Notice2022-14033
Notice of Request for Information on the Department of Veterans Affairs Blind Rehabilitation Specialist and Visual Impairment Services Team Coordinator Standard of Practice
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Published
July 1, 2022
Issuing agencies
Veterans Affairs Department
Abstract
The Department of Veterans Affairs (VA) is requesting information to assist in developing a national standard of practice for VA Blind Rehabilitation Specialists (BRS) and Visual Impairment Services Team (VIST) Coordinators. VA seeks comments on various topics to help inform VA's development of this national standard of practice.
Full Text
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<title>Federal Register, Volume 87 Issue 126 (Friday, July 1, 2022)</title>
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[Federal Register Volume 87, Number 126 (Friday, July 1, 2022)]
[Notices]
[Pages 39595-39598]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2022-14033]
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DEPARTMENT OF VETERANS AFFAIRS
Notice of Request for Information on the Department of Veterans
Affairs Blind Rehabilitation Specialist and Visual Impairment Services
Team Coordinator 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 Blind Rehabilitation Specialists (BRS) and Visual Impairment
Services Team (VIST) Coordinators. 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 August 30, 2022.
ADDRESSES: Comments may be submitted through <a href="http://www.regulations.gov">www.regulations.gov</a>.
Comments received will be available at <a href="http://www.regulations.gov">www.regulations.gov</a> for public
viewing, inspection or copies.
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, at
202-461-0500. This is not a toll-free number.
SUPPLEMENTARY INFORMATION:
Authority
Chapters 73 and 74 of the title 38 of the U.S.C. and 38 U.S.C. 303
authorize the Secretary to regulate the professional activities of 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 allowing VA health care
professionals to deliver health care
[[Page 39596]]
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.
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 VA medical facility
where they are located or the State license, registration,
certification, or other State requirement they hold. We emphasized in
the rulemaking and reiterate that VA will determine, on an individual
basis, that a health care professional has the necessary education,
training and skills to perform the tasks and duties detailed in the
national standard of practice and 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.
Need for National Standards of Practice
As the Nation's largest integrated health care system, it is
critical that VA develop national standards of practice to ensure
beneficiaries receive the same high-quality care regardless of where
they enter the system and to ensure 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 COVID-19 pandemic. With an increased need
for mobility in our workforce, including through VA's Disaster
Emergency Medical Personnel System, creating a uniform standard of
practice better supports VA health care professionals who already
frequently practice across State lines. In addition, the development of
national standards of practice aligns with VA's long-term deployment of
a new electronic health record (EHR). National standards of practice
are critical for optimal EHR implementation to enable the specific
roles for each health care profession in EHR to be consistent across
the Veterans Health Administration (VHA) and to support increased
interoperability between VA and the Department of Defense (DoD). DoD
has historically standardized practice for certain health care
professionals, and VHA closely partnered with DoD to learn from their
experience.
Process To Develop National Standards of Practice
Consistent with 38 CFR 17.419, VA is developing national standards
of practice via policy. There will be one overarching national standard
of practice directive that will generally describe VHA's policy and
have each individual national standard of practice as an appendix to
the directive. The directive and all appendices will be accessible on
VHA Publications website at: <a href="https://vaww.va.gov/vhapublications/">https://vaww.va.gov/vhapublications/</a>
(internal) and <a href="https://www.va.gov/vhapublications/">https://www.va.gov/vhapublications/</a> (external) once
published.
To develop these national standards, VA is using a robust,
interactive process that is consistent with the guidance outlined in
Executive Order (E.O.) 13132 to preempt State law. 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 identified
VA occupation, a workgroup comprised of health care professionals
conducts State variance 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 the agency. The workgroup may consult with
internal stakeholders at any point throughout the process. 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 task or duty. The workgroup then drafts a
proposed VA national standard of practice using the data gathered
during the State variance research and incorporates internal
stakeholder feedback to date.
The proposed national standard of practice is internally reviewed,
to include by an interdisciplinary workgroup consisting of
representatives from Quality Management; Field Chief of Staff; Academic
Affiliates; Associate Director Patient Care Services; Ethics; Workforce
Management and Consulting; Surgery; Credentialing and Privileging;
Field Chief Medical Office; and Electronic Health Record Modernization.
Externally, the proposed national standard of practice is provided
to our partners in DoD. In addition, VA labor partners are engaged
informally as part of a pre-decisional collaboration. Consistent with
E.O. 13132, a letter is sent to each State board and certifying
organization that includes the proposed national standard and an
opportunity to further discuss the national standard with VA. After the
States have received notification, the proposed national standard of
practice is published to the Federal Register for 60 days to obtain
feedback from the public, including professional associations and
unions. At the same time, the proposed national standard is published
on an internal VA site to obtain feedback from VA employees. Feedback
from State boards, professional associations, unions, VA employees and
any other person or organization who informally 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, and that are better for Veterans or VA health care
professionals. We will publish a collective response to all comments at
<a href="https://www.va.gov/standardsofpractice">https://www.va.gov/standardsofpractice</a>.
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 incorporated into an
individual health care professional's privileges, scope of practice, or
functional statement following any training and education necessary for
the health care professional to perform those functions. Implementation
of the national standard of practice may be phased in across all
medical facilities, with limited exemptions for health care
professionals as needed.
National Standard for BRS and VIST Coordinators
The proposed format for national standards of practice when there
is a national certifying body is as follows. The first paragraph
provides general information about the profession and what the health
care professionals can do. The second paragraph references the
education, certification, license, registration, or other requirement
needed to practice this profession at VA
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and confirms that this profession follows the standard of practice set
by the national certifying body. A final statement confirms that as of
the date of the workgroup's research into requirements, all individuals
in this profession follow the same standard of practice.
We note that proposed standards of practice do not contain an
exhaustive list of every task and duty that each VA health care
professional can perform. Rather, it is designed to highlight whether
there are any areas of variance in how this profession can practice
across States and how this profession will be able to practice within
VA notwithstanding their State license, certification, registration and
other requirements.
VA qualification standards require BRSs to have at least one
active, current, full, and unrestricted certification granted by the
Academy for Certification of Vision Rehabilitation and Education
Professionals (ACVREP). The following four national certifications from
the ACVREP correspond with four distinct specialties within the
occupation:
1. Certified Low Vision Therapist (CLVT);
2. Certified Orientation and Mobility Specialist (COMS);
3. Certified Assistive Technology Instructional Specialist for
People with Visual Impairments (CATIS); and
4. Certified Vision Rehabilitation Therapist (CVRT).
BRSs can practice under any of these four ACVREP certifications.
BRSs who provide orientation and mobility training, communication and
daily living therapy, low vision therapy, or assistive technology must
possess the corresponding ACVREP certification for the type of service
they provide. For example, a BRS who provides low vision therapy must
be certified as a CLVT. VA reviewed whether there are any alternative
certifications or requirements from any State that could be required
for a BRS and found that there were none. Therefore, VA proposes to
adopt a standard of practice consistent with these four national
certifications; therefore, VA BRSs in each of these four specialties
will continue to follow the same standard as set by their national
certifications. Standards of practice for each of the four
certifications can be found at the following websites:
<bullet> CLVT: <a href="https://www.acvrep.org/certifications/clvt-scope">https://www.acvrep.org/certifications/clvt-scope</a>;
<bullet> COMS: <a href="https://www.acvrep.org/certifications/coms-scope">https://www.acvrep.org/certifications/coms-scope</a>;
<bullet> CATIS: <a href="https://www.acvrep.org/certifications/catis-scope">https://www.acvrep.org/certifications/catis-scope</a>;
and
<bullet> CVRT: <a href="https://www.acvrep.org/certifications/cvrt-scope">https://www.acvrep.org/certifications/cvrt-scope</a>.
This national standard of practice for BRSs includes VIST
Coordinator because all VIST Coordinator positions are appointed as
BRSs. BRS VIST Coordinators may be drawn from traditional blind/vision
rehabilitation backgrounds or from counseling backgrounds. There is no
national or State license or certification for VIST Coordinators;
therefore, there is no variance with a State in the standard of
practice for VIST Coordinators. VA VIST Coordinators must be licensed,
certified, or registered as BRSs, Social Workers, Certified
Rehabilitation Counselors, or other health care professionals. VIST
Coordinators who are licensed, certified, or registered as BRSs, Social
Workers, Certified Rehabilitation Counselors, or in other health care
occupations must adhere to the VA national standard of practice for
that specific occupation.
Because the practice of Blind Rehabilitation Specialists and VIST
Coordinators is not changing, there will be no impact on the practice
of this occupation when this national standard of practice is
implemented. However, national standards of practice for other
occupations may impact practice of those occupations at VA once they
are implemented.
Proposed National Standard of Practice for BRSs
BRSs use assessments, therapies and technologies to improve the
independent function, quality of life and adjustment for Veterans who
are blind or visually impaired. BRSs evaluate Veterans through
interviews, tests and measurements and use such findings either solely
or as a part of an interdisciplinary team to develop and implement
blind and vision rehabilitation programs for individual Veterans.
Instructional activities are directed toward achieving therapeutic
objectives for Veterans who are blind or visually impaired. These
activities include effective communication and visual skills;
instruction on optical low vision devices; orientation to and
management of the environment; safe ambulation and travel; access to
information through the use of assistive technologies; manual skills;
proficiency and understanding in activities of daily living; pursuit of
avocational and vocational skills; and education and adjustment to
visual impairment.
BRSs in VA possess the required education and certification from
ACVREP in accordance with VA qualification standards, as more
specifically described in VA Handbook 5005, Staffing, Part II, Appendix
G41. This national standard of practice confirms BRSs practice in
accordance with the ACVREP standards based on the certification they
hold, including CLVT, COMS, CATIS and CVRT, available at:
<a href="http://www.acvrep.org">www.acvrep.org</a>. As of August 2021, BRSs in all States follow these
national certifications.
Proposed National Standard of Practice for VIST Coordinators
VIST Coordinators provide adjustment counseling, coordination of
services, assure adequate compensation and benefits and conduct complex
negotiations with the medical and benefit systems as well as non-VA
service delivery systems for Veterans who are blind or visually
impaired.
There is no national or State license or certification for VIST
Coordinators; therefore, there is no variance with a State in the
standard of practice for VIST Coordinators. VA VIST Coordinators must
be licensed, certified, or registered as BRSs, Social Workers,
Certified Rehabilitation Counselors, or other health care professionals
as outlined in VA Handbook 5005, Staffing, Part II, Appendix G41. More
specifically, VIST Coordinators must be credentialed or certified
through the following:
a. Any certification via ACVREP, including CLVT, COMS, CATIS and
CVRT;
b. License or certification by a State to independently practice
social work at the master's degree level;
c. Certification via the Commission on Rehabilitation Counselor
Certification, Certified Rehabilitation Counselor; or
d. License or certification by a State to independently practice in
other health care occupations.
VIST Coordinators licensed, certified, or registered as BRSs,
Social Workers and Certified Rehabilitation Counselors, or in other
health care occupations, must adhere to the VA national standard of
practice for that specific occupation.
Request for Information
1. Are there any required trainings for the aforementioned
practices that we should consider?
2. Are there any factors that would inhibit or delay the
implementation of the aforementioned practices for VA health care
professionals in any States?
3. Is there any variance in practice that we have not listed?
4. What should we consider when preempting conflicting State laws,
regulations, or requirements regarding supervision of individuals
working toward obtaining their license or unlicensed personnel?
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5. Is there anything else you would like to share with us about
these national standards of practice?
Signing Authority
Denis McDonough, Secretary of Veterans Affairs, approved this
document on June 14, 2022, 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. 2022-14033 Filed 6-30-22; 8:45 am]
BILLING CODE 8320-01-P
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