Notice2023-05141
Notice of Request for Information on the Department of Veterans Affairs Therapeutic Medical Physicists 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
March 14, 2023
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 Therapeutic Medical Physicists Standard of Practice. 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 88 Issue 49 (Tuesday, March 14, 2023)</title>
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[Federal Register Volume 88, Number 49 (Tuesday, March 14, 2023)]
[Notices]
[Pages 15855-15857]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2023-05141]
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DEPARTMENT OF VETERANS AFFAIRS
Notice of Request for Information on the Department of Veterans
Affairs Therapeutic Medical Physicists 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 Therapeutic Medical Physicists Standard of Practice. 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 May 15, 2023.
ADDRESSES: Comments must be submitted through <a href="http://www.regulations.gov">www.regulations.gov</a>.
Except as provided below, comments received before the close of the
comment period will be available at <a href="http://www.regulations.gov">www.regulations.gov</a> 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: <a href="https://www.regulations.gov">https://www.regulations.gov</a>. VA will not post on
<a href="http://Regulations.gov">Regulations.gov</a> 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 is considered late and will not be considered in a
potential rulemaking.
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 of 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 its health care professionals which
[[Page 15856]]
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 here 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 is comprised of VA
employees who are health care professionals in the identified
occupation; they 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; Field Chief Nursing Officer; Ethics; Workforce Management
and Consulting; Surgery; Credentialing and Privileging; Field Chief
Medical Officer; 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 and certifying organizations 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 Therapeutic Medical Physicists
The proposed format for national standards of practice when there
are State licenses and a national certifying organization 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 and certification needed to practice
this profession at VA. The third paragraph confirms that this
profession follows the standard of practice set by the national
standards body. A final statement explains that while VA only
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requires a national certification, some States also require licensure
for this profession. The standard includes information on which States
offer an exemption for Federal employees and where VA will preempt
State laws, if applicable.
We note that the 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.
Therapeutic Medical Physicists are health care professionals who
are specifically educated and trained in the administration or
supervision of radiation oncology. VA qualification standards require
Therapeutic Medical Physicists to have an active, current, full, and
unrestricted certification from the American Board of Radiology (ABR),
the American Board of Medical Physics (ABMP), or the Canadian College
of Physicists in Medicine (CCPM). While ABMP discontinued certification
in Therapeutic Medical Physics in December 2002, Therapeutic Medical
Physicists who obtained a certification from ABMP prior to that date
also have a Letter of Certification Equivalence by ABR. All three
certifications follow the Medical Physics Practice Guidelines (MPPG)
standards from the American Association of Physicists in Medicine
(AAPM). VA also researched other alternative certifications and State
requirements and found that four States also require a license for
Therapeutic Medical Physicists. All four State licenses align with the
national MPPG standards from AAPM. Therefore, there is no variance in
how Therapeutic Medical Physicists practice in any State.
VA proposes to adopt a standard of practice consistent with the
MPPG standard that all three certifying bodies follow; therefore, VA
Therapeutic Medical Physicists will continue to follow the standard set
by their national certification. The MPPG standard by AAPM can be found
here: <a href="https://www.aapm.org/pubs/MPPG/default.asp">https://www.aapm.org/pubs/MPPG/default.asp</a>.
Because the practice of Therapeutic Medical Physicists 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 Therapeutic Medical
Physicists
Therapeutic Medical Physicists (TMPs) assure the safe and effective
use of radiation in radiation oncology. TMPs perform or oversee the
scientific and technical aspects of radiotherapy procedures necessary
to achieve this objective. In the clinical setting, this involves the
use of ionizing or nonionizing radiation in the planning and delivery
of radiotherapy treatments. TMPs collaborate with radiation oncologists
and monitor equipment to ensure each patient's safety.
Therapeutic Medical Physicists in the Department of Veterans
Affairs (VA) possess the education and certification from the American
Board of Radiology (ABR), the American Board of Medical Physics (ABMP),
or the Canadian College of Physicists in Medicine (CCPM) required by VA
qualification standards, as more specifically described in VA Handbook
5005, Staffing, Part II, Appendix G48.
This national standard of practice confirms that VA Therapeutic
Medical Physicists practice in accordance with the Medical Physics
Practice Guidelines (MPPG) standards from the American Association of
Physicists in Medicine (AAPM), available at: <a href="https://www.aapm.org/">https://www.aapm.org/</a>. As
of November 2022, all three certifications from ABR, AMBP, and CCPM
follow MPPG standards.
Although VA only requires a certification, four States require a
State license in order to practice occupation in that State: Hawaii,
Florida, New York, and Texas. As of November 2022, all four States
follow the MPPG standards so there is no variance in how VA Therapeutic
Medical Physicists practice in any State.
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 February 21, 2023, 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. 2023-05141 Filed 3-13-23; 8:45 am]
BILLING CODE 8320-01-P
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</html>Indexed from Federal Register on March 14, 2023.
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