[Federal Register Volume 89, Number 94 (Tuesday, May 14, 2024)]
[Notices]
[Pages 42057-42060]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-10528]
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DEPARTMENT OF VETERANS AFFAIRS
Notice of Request for Information on the Department of Veterans
Affairs Nuclear Medicine Technologist 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 Nuclear Medicine 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 15, 2024.
ADDRESSES: Comments must be submitted through https://www.regulations.gov/. Except as provided below, comments received
before the close of the comment period will be available at https://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: https://www.regulations.gov/. VA will not post on https://www.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 will not be
considered.
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 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 State 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, regardless of conflicting State laws, rules, regulations,
or other State requirements.
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
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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 State 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 proper
education, training, and skills to perform the tasks and duties
detailed in the national standard of practice, and that they 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.
Preemption of State Requirements
The national standard of practice will preempt any State laws,
rules, regulations, or requirements that both are and are not listed in
the national standard as conflicting, but that do in fact conflict with
the tasks and duties as authorized in VA's national standard of
practice. In the event that a State changes their requirements and
places new limitations on the tasks and duties it allows in a manner
that would be inconsistent with what is authorized under the national
standard of practice, the national standard of practice will preempt
such limitations and authorize the VA health care professional to
continue to practice consistently with the tasks and duties outlined in
the national standard of practice.
In cases where a VA health care professional's license,
registration, certification, or other State requirement allows a
practice that is not included in a national standard of practice, the
individual may continue that practice so long as it is permissible by
Federal law and VA policy, is not explicitly prohibited by the national
standard of practice and is approved by the VA medical facility.
Need for National Standards of Practice
It is critical that VA, the Nation's largest integrated health care
system, develops national standards of practice to ensure, first, that
beneficiaries receive the same high-quality care regardless of where
they enter the system and, second, 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 (COVID-19)
pandemic. The increased need for mobility in VA's workforce, including
through VA's Disaster Emergency Medical Personnel System, highlighted
the importance of creating uniform national standards of practice to
better support VA health care professionals who practice across State
lines. Creating national standards of practice also promotes
interoperability of medical data between VA and the Department of
Defense (DoD), providing a complete picture of a Veteran's health
information and improving VA's delivery of health care to the Nation's
Veterans. DoD has historically standardized practice for certain health
care professionals, and VA has closely partnered with DoD to learn from
their experience.
Process To Develop National Standards of Practice
As authorized by 38 CFR 17.419, VA is developing national standards
of practice via policy. There is one overarching directive to describe
Veterans Health Administration (VHA) policy on national standards of
practice. The directive is accessible on the VHA Publications website
at https://vaww.va.gov/vhapublications/ (internal) and https://www.va.gov/vhapublications/ (external). As each individual national
standard of practice is finalized, it is published as an appendix to
the directive and accessible at the same websites.
To develop these national standards, VA is using a robust,
interactive process that adheres to the guidelines outlined in
Executive Order (E.O.) 13132 to preempt conflicting State laws, rules,
regulations, or other requirements. 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 VA occupation, a
workgroup comprised of VA health care professionals in the identified
occupation conducts 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 VA. 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 tasks and
duties. The workgroup then drafts a proposed VA national standard of
practice using the data gathered during the research and incorporates
internal stakeholder feedback into the standard. The workgroup may
consult with internal or external stakeholders at any point throughout
the process.
The proposed national standard of practice is then internally
reviewed, to include by an interdisciplinary VA workgroup consisting of
representatives from Quality Management, VA medical facility Chiefs of
Staff, Academic Affiliates, Veterans Integrated Services Network (VISN)
Chief Nursing Officers, Ethics, Workforce Management and Consulting,
Surgery, Credentialing and Privileging, VISN Chief Medical Officers,
and Electronic Health Record Modernization.
Externally, VA hosts listening sessions for members of the public,
professional associations, and VA employees to provide comments on the
variance between State practice acts for specific occupations and what
should be included in the national standard of practice for that
occupation. The listening session for Nuclear Medicine Technologists on
September 7, 2023, included five presenters, representing VA employees
and the Nuclear Medicine Technology Certification Board. The presenters
spoke about the qualifications of and scope of practice for Nuclear
Medicine Technologists. Presenters were supportive of the national
standard of practice. VA appreciates the thoughtful presentations and
is considering the information presented at the listening session when
drafting the proposed VA national standard of practice.
VA has developed a robust process to engage with partners, members
of the public, States, and employees on the proposed national standard
of practice. VA provides the proposed national standard of practice to
our DoD partners as an opportunity to flag inconsistencies with DoD
standards. VA also engages with labor partners informally as part of a
pre-decisional collaboration. Consistent with E.O. 13132, VA sends a
letter to each State board and certifying organization or registration
organization, as appropriate, which includes the proposed national
standard and offers the recipient an opportunity to discuss the
national standard with VA. After the State boards, certifying
organizations, or registration organizations have received
notification, the proposed national standard of practice is posted in
the Federal Register for 60 days to obtain feedback from the public,
professional associations, and any other interested parties. At the
same time, the proposed national standard is posted to an
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internal VA site to obtain feedback from VA employees. Responses
received through all vehicles--from State boards, professional
associations, unions, VA employees, and any other individual or
organization who 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. 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 properly incorporated into an
individual health care professional's privileges, scope of practice, or
functional statement once it has been determined by their VA medical
facility that the individual has the proper education, training, and
skills to perform the task or duty. Implementation of the national
standard of practice may be phased in across all VA medical facilities,
with limited exemptions for health care professionals, as needed.
Format for the Proposed National Standard for Nuclear Medicine
Technologists
The format for the proposed national standards of practice when
there are national certification bodies and State licenses is described
as follows. The first paragraph provides general information about the
profession and what the health care professionals can do. For this
national standard, Nuclear Medicine Technologists administer
radionuclides, radiopharmaceuticals, and adjunct medications under the
direction of a Nuclear Medicine Physician or Radiologist. We reiterate
that the proposed standard of practice does not contain an exhaustive
list of every task and duty that each VA health care professional can
perform. Rather, it is designed to highlight generally what tasks and
duties the health care professionals perform and how they will be able
to practice within VA notwithstanding their State license,
certification, registration, or other State requirements.
The second paragraph references the education and certification
needed to practice this profession at VA. Qualification standards for
employment of health care professionals by VA are outlined in VA
Handbook 5005, Staffing, dated April 8, 2024. VA follows the
requirements outlined in the VA qualification standards even if the
requirements conflict with or differ from a State requirement. National
standards of practice do not affect those requirements. This includes,
but is not limited to, when a State requires a license to practice a
specific occupation, but VA does not require a State license as part of
the qualification standards. For Nuclear Medicine Technologists, VA
qualification standards require an active, current, full, and
unrestricted certification from the Nuclear Medicine Technology
Certification Board (NMTCB) or the American Registry of Radiologic
Technology (ARRT).
The second paragraph also notes whether the national standard of
practice explicitly excludes individuals who practice under
``grandfathering'' provisions. Qualification standards may include
provisions to permit employees who met all requirements prior to
revisions to the qualification standards to maintain employment at VA
even if they no longer meet the new qualification standards. This
practice is referred to as grandfathering. Nuclear Medicine
Technologists have grandfathering provisions included within their
qualification standards, and VA proposes to have those individuals be
authorized to follow the Nuclear Medicine Technologist national
standard of practice. Therefore, there would be no notation regarding
grandfathered employees in the national standard of practice as they
would be required to adhere to the national standard as would any other
VA Nuclear Medicine Technologist who meets the current qualification
standards.
The third paragraph establishes what the national standard of
practice will be for the occupation in VA. For this national standard,
VA Nuclear Medicine Technologists follow the standard set by Society of
Nuclear Medicine and Molecular Imaging (SNMMI), which can be found at:
https://www.snmmi.org/Technologists. For Nuclear Medicine
Technologists, VA confirmed that all individuals, whether certified by
NMTCB or ARRT, followed the Nuclear Medicine Technologist Scope of
Practice and Performance Standards from SNMMI.
The fourth paragraph identifies if there are additional
registrations, regulations, certifications, licenses, or Federal
exemptions for the profession. It explains if VA is preempting any
conflicting State laws, rules, regulations, or requirements. For this
national standard of practice, VA reviewed if there are any required
alternative registrations, certifications, licenses, or other State
requirements for Nuclear Medicine Technologists. VA found that 34
States require a State license for Nuclear Medicine Technologists.
The fourth paragraph also includes information on which States
offer an exemption for Federal employees and whether VA is preempting
any conflicting State laws, rules, regulations, or requirements. Of
those 34 States that require a license, 24 States exempt Federal
employees from their State license requirements. Furthermore, the tasks
and duties set forth in the State license requirements for all 34
States are consistent with what is permitted under the national
certification. Therefore, there is no variance in how Nuclear Medicine
Technologists practice in any State. VA thus proposes to adopt a
standard of practice consistent with the national certification. VA
Nuclear Medicine Technologists will continue to follow this standard.
This national standard or practice does not address training
because it will not authorize VA Nuclear Medicine Technologists to
perform any tasks or duties not already authorized under their national
certification and State license.
Following public and VA employee comments and revisions, each
national standard of practice that is published in policy will also
include the date for recertification of the standard of practice and a
point of contact for questions or concerns.
Proposed National Standard of Practice for Nuclear Medicine
Technologists
1. Nuclear Medicine Technologists perform technical work in support
of the Diagnostic Imaging Service's Nuclear Medicine section under the
direction of a Nuclear Medicine Physician or Radiologist. Nuclear
Medicine Technologists administer radionuclides, radiopharmaceuticals,
and adjunct medications. They also operate radiation detectors,
scanning apparatus, and related equipment for patients having General
Nuclear Medicine, Nuclear Cardiology, Positron Emission Tomography and
Computerized Tomography (PET/CT), and Positron Emission Tomography and
Magnetic Resonance Imaging (PET/MRI) exams. Under the supervision of an
authorized user, Nuclear Medicine Technologists are responsible for the
safe use of ionizing and non-ionizing radiation and molecular imaging
for diagnostic, therapeutic, and research purposes. Nuclear Medicine
Technologists review patients' medical histories to understand their
illnesses, medical issues, and pending diagnostic or treatment
procedures; instruct
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patients before, during, and following procedures; evaluate the
satisfactory preparation of patients before beginning procedures;
complete documentation within electronic health records as necessary;
and recognize and respond appropriately to emergency situations.
2. Nuclear Medicine Technologists in the Department of Veterans
Affairs (VA) possess the education and certification required by VA
qualification standards. See VA Handbook 5005, Staffing, part II,
appendix G19, dated December 10, 2019.
3. VA Nuclear Medicine Technologists practice in accordance with
the Nuclear Medicine Technologist Scope of Practice and Performance
Standards from the Society of Nuclear Medicine and Molecular Imaging
(SNMMI), available at https://www.snmmi.org/Technologists. Nuclear
Medicine Technology Certification Board and the American Registry of
Radiologic Technology, the two national certifying bodies of Nuclear
Medicine Technologists, follow the SNMMI standards. VA reviewed license
and certification requirements for this occupation in September 2023
and confirmed that all Nuclear Medicine Technologists in VA followed
SNMMI standards.
4. Although VA only requires a certification, 34 States require a
State license in order to practice as a Nuclear Medicine Technologist
in that State: Alaska, Arizona, Arkansas, California, Delaware,
Florida, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana,
Maine, Maryland, Massachusetts, Mississippi, Nevada, New Hampshire, New
Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Puerto Rico,
Rhode Island, South Carolina, Texas, Utah, Vermont, Virginia, West
Virginia, and Wyoming.
Of those, 24 States exempt Federal employees from their State
license requirements: Alaska, Arizona, California, Delaware, Florida,
Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts,
Nevada, New Hampshire, New Jersey, New York, North Dakota, Ohio,
Oregon, Texas, Utah, Vermont, Virginia, and West Virginia.
VA reviewed license and certification requirements for this
occupation in September 2023 and confirmed there was no variance in how
VA Nuclear Medicine Technologists practice in any State.
Request for Information
1. Are there any additional trainings for the aforementioned tasks
and duties where VA is preempting States that we should consider?
2. Are there any factors that would inhibit or delay the
implementation of the aforementioned tasks and duties for VA health
care professionals in any States?
3. Is there any variance in tasks and duties that we have not
listed?
4. What should we consider when preempting conflicting State laws,
rules, 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 and signed
this document on April 25, 2024, 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. 2024-10528 Filed 5-13-24; 8:45 am]
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