Notice2023-05143
Notice of Request for Information on the Department of Veterans Affairs Registered Dietitian Nutritionists 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 Registered Dietitian Nutritionists (RDN). 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 15860-15862]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2023-05143]
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DEPARTMENT OF VETERANS AFFAIRS
Notice of Request for Information on the Department of Veterans
Affairs Registered Dietitian Nutritionists 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 Registered Dietitian Nutritionists (RDN). 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
[[Page 15861]]
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; 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 organization 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 Registered Dietitian Nutritionists
The proposed format for national standards of practice when there
are State licenses and a national registration 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 registration needed to practice this profession at
VA. The third paragraph confirms that this profession follows the
standard set by the national registration body. A final statement
explains that while VA only requires a national registration, 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 Registered Dietitian Nutritionists (RDNs) are experts in the
disciplines of nutrition and food. They translate the complex science
of nutrition into healthy, real-world solutions. VA qualification
standards require
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Registered Dietitian Nutritionists (RDNs) to have an active, current,
full, and unrestricted registration from the Commission on Dietetic
Registration, the credentialing branch of the Academy of Nutrition and
Dietetics. VA reviewed whether there are any alternative registrations,
certifications, or State requirements that could be required for a RDN
and found that 46 States require a license to practice as a RDN in that
State. Of those, 34 States exempt Federal employees from their State
license requirements. The standard set forth in the licensure
requirements for all 46 States are consistent with what is permitted
under the national registration. Therefore, there is no variance in how
any RDN practices in any State.
VA proposes to adopt a standard of practice consistent with the
national registration; therefore, VA RDNs will continue to follow the
same standard as set by their national registration. Standard of
practice for the registration can be found here: Academy of Nutrition
and Dietetics: Revised 2017 Scope of Practice for the Registered
Dietitian Nutritionist--Journal of the Academy of Nutrition and
Dietetics (<a href="http://jandonline.org">jandonline.org</a>).
Because the practice of RDN 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 Registered Dietitian
Nutritionist
RDNs are experts in the disciplines of nutrition and food. They
translate the complex science of nutrition into healthy, real-world
solutions. RDNs within the Department of Veterans Affairs (VA) are
fully integrated into a health care team and work within a variety of
settings including inpatient, outpatient, long term care, food
operations, and community clinics. Clinical RDNs are responsible for
utilizing the nutrition care process framework to provide patient-
centered care using evidence-based guidelines to make decisions. RDNs
in the food service setting are responsible for scientific preparation
and service of high-quality food by selection, requisition, receipt,
storage, issuance, and transportation of food and supplies. They assure
sanitation, safety, competency, and training programs are robust and
effective.
RDNs employed by VA possess the education and registration from the
Commission on Dietetic Registration (CDR) required by VA qualification
standards, as more specifically described in VA Handbook 5005,
Staffing, Part II, Appendix G20.
This national standard of practice confirms RDNs practice in
accordance with the Registered Dietitian Nutritionist standards from
the Academy of Nutrition and Dietetics, available at: <a href="http://www.eatright.org">www.eatright.org</a>.
As of March 2022, RDNs in VA follow the standards associated with this
national registration.
Although VA only requires a registration, 46 States require a State
license in order to practice as RDNs in that State: Alabama, Alaska,
Arkansas, Delaware, District of Columbia, Florida, Georgia, Guam,
Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana,
Maine, Maryland, Massachusetts, Minnesota, Mississippi, Missouri,
Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North
Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Puerto
Rico, Rhode Island, South Carolina, South Dakota, Tennessee, Texas,
Utah, Vermont, Washington, West Virginia, Wisconsin, and Wyoming.
Of those, the following States exempt Federal employees from its
State license requirements: Alabama, Alaska, Arkansas, Delaware,
District of Columbia, Florida, Georgia, Guam, Hawaii, Illinois, Iowa,
Kansas, Kentucky, Louisiana, Maine, Maryland, Minnesota, Mississippi,
Montana, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina,
North Dakota, Ohio, Oklahoma, Puerto Rico, Rhode Island, South
Carolina, South Dakota, Tennessee, Wisconsin, and Wyoming.
As of May 2022, there is no variance in how VA RDNs 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. 2023-05143 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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