[Federal Register Volume 89, Number 132 (Wednesday, July 10, 2024)]
[Notices]
[Pages 56812-56815]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-15109]


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DEPARTMENT OF VETERANS AFFAIRS


Notice of Request for Information on the Department of Veterans 
Affairs Registered Radiologist Assistant 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 Registered Radiologist Assistants. 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 9, 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 Governance, 
Regulations, Appeals and Policy (10B-GRAP), 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.

[[Page 56813]]

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 consistent 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 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 Chief of 
Staff, Academic Affiliates, Veterans Integrated Services Network (VISN) 
Chief Nursing Officer, Ethics, Workforce Management and Consulting, 
Surgery, Credentialing and Privileging, VISN Chief Medical Officer, 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 Registered Radiologist Assistant 
on September 7, 2023, included one presenter representing the American 
College of Radiology. The presenter shared the duties performed by a 
Registered Radiologist Assistant should be well-defined and performed 
under the supervision of a Radiologist to ensure the highest quality 
patient care. VA appreciates the thoughtful presentations and considers 
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 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

[[Page 56814]]

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 National Standard for Registered Radiologist Assistants

    The proposed format for national standards of practice when there 
is a national certification body 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, Registered Radiologist Assistants are Diagnostic 
Radiologic Technologists with advanced training, education, and 
certification, who are responsible for the safe use of ionizing 
radiation and magnetic fields for diagnostic, therapeutic, and research 
purposes for selected invasive and non-invasive clinical imaging 
procedures under the supervision of a 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 June 21, 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 Registered Radiologist Assistants, who 
are Diagnostic Radiologic Technologists with advanced training, 
education, and certification, VA qualification standards require an 
active, current, full, and unrestricted certification in Radiography 
from the American Registry of Radiologic Technologists (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. Registered Radiologist 
Assistants do not have grandfathering provisions within their 
qualification standards.
    The third paragraph confirms that this profession follows the 
standard set by the American Society of Radiologic Technologists 
(ASRT). ARRT, this profession's national certification body, follows 
ASRT standards. The standard of practice for the certification can be 
found at: https://www.asrt.org/main/standards-and-regulations/professional-practice/practice-standards. For Registered Radiologist 
Assistants, VA confirmed that all individuals follow the standards from 
ASRT.
    The fourth paragraph notes that VA reviewed if there are any 
required alternative registrations, certifications, licenses, or other 
State requirements for Registered Radiologist Assistants. VA found that 
18 States also require a State license for Registered Radiologic 
Assistants.
    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 18 States that require a license, 14 States exempt Federal 
employees from their State license requirements. Furthermore, the tasks 
and duties set forth in the State license requirements for all 18 
States are consistent with what is permitted under the national 
certification. Therefore, there is no variance in how Registered 
Radiologist Assistants practice in any State. VA thus proposes to adopt 
a standard of practice consistent with the standards from ASRT, as 
followed by the ARRT, this profession's national certification body. VA 
Registered Radiologist Assistants will continue to follow this 
standard.
    This national standard of practice does not address training 
because it will not authorize VA Registered Radiologist Assistants 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 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 Registered Radiologist 
Assistants

    Note:  All references herein to VA and VHA documents incorporate 
by reference subsequent VA and VHA documents on the same or similar 
subject matter.

    1. Registered Radiologist Assistants are Diagnostic Radiologic 
Technologists with advanced education, training, and certification. 
Under the supervision of a Radiologist, Registered Radiologist 
Assistants are responsible for the safe use of ionizing radiation and 
magnetic fields for diagnostic, therapeutic, and research purposes for 
selected invasive and non-invasive clinical imaging procedures. 
Registered Radiologist Assistants review patients' medical histories to 
understand their illnesses, medical issues, and pending diagnostic or 
treatment procedures; instruct patients before, during, and following 
procedures; evaluate the satisfactory preparation of patients before 
beginning procedures; perform patient assessment, management, and 
medication administration; complete documentation within electronic 
health records as necessary; and recognize and respond appropriately to 
emergency situations. They make and communicate initial observations 
only to the Radiologist.
    2. Registered Radiologist Assistants 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 G54 dated May 21, 2019.

    Note:  Registered Radiologist Assistants are Diagnostic 
Radiologic Technologists with advanced education, training, and 
certification and, as such, they must maintain the American Registry 
of Radiologic Technologists (ARRT), Radiographer (R) certification 
as required for all VA Diagnostic Radiologic Technologists.

    3. VA Registered Radiologist Assistants practice in accordance with 
the Radiographer standards from the American Society of Radiologic 
Technologists (ASRT), available at: https://www.asrt.org/. ARRT, the 
national certifying body of Registered Radiologist Assistants, follows 
the ASRT standards. VA reviewed certification requirements from ARRT 
for this occupation in February 2024 and confirmed that all Registered 
Radiologist Assistants in VA followed the Radiographer standards from 
ASRT.
    4. Although VA only requires certification, 18 states require a 
state license in order to practice as a Registered Radiologist 
Assistant in that

[[Page 56815]]

state: Arizona, Arkansas, Connecticut, Florida, Illinois, Iowa, 
Massachusetts, Nevada, New Hampshire, Oklahoma, Oregon, Rhode Island, 
Tennessee, Texas, Utah, Virginia, Washington, and West Virginia.
    Of those, 14 states exempt Federal employees from its state license 
requirements: Arizona, Florida, Illinois, Iowa, Massachusetts, Nevada, 
New Hampshire, Oklahoma, Oregon, Texas, Utah, Virginia, Washington, and 
West Virginia.
    VA reviewed state laws, state practice acts, and certification 
requirements for Registered Radiologist Assistants in February 2024 and 
did not identify any conflicts that impact practice of this profession 
in VA.

Request for Information

    1. Is VA's assessment of what States allow and do not allow 
accurate?
    2. Are there any other areas of variance between State licenses, 
certifications, or registrations that VA should preempt that are not 
listed?
    3. Is there anything else you would like to share with us about 
this VA national standard of practice?

Signing Authority

    Denis McDonough, Secretary of Veterans Affairs, approved and signed 
this document on June 5, 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 and 
Management, Office of General Counsel, Department of Veterans Affairs.
[FR Doc. 2024-15109 Filed 7-9-24; 8:45 am]
BILLING CODE 8320-01-P