of practice for the national registration can be found here: 
https://documents.jcahpo.org/documents/Certification/IJCAHPO_Core_Criteria.pdf.
    Because the practice of Ophthalmology Technicians is not changing, 
there will be no impact on the practice of this occupation when this 
national standard of practice is implemented.

Proposed National Standard of Practice for Ophthalmology Technicians

    Ophthalmology Technicians are eye health care professionals 
qualified to assist ophthalmologists in the diagnostic evaluation, 
management, treatment and education of patients with medical and 
surgical conditions affecting the visual system. Their duties include, 
but are not limited to, documenting patient histories, assessing visual 
and ocular function, performing tests and ophthalmology imaging, 
administering topical ocular medications (i.e., drops or ointment, 
including anesthetic, dye, dilation, cycloplegic or antibiotics) and 
providing patient care.
    Ophthalmology Technicians in VA possess the required education and 
certification from JCAHPO, in accordance with VA qualification 
standards, as more specifically described in VA Handbook 5005, 
Staffing, Part II, Appendix G52.
    This national standard of practice confirms Ophthalmology 
Technicians practice in accordance with the Allied Ophthalmology 
Personnel Certification standards from JCAHPO, which are available at: 
https://jcahpo.org/. As ofAugust 2021, Ophthalmology Technicians in all 
States follow this national certification.

Request for Information

    1. Are there any required trainings for the aforementioned 
practices that we should consider?
    2. Are there any factors that would inhibit or delay the 
implementation of the aforementioned practices for VA health care 
professionals in any States?
    3. Is there any variance in practice that we have not listed?
    4. What should we consider when preempting conflicting State laws, 
regulations or requirements regarding supervision of individuals 
working toward obtaining their license or unlicensed personnel?
    5. Is there anything else you would like to share with us about 
this national standard of practice?

Signing Authority

    Denis McDonough, Secretary of Veterans Affairs, approved this 
document on July 18, 2022, and authorized the undersigned to sign and 
submit the document to the Office of the Federal Register for 
publication electronically as an official document of the Department of 
Veterans Affairs.

Luvenia Potts,
Regulation Policy Coordinator, Office of Regulation Policy & 
Management, Office of General Counsel, Department of Veterans Affairs.
[FR Doc. 2022-16325 Filed 7-28-22; 8:45 am]
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