[Federal Register Volume 88, Number 94 (Tuesday, May 16, 2023)]
[Notices]
[Pages 31308-31310]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-10424]


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DEPARTMENT OF VETERANS AFFAIRS


Notice of Request for Information on the Department of Veterans 
Affairs; Histopathology Technologists 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 Histopathology Technologists. 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 July 17, 2023.

ADDRESSES: Comments must be submitted through www.regulations.gov. 
Except as provided below, comments received before the close of the 
comment period will be available at www.regulations.gov for public 
viewing, inspection, or copying, including any personally identifiable 
or confidential business information that is included in a comment. We 
post the comments received before the close of the comment period on 
the following website as soon as possible after they have been 
received: http://www.regulations.gov. VA will not post on 
Regulations.gov public comments that make threats to individuals or 
institutions or suggest that the commenter will take actions to harm 
the individual. VA encourages individuals not to submit duplicative 
comments. We will post acceptable comments from multiple unique 
commenters even if the content is identical or nearly identical to 
other comments. Any public comment received after the comment period's 
closing date is considered late and will not be considered in a 
potential rulemaking.

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

    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.

[[Page 31309]]

    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 its 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 develop 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 Coronavirus Disease, 2019 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 policy and have 
each individual national standard of practice as an appendix to the 
directive. The directive and all appendices will be accessible on the 
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, Federalism, 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 
is comprised of VA employees who are health care professionals in the 
identified occupation, and they 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 a 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, 
and which includes review by an interdisciplinary workgroup consisting 
of representatives from Quality Management; Field Chief of Staff; 
Academic Affiliates; Field Chief Nursing Officer; 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 and certifying organization 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, 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 its 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

[[Page 31310]]

national standard of practice may be phased in across all medical 
facilities, with limited exemptions for health care professionals as 
needed.

National Standard for Histopathology Technologists

    The proposed format for national standards of practice when there 
are state licenses and a national certification is as follows: The 
first paragraph provides general information about the profession and 
what the health care professionals can do. The second paragraph 
references the education and certification needed to practice this 
profession at VA. The third paragraph confirms that this profession 
follows the standard set by the national certifying body. A final 
statement explains that while VA only requires a national 
certification, some states also require licensure for this profession. 
The standard includes information on which states offer an exemption 
for Federal employees and where VA will preempt state laws, if 
applicable.
    We note that the proposed standards of practice do not contain an 
exhaustive list of every task and duty that each VA health care 
professional 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.
    Histopathology technologists, also referred to as 
histotechnologists, are highly skilled medical laboratory professionals 
who are responsible for the preanalytical processing of human tissue 
and body fluid specimens. VA qualification standards require 
histopathology technologists to have an active, current, full and 
unrestricted histotechnologist (HTL) certification from the American 
Society for Clinical Pathology. VA reviewed whether there are any 
alternative registrations, certifications or state requirements that 
could be required for histopathology technologists and found that eight 
states require a license to practice as a histopathology technologist 
in that state. Of those, six states exempt Federal employees from their 
state license requirements. The standards set forth in the licensure 
requirements for all eight states are consistent with what is permitted 
under the national certification. Therefore, there is no variance in 
how histopathology technologists practice in any State.
    VA proposes to adopt a standard of practice consistent with the 
national certification. Therefore, VA histopathology technologists will 
continue to follow the same standard as set by their national 
certification. The standard for the certification can be found here: 
https://www.ascp.org/content/docs/default-source/policy-statements/ascp-pdft-pp-personnel-standards.pdf?sfvrsn=2.
    Because the practice of Histopathology Technologists 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 Histopathology Technologist

    Histopathology technologists are highly skilled medical laboratory 
professionals who are responsible for the preanalytical processing of 
human tissue and body fluid specimens. Through the utilization of a 
broad range of specialized techniques and procedures, both manual and 
automated, histopathology technologists preserve and prepare specimens 
for pathologist review, interpretation, evaluation and diagnosis of 
patient conditions or disease.
    Histopathology technologists in VA possess the education and 
certification required by VA qualification standards, as more 
specifically described in VA Handbook 5005, Staffing, dated February 4, 
2022.
    This national standard of practice confirms that histopathology 
technologists practice according to the HTL certification standards 
from the American Society for Clinical Pathology (ASCP), available at: 
www.ascp.org. As of March 2022, all histopathology technologists in VA 
follow this national certification.
    Although VA only requires a certification, the following eight 
States require a State license in order to practice as a 
histopathologist in that State: Florida, Louisiana, Montana, Nevada, 
New York, Puerto Rico, Tennessee, and West Virginia. Of these, the 
following States exempt Federal employees from their State license 
requirements: Florida, Louisiana, Montana, New York, Tennessee and West 
Virginia. As of October 2022, there is no variance in how VA 
Histopathology Technologists practice in any State.

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 April 28, 2023, 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 Development Coordinator, Office of Regulation Policy & 
Management, Office of General Counsel, Department of Veterans Affairs.
[FR Doc. 2023-10424 Filed 5-15-23; 8:45 am]
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