[Federal Register Volume 89, Number 132 (Wednesday, July 10, 2024)]
[Notices]
[Pages 56818-56820]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-15111]


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DEPARTMENT OF VETERANS AFFAIRS


Notice of Request for Information on the Department of Veterans 
Affairs Diagnostic Radiologic 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 Diagnostic Radiologic 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 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.

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

[[Page 56819]]

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 Diagnostic Radiologic 
Technologist was held on September 7, 2023. No professional 
associations presented their comments on the Diagnostic Radiologic 
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 National Standard for Diagnostic Radiologic Technologists

    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, Diagnostic Radiologic Technologists are responsible 
for the safe use of ionizing radiation for diagnostic, therapeutic, and 
research purposes 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 Diagnostic Radiologic Technologists, 
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. Diagnostic Radiologic 
Technologists have grandfathering provisions included within their 
qualification standards, and

[[Page 56820]]

VA proposes to have those individuals be authorized to follow the 
Diagnostic Radiologic 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 Diagnostic Radiologic 
Technologist who meets the current 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 
the 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 Diagnostic Radiologic 
Technologists, VA confirmed that all individuals follow the standards 
from the ASRT.
    The fourth paragraph notes that VA reviewed if there are any 
required alternative registrations, certifications, licenses, or other 
State requirements for Diagnostic Radiologic Technologists. VA found 
that 38 States also require a State license for Diagnostic Radiologic 
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 38 States that require a license, 25 States exempt Federal 
employees from their State license requirements. Furthermore, the tasks 
and duties set forth in the State license requirements for all 38 
States are consistent with what is permitted under the national 
certification. Therefore, there is no variance in how Diagnostic 
Radiologic Technologists practice in any State. VA thus proposes to 
adopt a standard of practice consistent with the standards from the 
ASRT, as followed by ARRT, this profession's national certification 
body. VA Diagnostic Radiologic Technologists will continue to follow 
this standard.
    This national standard of practice does not address training 
because it will not authorize VA Diagnostic Radiologic 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 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 Diagnostic Radiologic 
Technologists

    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. Diagnostic Radiologic Technologists perform technical work in 
support of the Diagnostic Service's Radiology section. Under the 
supervision of a Radiologist, Diagnostic Radiologic Technologists are 
responsible for the safe use of ionizing radiation for diagnostic, 
therapeutic, and research purposes. Imaging modalities include x-ray, 
magnetic resonance imaging, ultrasound, computed tomography 
interventional radiology, and noninterpretive fluoroscopic procedures 
as prescribed by a licensed practitioner. Diagnostic Radiologic 
Technologists perform venipuncture, maintain and remove intravenous 
access, and prepare and administer contrast media and adjunct 
medications under the supervision of a licensed practitioner. Acquired 
images are used in the diagnosis and treatment of medical conditions 
and pathologies. Diagnostic Radiologic Technologists 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; complete documentation within 
electronic health records as necessary; and recognize and respond 
appropriately to emergency situations.
    2. Diagnostic Radiologic 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 G25, dated December 13, 2019.
    3. VA Diagnostic Radiologic Technologists practice in accordance 
with the Radiographer standards from the American Society of Radiologic 
Technologists (ASRT), available at: https://www.asrt.org/. The American 
Registry of Radiologic Technologists (ARRT), the national certifying 
body of Diagnostic Radiologic Technologists, follows the ASRT 
standards. VA reviewed certification requirements from ARRT for this 
occupation in February 2024 and confirmed that all Diagnostic 
Radiologic Technologists in VA followed the Radiographer standards from 
ASRT.
    4. Although VA only requires a certification, 38 states require a 
state license in order to practice as a Diagnostic Radiologic 
Technologists in that state: Arizona, Arkansas, California, Colorado, 
Connecticut, Florida, Hawaii, Illinois, Indiana, Iowa, Kansas, 
Kentucky, Louisiana, Maine, Maryland, Massachusetts, Minnesota, 
Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New 
York, North Dakota, Ohio, Oregon, Puerto Rico, Rhode Island, Tennessee, 
Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, 
and Wyoming.
    Of those, 25 states exempt Federal employees from their state 
license requirements: Arizona, California, Colorado, Florida, Illinois, 
Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Nebraska, 
Nevada, New Hampshire, New Jersey, New York, North Dakota, Ohio, 
Oregon, Texas, Utah, Vermont, Virginia, Washington, and West Virginia.
    VA reviewed state laws, state practice acts, and certification 
requirements for Diagnostic Radiologic Technologists 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 13, 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. 2024-15111 Filed 7-9-24; 8:45 am]
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