[Federal Register Volume 88, Number 144 (Friday, July 28, 2023)]
[Notices]
[Pages 48951-48953]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-16004]


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DEPARTMENT OF VETERANS AFFAIRS


Notice of Request for Information on the Department of Veterans 
Affairs Creative Arts Therapists (Drama) 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 Creative Arts Therapists (Drama). 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 26, 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 any 
potential future 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.
    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 that 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. VA emphasized in 
the rulemaking and now reiterate herein 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

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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 
historically has 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, 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 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 
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 Officer; 
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 registration 
organization that includes the proposed national standard and an 
opportunity to further discuss the national standard with VA. After the 
States and registration 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 our mission and goals and that are better for 
Veterans or VA health care professionals. VA 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 Creative Arts Therapists (Drama)

    Please note that while VA Handbook 5005, Part II, Appendix G60 
refers to this position as Creative Arts Therapists (Drama), these 
positions are commonly referred to as Drama Therapists and that 
terminology will be used throughout herein.
    The proposed format for national standards of practice follows for 
when there are State licenses and a national registration. The first 
paragraph provides general information about the profession and what 
the health care professionals can do. The second paragraph references 
the education and registration needed to practice this profession at 
VA. The third paragraph confirms that this profession follows the 
standard set by the national registration body. A final statement 
explains that while VA only requires a national registration, 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.
    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.
    Drama Therapists use storytelling, projective play, purposeful 
improvisation and performance to invite participants to rehearse 
desired behaviors; practice being in a relationship; expandand find 
flexibility between life roles; and perform personal and social change. 
VA qualification standards require Drama Therapists to have an active, 
current, full and unrestricted Registered Drama Therapists (RDT) 
registration from the North American Drama Therapy Association (NADTA). 
VA reviewed whether there are any alternative registrations, 
certifications or State requirements that could be required for a Drama 
Therapist and found that one State requires a license. The standard set 
forth in the licensure requirements for the one State is consistent 
with what is permitted under the national registration. Therefore, 
there is no variance in how Drama Therapists practice in any State.
    VA proposes to adopt a standard of practice consistent with the 
national registration; therefore, VA Drama Therapists will continue to 
follow the same standard as set by the registration. The standard for 
the registration can be found at https://www.nadta.org/scope-of-practice.

[[Page 48953]]

    Because the practice of Drama Therapists 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 Drama Therapists

    1. Drama Therapists use an active, experiential approach to 
facilitate social, emotional and cognitive change. Through 
storytelling, projective play, purposeful improvisation and 
performance, participants are invited to rehearse desired behaviors, 
practice being in relationship, expandand find flexibility between life 
roles and perform personal and social change.
    2. Drama Therapists in the Department of Veterans Affairs (VA) 
possess the education and registration required by VA qualification 
standards. See VA Handbook 5005, Staffing, Part II, Appendix G60, dated 
June 7, 2019.
    3. VA Drama Therapists practice in accordance with the Registered 
Drama Therapists (RDT) national standards from the North American Drama 
Therapy Association, available at https://www.nadta.org/. VA reviewed 
license and certification requirements for this occupation in June 2023 
and confirmed that all Drama Therapists in VA follow this national 
registration.
    4. Although VA only requires a registration, one State, New York, 
requires a State license to practice as a Drama Therapist in that 
State.
    VA reviewed license and certification requirements for this 
occupation in June 2023 and confirmed that there is no variance in how 
VA Drama Therapists practice in any State.

Request for Information

    1. Are there any required trainings for the aforementioned 
practices that VA 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 VA has not listed?
    4. What should VA 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 VA about 
this national standard of practice?

Signing Authority

    Denis McDonough, Secretary of Veterans Affairs, approved and signed 
this document on July 10, 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.

Jeffrey M. Martin,
Assistant Director, Office of Regulation Policy & Management, Office of 
General Counsel, Department of Veterans Affairs.
[FR Doc. 2023-16004 Filed 7-27-23; 8:45 am]
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