[Federal Register Volume 89, Number 102 (Friday, May 24, 2024)]
[Notices]
[Pages 45940-45942]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-11411]


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DEPARTMENT OF VETERANS AFFAIRS


Notice of Request for Information on the Department of Veterans 
Affairs Medical 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 Medical 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 23, 2024.

ADDRESSES: Comments must be submitted through http://www.regulations.gov/. Except as provided below, comments received 
before the close of the comment period will be available at http://www.regulations.gov/ for public viewing, inspection, 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 http://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 accepted.

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 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,

[[Page 45941]]

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 our 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 requirements of 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 Medical Technologists was held on 
September 7, 2023. No professional associations presented comments on 
the Medical Technologist scope 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 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 Medical Technologists

    The format for the proposed national standards of practice when 
there are national certification bodies, and there are State licenses 
is as follows. The first paragraph provides general information about 
the profession and what the health care professionals can do. For this 
national standard, Medical Technologists are highly skilled medical 
laboratory professionals responsible for the testing of blood, other 
body fluids, and tissue specimens, using a variety of manual and 
automated methods. 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 November 8, 2023. VA follows the 
requirements outlined in the

[[Page 45942]]

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 
Medical Technologists, VA qualification standards require an active, 
current, full, and unrestricted certification from either the American 
Society for Clinical Pathology (ASCP) or from American Medical 
Technologists (AMT).
    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. Medical Technologists have 
grandfathering provisions included within their qualification 
standards, and VA proposes to have those individuals be authorized to 
follow the Medical 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 same standard as any other VA Medical Technologist who 
meets the current qualification standards.
    The third paragraph confirms which standard the profession will 
follow under this VA national standard of practice. VA qualification 
standards for Medical Technologists require a national certification 
from either ASCP or AMT. VA proposes to adopt a standard of practice 
consistent with ASCP. There is no variance between these two national 
certifications; however, ASCP provides a more detailed scope of 
practice for the Medical Technologist profession. Therefore, VA Medical 
Technologists will follow the standard as set by this national 
certification. The national certification body standard can be found at 
https://www.ascp.org/content/docs/default-source/policy-statements/ascp-pdft-pp-personnel-standards.pdf?sfvrsn=2. For Medical 
Technologist, VA confirmed that all individuals follow the Medical 
Technologist standards from ASCP.
    The fourth paragraph defines 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. VA found that 11 States also 
require a State license for Medical Technologists, and seven of these 
States exempt Federal employees from their State license requirements. 
Furthermore, the tasks and duties set forth in the State license 
requirements for all seven States are consistent with what is permitted 
by the ASCP. Therefore, there is no variance in how Medical 
Technologists practice in any State. VA thus proposes to adopt a 
standard of practice consistent with the ASCP standards of practice. VA 
Medical Technologists will continue to follow this standard.
    This national standard of practice does not address training 
because it will not authorize VA Medical Technologists to perform any 
tasks or duties not already authorized under their national 
certification and/or state license.
    Following public and VA employee comments and revisions, each 
national standard of practice that is published into 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 Medical Technologists

    1. Medical Technologists are highly skilled medical laboratory 
professionals responsible for the testing of blood, other body fluids, 
and tissue specimens using a variety of manual and automated methods. 
Medical Technologists maintain laboratory testing instrumentation and 
equipment and ensure accurate reporting of test results which aid 
health care providers in the prevention (monitoring), diagnosis, and 
treatment of disease.
    2. Medical 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 G24, dated 
May 12, 2014.
    3. VA Medical Technologists practice in accordance with the Medical 
Technologist national certification standards from the American Society 
for Clinical Pathology, available at: https://www.ascp.org/. VA 
reviewed license and certification requirements for this occupation in 
January 2024 and confirmed that all Medical Technologists in VA 
followed this national certification.
    4. Although VA only requires a certification, the following 11 
states currently require a State license in order to practice as 
Medical Technologists in that state: California, Florida, Hawaii, 
Louisiana, Montana, Nevada, New York, North Dakota, Puerto Rico, 
Tennessee, and West Virginia.
    Of these, the seven following States exempt Federal employees from 
their state license requirements: Florida, Louisiana, Montana, New 
York, North Dakota, Tennessee, and West Virginia.
    VA reviewed license and certification requirements for this 
occupation in January 2024 and confirmed there was no variance in how 
VA Medical Technologists practice in any state.

Request for Information

    1. Are there any required or necessary trainings for Medical 
Technologists that we should consider?
    2. Are there any factors that would inhibit or delay the 
implementation of the aforementioned tasks and duties for VA Medical 
Technologists in any States?
    3. Is there any variance in the license, certification, or the 
tasks and duties that we have not listed?
    4. Is there anything else you would like to share with us about 
this national standard of practice for VA Medical Technologists?

Signing Authority

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

Michael P. Shores,
Director, Office of Regulation Policy & Management, Office of General 
Counsel, Department of Veterans Affairs.
[FR Doc. 2024-11411 Filed 5-23-24; 8:45 am]
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