Notice2023-16004
Notice of Request for Information on the Department of Veterans Affairs Creative Arts Therapists (Drama) Standard of Practice
Primary source
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Published
July 28, 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 Creative Arts Therapists (Drama). 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 144 (Friday, July 28, 2023)</title>
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[Federal Register Volume 88, Number 144 (Friday, July 28, 2023)]
[Notices]
[Pages 48951-48953]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2023-16004]
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DEPARTMENT OF VETERANS AFFAIRS
Notice of Request for Information on the Department of Veterans
Affairs Creative Arts Therapists (Drama) 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 Creative Arts Therapists (Drama). 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 26, 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="http://www.regulations.gov">http://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 any
potential future 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 that 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. VA emphasized in
the rulemaking and now reiterate herein 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
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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
historically has 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, Federalism, 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 and 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
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 registration
organization that includes the proposed national standard and an
opportunity to further discuss the national standard with VA. After the
States and registration 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. VA 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 Creative Arts Therapists (Drama)
Please note that while VA Handbook 5005, Part II, Appendix G60
refers to this position as Creative Arts Therapists (Drama), these
positions are commonly referred to as Drama Therapists and that
terminology will be used throughout herein.
The proposed format for national standards of practice follows for
when there are State licenses and a national registration. 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.
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.
Drama Therapists use storytelling, projective play, purposeful
improvisation and performance to invite participants to rehearse
desired behaviors; practice being in a relationship; expandand find
flexibility between life roles; and perform personal and social change.
VA qualification standards require Drama Therapists to have an active,
current, full and unrestricted Registered Drama Therapists (RDT)
registration from the North American Drama Therapy Association (NADTA).
VA reviewed whether there are any alternative registrations,
certifications or State requirements that could be required for a Drama
Therapist and found that one State requires a license. The standard set
forth in the licensure requirements for the one State is consistent
with what is permitted under the national registration. Therefore,
there is no variance in how Drama Therapists practice in any State.
VA proposes to adopt a standard of practice consistent with the
national registration; therefore, VA Drama Therapists will continue to
follow the same standard as set by the registration. The standard for
the registration can be found at <a href="https://www.nadta.org/scope-of-practice">https://www.nadta.org/scope-of-practice</a>.
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Because the practice of Drama Therapists 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 Drama Therapists
1. Drama Therapists use an active, experiential approach to
facilitate social, emotional and cognitive change. Through
storytelling, projective play, purposeful improvisation and
performance, participants are invited to rehearse desired behaviors,
practice being in relationship, expandand find flexibility between life
roles and perform personal and social change.
2. Drama Therapists in the Department of Veterans Affairs (VA)
possess the education and registration required by VA qualification
standards. See VA Handbook 5005, Staffing, Part II, Appendix G60, dated
June 7, 2019.
3. VA Drama Therapists practice in accordance with the Registered
Drama Therapists (RDT) national standards from the North American Drama
Therapy Association, available at <a href="https://www.nadta.org/">https://www.nadta.org/</a>. VA reviewed
license and certification requirements for this occupation in June 2023
and confirmed that all Drama Therapists in VA follow this national
registration.
4. Although VA only requires a registration, one State, New York,
requires a State license to practice as a Drama Therapist in that
State.
VA reviewed license and certification requirements for this
occupation in June 2023 and confirmed that there is no variance in how
VA Drama Therapists practice in any State.
Request for Information
1. Are there any required trainings for the aforementioned
practices that VA 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 VA has not listed?
4. What should VA 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 VA about
this national standard of practice?
Signing Authority
Denis McDonough, Secretary of Veterans Affairs, approved and signed
this document on July 10, 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.
Jeffrey M. Martin,
Assistant Director, Office of Regulation Policy & Management, Office of
General Counsel, Department of Veterans Affairs.
[FR Doc. 2023-16004 Filed 7-27-23; 8:45 am]
BILLING CODE 8320-01-P
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</html>Indexed from Federal Register on July 28, 2023.
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