Notice2022-16325
Notice of Request for Information on the Department of Veterans Affairs Ophthalmology Technician Standard of Practice
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
July 29, 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 Ophthalmology Technicians. VA seeks comments on various topics to help inform VA's development of this national standard of practice.
Full Text
<html>
<head>
<title>Federal Register, Volume 87 Issue 145 (Friday, July 29, 2022)</title>
</head>
<body><pre>
[Federal Register Volume 87, Number 145 (Friday, July 29, 2022)]
[Notices]
[Pages 45853-45855]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2022-16325]
-----------------------------------------------------------------------
DEPARTMENT OF VETERANS AFFAIRS
Notice of Request for Information on the Department of Veterans
Affairs Ophthalmology Technician Standard of Practice
AGENCY: Department of Veterans Affairs.
ACTION: Request for information.
-----------------------------------------------------------------------
SUMMARY: The Department of Veterans Affairs (VA) is requesting
information to assist in developing a national standard of practice for
VA Ophthalmology
[[Page 45854]]
Technicians. 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, 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, or by
phone at 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 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 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 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 develops 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 EHR 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,
[[Page 45855]]
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 Ophthalmology Technicians
The proposed format for national standards of practice when there
is a national certifying body is as follows. The first paragraph is
general information about the profession and what the health care
professionals can do. The second paragraph references the education,
certification, license, registration, or other requirements needed to
practice this profession at VA and confirms that this profession
follows the standard of practice set by the 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 this profession 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 Ophthalmology Technicians to
have an active, current, full and unrestricted national certification
from the Joint Commission on Allied Health Personnel in Ophthalmology
(JCAHPO). VA reviewed whether there are any alternative registrations,
certifications, or State requirements that could be required for an
Ophthalmology Technician and found that there were none. VA proposes to
adopt a standard of practice consistent with the national
certification; therefore, VA Ophthalmology Technicians will continue to
follow the same standard as set by their national certification. The
standard of practice for the national registration can be found here:
<a href="https://documents.jcahpo.org/documents/Certification/IJCAHPO_Core_Criteria.pdf">https://documents.jcahpo.org/documents/Certification/IJCAHPO_Core_Criteria.pdf</a>.
Because the practice of Ophthalmology Technicians is not changing,
there will be no impact on the practice of this occupation when this
national standard of practice is implemented.
Proposed National Standard of Practice for Ophthalmology Technicians
Ophthalmology Technicians are eye health care professionals
qualified to assist ophthalmologists in the diagnostic evaluation,
management, treatment and education of patients with medical and
surgical conditions affecting the visual system. Their duties include,
but are not limited to, documenting patient histories, assessing visual
and ocular function, performing tests and ophthalmology imaging,
administering topical ocular medications (i.e., drops or ointment,
including anesthetic, dye, dilation, cycloplegic or antibiotics) and
providing patient care.
Ophthalmology Technicians in VA possess the required education and
certification from JCAHPO, in accordance with VA qualification
standards, as more specifically described in VA Handbook 5005,
Staffing, Part II, Appendix G52.
This national standard of practice confirms Ophthalmology
Technicians practice in accordance with the Allied Ophthalmology
Personnel Certification standards from JCAHPO, which are available at:
<a href="https://jcahpo.org/">https://jcahpo.org/</a>. As ofAugust 2021, Ophthalmology Technicians in all
States follow this national certification.
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?
5. Is there anything else you would like to share with us about
this national standard of practice?
Signing Authority
Denis McDonough, Secretary of Veterans Affairs, approved this
document on July 18, 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.
Luvenia Potts,
Regulation Policy Coordinator, Office of Regulation Policy &
Management, Office of General Counsel, Department of Veterans Affairs.
[FR Doc. 2022-16325 Filed 7-28-22; 8:45 am]
BILLING CODE 8320-01-P
</pre></body>
</html>Indexed from Federal Register on July 29, 2022.
This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.