Notice2023-16007
Notice of Request for Information on the Department of Veterans Affairs Recreation Therapists 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 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 Recreation Therapists. 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 48963-48965]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2023-16007]
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DEPARTMENT OF VETERANS AFFAIRS
Notice of Request for Information on the Department of Veterans
Affairs Recreation Therapists 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 Recreation Therapists. 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 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
[[Page 48964]]
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
the 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 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 Recreation Therapists
The proposed format for national standards of practice when there
is a national certification, and some States require a license 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 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.
Recreation Therapists systematically use recreation and activity-
based interventions for the specific purpose of improving the physical,
social, emotional, cognitive and spiritual functioning of individuals;
enhancing well-being; and enabling greater quality
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of life through recreation participation for individuals with injury,
illness or disability. VA qualification standards require Recreation
Therapists to have an active, current, full and unrestricted
certification as a Certified Therapeutic Recreation Specialist from the
National Council for Therapeutic Recreation Certification (NCTRC).
Although NCTRC is the certification body for Recreation Therapists, the
American Therapeutic Recreation Association (ATRA) has developed the
Standards for the Practice of Recreational Therapy, which is followed
by all VA Recreation Therapists.
VA reviewed whether there are any alternative registrations,
certifications or State requirements that could be required for a
Recreation Therapist and found that five States require a license to
practice as a Recreation Therapist in that State. Of those, one State
exempts Federal employees from its State license requirements. The
standards set forth in the licensure requirements for all five States
are consistent with what is permitted under the Standards of Practice
for Recreational Therapy from the ATRA. Therefore, there is no variance
in how any Recreation Therapists practice in any State.
VA proposes to adopt a standard of practice consistent with the
ATRA standards. Therefore, VA Recreation Therapists will continue to
follow the same standard as set by their national certification. The
ATRA standards can be found here: <a href="https://www.atra-online.com/general/custom.asp?page=SOP">https://www.atra-online.com/general/custom.asp?page=SOP</a>.
Because the practice of Recreation 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 Recreation Therapists
1. Recreation Therapists systematically use recreation and
activity-based interventions for the specific purpose of improving the
physical, social, emotional, cognitive and spiritual functioning of
individuals; enhancing wellbeing; and enabling greater quality of life
through recreation participation for individuals with injury, illness
or disability. Recreation Therapists utilize treatment interventions,
leisure education and recreation experiences to improve functional
abilities, foster recovery, enhance health and wellness, promote the
development and maintenance of a healthy leisure lifestyle and increase
independent participation in activities of choice through activity
modification, adaptation and facilitation.
2. Recreation Therapists in VA possess the education and
certification required by VA qualification standards. See VA Handbook
5005, Staffing, Part II, Appendix G60, dated June 7, 2019.
3. VA Recreation Therapists practice in accordance with the
Standards for the Practice of Recreational Therapy from ATRA available
at: <a href="https://www.atra-online.com/">https://www.atra-online.com/</a>. VA reviewed license and certification
requirements for this occupation in June 2023 and confirmed that all
Recreation Therapists in VA follow the ATRA standards.
4. Although VA only requires a certification, five States require a
State license in order to practice as a Recreation Therapist in that
State: New Hampshire, New Jersey, North Carolina, Oklahoma and Utah. Of
those, the following State exempts Federal employees from its State
license requirements: Oklahoma.
VA reviewed license and certification requirements for this
occupation in June 2023 and confirmed that there is no variance in how
VA Recreation Therapists 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 and signed
this document on July 12, 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. 2023-16007 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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