[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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