[Federal Register Volume 87, Number 145 (Friday, July 29, 2022)]
[Notices]
[Pages 45857-45858]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-16326]


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DEPARTMENT OF VETERANS AFFAIRS


Notice of Request for Information on the Department of Veterans 
Affairs Kinesiotherapist 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 Kinesiotherapists. 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, 202-
461-0500. This is not a toll-free number.

SUPPLEMENTARY INFORMATION:

Authority

    38 U.S.C. 73 and 74 and 38 U.S.C. 303 permit the Secretary to 
further regulate VA's 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 to confirm 
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 here, 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 COVID-19 pandemic underscored 
the importance of this initiative. 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 practice across state 
lines. In addition, developing 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 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 with 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 our authority under the 
Supremacy Clause of the United States Constitution and consistent with 
the guidance outlined in Executive Order (E.O.) 13132 to utilize such 
authority. The process includes consulting with internal and external

[[Page 45858]]

stakeholders, including State licensing boards.
    For each identified VA occupation, a workgroup comprised of health 
care professionals is established to conduct 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 review 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 Electronic Health Record.
    Externally, the proposed national standard of practice is provided 
to our partners in DoD. In addition, unions are engaged informally as 
part of a pre-decisional collaboration. We note that the opportunity 
for bargaining exists later in the process and prior to publication of 
the national standard. Consistent with E.O. 13132, a letter is sent to 
each State board 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, the Federal Register, VA employees and any other 
person or organization who informally provides comments will be 
reviewed. VA will make appropriate revisions based on comments, 
including those that present evidence-based 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 published and effective, 
any additional 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 only if their VA 
medical facility performs this function for beneficiaries and the 
health care professional has the necessary education, training and 
skill to perform the task or duty.

National Standard for Kinesiotherapists

    The proposed structure for national standards of practice when 
there is a national registration body is as follows: the first 
paragraph is general information about the profession and what the 
health care professionals can do at a high level; the second paragraph 
references the education and credential needed to practice this 
profession at VA and confirms that this profession follows the standard 
of practice set by the registration body; and 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 requirements.
    VA qualification standards require Kinesiotherapists to be 
registered with the Council on Professional Standards for 
Kinesiotherapy (COPSKT). VA reviewed whether there are any alternative 
registrations, certifications or state requirements that could be 
required for a Kinesiotherapist and found that there were none. VA 
proposes to adopt a standard of practice consistent with this national 
registration; therefore, Kinesiotherapists will continue to follow the 
same standard as set by their national registration. The standard of 
practice for the national registration can be found at https://akta.org/professional-development/scope-of-practice.

Proposed National Standard of Practice for Kinesiotherapists

    The Kinesiotherapist is an allied health professional competent in 
the administration of scientifically based musculoskeletal, 
neurological, ergonomic, biomechanical, psychosocial and task-specific 
functional tests and measures combined with other evidence-based 
modalities used to physically, physiologically and psychologically 
improve the human function, movement and well-being of the Veteran. The 
Kinesiotherapist provides acute, sub-acute or post-acute rehabilitative 
therapy and wellness interventions focusing on therapeutic exercise, 
mobility, reconditioning, education and behavior change emphasizing the 
psychological as well as physical interventions to enhance outcomes for 
a holistic approach to rehabilitation.
    Kinesiotherapists in VA possess the required education and 
registration with COPSKT, which is a national board for 
Kinesiotherapist in accordance with VA qualification standards, as more 
specifically described in VA Handbook 5005, Staffing, Part II, Appendix 
G21. This national standard of practice confirms Kinesiotherapists 
practice in accordance with the American Board of Registration for 
Kinesiotherapists standards from COPSKT, available at: https://akta.org/. As of July 2021, Kinesiotherapists in all States follow this 
national registration.
    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 implementing 
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 11, 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. 2022-16326 Filed 7-28-22; 8:45 am]
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