Notice2023-05142
Notice of Request for Information on the Department of Veterans Affairs Orthotist, Prosthetist, and Prosthetist-Orthotist Standard of Practice
Primary source
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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 Orthotists, Prosthetists, and Prosthetist-Orthotists. 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 15858-15860]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2023-05142]
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DEPARTMENT OF VETERANS AFFAIRS
Notice of Request for Information on the Department of Veterans
Affairs Orthotist, Prosthetist, and Prosthetist-Orthotist 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 Orthotists, Prosthetists, and Prosthetist-Orthotists. 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 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 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
[[Page 15859]]
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 Orthotist, Prosthetist, and Prosthetist-Orthotist
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
certifying body. A final statement explains that while VA only 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.
VA Orthotists, Prosthetists, and Prosthetist-Orthotists are health
care professionals who are specifically educated and trained to manage
comprehensive orthotic and/or prosthetic patient care. VA qualification
standards require Orthotists, Prosthetists, and Prosthetist-Orthotists
to have an active, current, full, and unrestricted certification from
either the American Board of Certification (ABC) in Orthotics,
Prosthetics & Pedorthics or from the Board of Certification (BOC). VA
reviewed whether there are any alternative certifications or State
requirements that could be required for Orthotists, Prosthetists, and
Prosthetist-Orthotists and found that 15 States require a license to
practice as an Orthotist, Prosthetist, and Prosthetist-Orthotist. Of
those, VA found that all 15 States exempt Federal employees from their
State license requirements.
While VA qualification standards for Orthotists, Prosthetists, and
Prosthetist-Orthotists require one certification from either ABC or
BOC, VA proposes to adopt a standard of practice consistent with the
ABC certification. There is no variance between these two national
certifications; however, ABC standards set more specific expectations
for education, training, and practice areas. Therefore, VA Orthotists,
Prosthetists, and Prosthetist-Orthotists will follow the standard as
set by this national certification. The standard for the ABC
certification can be found here: <a href="https://www.abcop.org/publication/scope-of-practice">https://www.abcop.org/publication/scope-of-practice</a>.
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Proposed National Standard of Practice for Orthotist, Prosthetist and
Prosthetist-Orthotist
Orthotists, Prosthetists and Prosthetist-Orthotists are health care
professionals who are specifically educated and trained to manage
comprehensive orthotic and/or prosthetic patient care. This includes
patient assessment, formulation of a treatment plan, implementation of
the treatment plan, follow-up, and practice management. Documentation
by the Orthotists, Prosthetists and Prosthetist-Orthotists is part of
the patient's medical record and assists with establishing medical
necessity for orthotic and/or prosthetic care.
Orthotists, Prosthetists and Prosthetist-Orthotists in the
Department of Veterans Affairs (VA) possess the education and
certification from either the American Board of Certification (ABC) or
Board of Certification (BOC) required by VA qualification standards, as
more specifically described in VA Handbook 5005, Staffing, Part II,
Appendix G32.
This national standard of practice confirms that Orthotists,
Prosthetists and Prosthetist-Orthotists practice according to the
Orthotist and Prosthetist standards from the American Board of
Certification, available at: <a href="https://www.abcop.org">https://www.abcop.org</a>. As of March 2022,
all Orthotists, Prosthetists and Prosthetist-Orthotists in VA follow
the standards associated with this national certification.
Although VA only requires a certification, 15 States require a
State license in order to practice as an Orthotist, Prosthetist and
Prosthetist-Orthotist in that State: Alabama, Arkansas, Florida,
Georgia, Illinois, Iowa, Kentucky, Minnesota, New Jersey, Ohio,
Oklahoma, Pennsylvania, Tennessee, Texas, and Washington. However, all
15 States exempt Federal employees from their State license
requirements.
As of March 2022, there is no variance in how VA Orthotists,
Prosthetists and Prosthetist-Orthotists 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. 2023-05142 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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