[Federal Register Volume 89, Number 145 (Monday, July 29, 2024)]
[Notices]
[Pages 60975-60978]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-16538]


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DEPARTMENT OF VETERANS AFFAIRS


Notice of Request for Information on the Department of Veterans 
Affairs Therapeutic 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 
a VA Therapeutic Radiologic Technologist. 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 27, 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 harmful actions. 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 closing date will not be considered.

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 requirements that unduly interfere with their 
practice. 38 CFR 17.419; 85 FR 71838. Specifically, this rulemaking 
confirmed VA's current practice of permitting 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 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 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

[[Page 60976]]

a national standard of practice means that individuals from the same VA 
health care profession may perform the same type of tasks and duties 
regardless of the State where they are located or the State license, 
registration, certification, or other requirement they hold. We 
emphasized in the rulemaking and reiterated 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 through policy.

Preemption of State Requirements

    The national standard of practice will preempt any State laws, 
rules, regulations, or other requirements that are and are not listed 
in the national standard as conflicting, but that do 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 permits 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 requirement permits a practice 
that is not included in a national standard of practice, the individual 
may continue that practice so long as it is permissible under Federal 
law and VA policy; is not explicitly restricted 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 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 through policy. The one overarching directive to describe 
Veterans Health Administration (VHA) policy on national standards of 
practice is VHA Directive 1900(5), VA National Standards of Practice, 
dated August 30, 2023. The directive is accessible on VHA's 
publications website at https://www.va.gov/vhapublications/. As each 
individual national standard of practice is finalized, it is published 
as an appendix to the directive and accessible at the same website.
    To develop these national standards, VA is using a robust 
interactive process that adheres to the requirements of Executive Order 
(E.O.) 13132, Federalism, to preempt conflicting State laws, rules, 
regulations, or other requirements. For each health care 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 and any internal stakeholder feedback 
received. The workgroup may consult with internal or external 
stakeholders at any point throughout the process.
    The process to develop VA national standards of practice includes 
listening sessions for members of the public, professional 
associations, and VA employees to provide comments on the variance 
between State practice acts for a specific occupation and what should 
be included in the national standard of practice for that occupation. 
The listening session for Therapeutic Radiologic Technologist was held 
on August 31, 2023. No professional associations presented comments on 
the Therapeutic Radiologic Technologist scope of practice. Following 
the listening session, VA received a letter from the American Society 
of Radiologic Technologists (ASRT), which expressed that the VA 
national standards of practice for radiation therapy should align with 
the ASRT practice standards. VA appreciates the thoughtful letter and 
considers the information shared when drafting the proposed VA national 
standard of practice.
    After the proposed standard is developed, it is first internally 
reviewed. This includes a review from an interdisciplinary VA workgroup 
consisting of representatives from Quality Management, the VA medical 
facility Chief of Staff, academic affiliates, the Veterans Integrated 
Services Network (VISN) Chief Nursing Officer, Ethics, Workforce 
Management and Consulting, Surgery, Credentialing and Privileging, the 
VISN Chief Medical Officer, and Electronic Health Record Modernization.
    After the internal review, 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

[[Page 60977]]

through 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/.
    The national standard of practice is then finalized, approved, and 
published in VHA policy. Any tasks or duties included in the national 
standard will be properly incorporated into individual VA health care 
professionals' 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. The 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 Therapeutic Radiologic 
Technologist

    The format for the proposed 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 VA health care professionals can do. For this 
national standard, Therapeutic Radiologic Technologists assist in the 
localization of tumors and deliver high doses of radiation prescribed 
by the radiation oncologists, utilizing ionizing radiation-generating 
equipment. 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 practice within VA.
    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 July 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 Therapeutic Radiologic Technologist, 
the VA qualification standards require an active, current, full, and 
unrestricted certification from the American Registry of Radiologic 
Technologists (ARRT) in Radiation Therapy.
    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. Therapeutic Radiologic 
Technologists have grandfathering provisions included within their 
qualification standards, and VA proposes to have those individuals be 
authorized to follow the Therapeutic 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 
Therapeutic Radiologic 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 Therapeutic Radiologic Technologists follow the standard set by the 
American Society of Radiologic Technologists (ASRT). ARRT, this 
profession's national certification body, follows the ASRT standards. 
The ASRT Radiation Therapy standards can be found at: https://www.asrt.org/main/standards-and-regulations/professional-practice/practice-standards/. VA confirmed that all VA Therapeutic Radiologic 
Technologists followed the Radiation Therapy standards from ASRT.
    The fourth paragraph identifies additional registrations, 
regulations, certifications, licenses, or other requirements, and 
whether any of those have Federal exemptions for the profession. For 
this national standard of practice, VA reviewed any required 
alternative registrations, certifications, licenses, or other 
requirements. VA also found that 40 States require a State license for 
Therapeutic Radiologic Technologists. Of those 40 States that require a 
license, 26 States exempt Federal employees from their State license 
requirements. Furthermore, the tasks and duties set forth in the State 
license requirements for all 40 States are consistent with what is 
permitted under the national certification. VA reviewed State laws, 
State practice acts, and certification requirements for Therapeutic 
Radiologic Technologists in March 2024 and did not identify any 
conflicts that impact practice on this profession in VA. VA thus 
proposes to adopt a standard of practice consistent with the standards 
from ASRT, as followed by ARRT, this profession's national 
certification body. VA Therapeutic Radiologic Technologists will 
continue to follow this standard.
    This national standard of practice does not address training 
because it will not authorize VA Therapeutic 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 Therapeutic Radiologic 
Technologist

    Note: All references herein to Department of Veterans Affairs 
(VA) and Veterans Health Administration (VHA) documents incorporate 
by reference subsequent VA and VHA documents on the same or similar 
subject matter.

    1. Therapeutic Radiologic Technologists assist in the localization 
of tumors and deliver high doses of radiation prescribed by the 
radiation oncologists, utilizing ionizing radiation-generating 
equipment.
    2. Therapeutic Radiologic Technologists in VA possess the education 
and certification required by VA qualification standards. See VA 
Handbook 5005, Staffing, Part II, Appendix G26, dated January 15, 2021.
    3. VA Therapeutic Radiologic Technologists practice in accordance 
with the Radiation Therapist standards from American Society of 
Radiologic Technologists (ASRT), available at: https://www.asrt.org/. 
The American Registry of Radiologic Technologists, the national 
certifying body of Therapeutic Radiologic Technologists, follows ASRT 
standards. VA reviewed certification requirements for this occupation 
in March 2024 and confirmed that all Therapeutic Radiologic 
Technologists in VA followed ASRT standards.
    4. Although VA only requires a certification, 40 States require a 
State license in order to practice as a Therapeutic Radiologic 
Technologist in that State: Alaska, Arizona, Arkansas, California, 
Connecticut, Delaware, Florida, Hawaii, Illinois, Indiana, Iowa,

[[Page 60978]]

Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, 
Mississippi, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New 
Mexico, New York, North Dakota, Ohio, Oregon, Pennsylvania, Puerto 
Rico, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, 
Virginia, Washington, West Virginia, and Wyoming.
    Of those, 26 States exempt Federal employees from their State 
license requirements: Alaska, Arizona, California, Florida, Illinois, 
Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, 
Nevada, New Hampshire, New Jersey, New York, North Dakota, Ohio, 
Oregon, Pennsylvania, Texas, Utah, Vermont, Virginia, Washington, and 
West Virginia.
    VA reviewed State laws, State practice acts, and certification 
requirements for Therapeutic Radiologic Technologists on March 2024 and 
did not identify any conflicts that impact practice on this profession 
in VA.

Request for Information

    1. Is VA's assessment of what States permit and restrict accurate?
    2. Are there any other areas of variance between State licenses 
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 July 3, 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.

Jeffrey M. Martin,
Assistant Director, Office of Regulation Policy & Management, Office of 
General Counsel, Department of Veterans Affairs.
[FR Doc. 2024-16538 Filed 7-26-24; 8:45 am]
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