[Federal Register Volume 89, Number 249 (Monday, December 30, 2024)]
[Notices]
[Pages 106762-106765]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-31205]
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DEPARTMENT OF VETERANS AFFAIRS
Notice of Request for Information on the Department of Veterans
Affairs Rehabilitation Counselor Standard of Practice
AGENCY: Department of Veterans Affairs.
ACTION: Request for Information.
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SUMMARY: The Department of Veterans Affairs is requesting information
to assist in developing a national standard of practice for VA
Rehabilitation Counselors. 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 February 28, 2025.
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 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
considered.
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 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
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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 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 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 other requirements that both 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. The term state as applied here means each of the several
states, territories, possessions of the United States, and the district
of Columbia, and the Commonwealth of Puerto Rico and is consistent with
the definition in 38 U.S.C. 101(20). 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 (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, VHA Directive 1900(5), VA National Standards of Practice,
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 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 specific occupations and what should be
included in the national standard of practice for that occupation. The
listening session for Rehabilitation Counselors was held on September
21, 2023. No one provided comments on Rehabilitation Counselors
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, 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.
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
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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/.
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. 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 Rehabilitation Counselors
The format for the proposed national standards of practice when
there is a national certification body is as follows. The first
paragraph provides general information about the profession and what
the health care professionals can do. For this national standard,
Rehabilitation Counselors help patients with disabilities to achieve
their personal career, independent living, social, and psychological
goals. 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.
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 available at: https://www.va.gov/OHRM/QualificationStandards/. 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. For Rehabilitation
Counselors, VA qualification standards require an active, current,
full, and unrestricted certification from the Commission on
Rehabilitation Counselor Certification (CRCC). For Rehabilitation
Counselors, VA qualification standards require an active, current,
full, and unrestricted certification from the certification body:
complete qualifications standards details for Rehabilitation Counselors
are found: https://www.va.gov/OHRM/QualificationStandards/HT38/0101-RehabilitationCounselor.pdf.
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. VA Rehabilitation Counselors
have grandfathering provisions included within their qualification
standards, and VA proposes to have those individuals not be authorized
to follow the Rehabilitation Counselor national standard of practice.
Instead, VA proposes its medical facilities will determine the tasks
and duties for Rehabilitation Counselors who are grandfathered under
the qualification standards. Such determinations are determined at the
VA medical facility based on the Rehabilitation Counselor's education,
training, and credentialing.
The third paragraph establishes what the national standard of
practice will be for the occupation in VA. For this national standard,
VA Rehabilitation Counselors follow the standard set by the CRCC, found
at: https://crccertification.com, with the exception of, the listed
task or duty VA proposes to restrict even though the certification
otherwise permits the profession to perform those tasks or duties.
The final paragraph provides justification for VA's proposal to
restrict the specified tasks and duties. It explains why VA is
restricting those tasks or duties and the clinical basis for this
proposed decision.
This national standard of practice does not address training
because it will not authorize VA Rehabilitation Counselors to perform
any tasks and duties not already authorized under their national
certification.
Following public and VA employee comments and revisions, each
national standard of practice that is published in 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 Rehabilitation Counselors
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. Rehabilitation Counselors are professional counselors educated
and trained at the graduate level who possess the specialized
knowledge, skills, and attitudes to work collaboratively with patients
with disabilities. Through a professional counseling process,
Rehabilitation Counselors help patients with disabilities to achieve
their personal career, independent living, social, and psychological
goals.
2. Rehabilitation Counselors in the Department of Veterans Affairs
(VA) possess the education and certification required by VA
qualification standards, available at: https://www.va.gov/OHRM/QualificationStandards/HT38/0101-RehabilitationCounselor.pdf.
Note: This national standard of practice does not apply to
Rehabilitation Counselors who were grandfathered into the position
on July 21, 2020, the effective date for the VA qualification
standards for Rehabilitation Counselors. Tasks and responsibilities
for Rehabilitation Counselors who are grandfathered under the
qualification standards are determined at the VA medical facility
based on their education, training, and credentialing.
3. VA Rehabilitation Counselors practice in accordance with the
Certified Rehabilitation Counselor scope of practice from the
Commission on Rehabilitation Counselor Certification (CRCC), available
at: https://crccertification.com/, except as noted in paragraph 3.a. VA
reviewed certification requirements for this occupation in October 2024
and confirmed that all Rehabilitation Counselors in VA followed this
national certification.
a. VA Rehabilitation Counselors, practicing within scope of their
VA employment and consistent with this standard, cannot diagnose mental
health disorders (F Codes in the International Classification of
Diseases 11th Revision) unless they have a license in a mental health
discipline, in addition to their CRCC certification and qualify as
licensed providers through the Medical
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Staff Bylaws of their VA medical facility.
Note: VA Rehabilitation Counselors meet CRCC certification
eligibility criteria of a master's degree in rehabilitation
counseling or a qualifying related mental health field with
additional graduate-level core rehabilitation coursework and
supervised experience. All Rehabilitation Counselors with CRCC
certification can diagnose ``Other Conditions That May Be a Focus of
Clinical Attention'' as outlined in the Diagnostic and Statistical
Manual of Mental Disorders Fifth Edition (Z codes in the
International Classification of Diseases 11th Revision).
4. Justification
a. VA Rehabilitation Counselors who only maintain a CRCC
certification are restricted from diagnosing mental health disorders
because VA has licensed mental health personnel with the specific
education, training, and expertise that VA would rely on to diagnose.
VA Rehabilitation Counselors who possess a CRCC certification, hold a
state license in a mental health field (e.g., Licensed Professional
Counselor, Licensed Clinical Professional Counselor, Licensed Clinical
Social Worker, Licensed Independent Social Worker, Licensed
Psychologist), and qualify as a licensed provider based on the medical
facility bylaws will be permitted to diagnose mental health disorders
because their education, training, and expertise provides the necessary
competency to diagnose.
Request for Information
1. Is VA's assessment of what the state and CRCC certification
permits, and prohibits, accurately represented?
2. Are there any other areas of variance of any state license,
certification, registration or other requirement 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 December 6, 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 &
Management, Office of General Counsel, Department of Veterans Affairs.
[FR Doc. 2024-31205 Filed 12-27-24; 8:45 am]
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