Notice2024-05237
Notice of Request for Information on the Department of Veterans Affairs
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 12, 2024
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 Peer Specialists. 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 89 Issue 49 (Tuesday, March 12, 2024)</title>
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[Federal Register Volume 89, Number 49 (Tuesday, March 12, 2024)]
[Notices]
[Pages 17898-17900]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2024-05237]
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DEPARTMENT OF VETERANS AFFAIRS
Notice of Request for Information on the Department of Veterans
Affairs
Peer Specialist 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 Peer Specialists. 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 13, 2024.
ADDRESSES: Comments must be submitted through <a href="http://www.regulations.gov">http://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">http://www.regulations.gov</a> for public viewing, inspection, 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://www.regulations.gov">http://www.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 will not be accepted.
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 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 State 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, regardless of conflicting State laws, rules, regulations,
or other State requirements.
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 State 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 proper education, training, and skills
to perform the tasks and duties detailed in the national standard of
practice, and that they 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.
Preemption of State Requirements
The national standard of practice will preempt any State laws,
rules, regulations, or requirements that both are and are not listed in
the national standard as conflicting, but that do in fact conflict with
the tasks and duties as authorized in VA's national standard of
practice. In the event that a State changes their requirements and
places new limitations on the tasks and duties it allows in a manner
that would be inconsistent with what is authorized under the national
standard of practice, the national standard of practice will preempt
such limitations and authorize the VA health care professional to
continue to practice consistent with the tasks and duties outlined in
the national standard of practice.
In cases where a VA health care professional's license,
registration, certification, or other State requirement allows a
practice that is not included in a national standard of practice, the
individual may continue that practice so long as it is permissible by
Federal law and VA policy, is not explicitly prohibited by the national
standard of practice, and is approved by the VA medical facility.
[[Page 17899]]
Need for National Standards of Practice
It is critical that VA, the Nation's largest integrated health care
system, develops national standards of practice to ensure, first, that
beneficiaries receive the same high-quality care regardless of where
they enter the system and, second, 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 coronavirus disease 2019 (COVID-19)
pandemic. The increased need for mobility in VA's workforce, including
through VA's Disaster Emergency Medical Personnel System, highlighted
the importance of creating uniform national standards of practice to
better support VA health care professionals who practice across State
lines. Creating national standards of practice also promotes
interoperability of medical data between VA and the Department of
Defense (DoD), providing a complete picture of a veteran's health
information and improving VA's delivery of health care to the Nation's
veterans. DoD has historically standardized practice for certain health
care professionals, and VA has closely partnered with DoD to learn from
their experience.
Process to Develop National Standards of Practice
As authorized by 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 Veterans Health
Administration (VHA) policy; each individual national standard of
practice will be 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 adheres to the requirements of Executive Order
(E.O.) 13132 to preempt conflicting State laws, rules, regulations, or
other requirements. 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 VA occupation, a workgroup comprised of
VA health care professionals in the identified occupation conducts
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 VA. 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 tasks and duties. The workgroup then
drafts a proposed VA national standard of practice using the data
gathered during the research and incorporates internal stakeholder
feedback into the standard. The workgroup may consult with internal or
external stakeholders at any point throughout the process.
The proposed national standard of practice is then internally
reviewed, to include by an interdisciplinary VA workgroup consisting of
representatives from Quality Management, VA medical facility Chief of
Staff, Academic Affiliates, Veterans Integrated Services Network (VISN)
Chief Nursing Officer, Ethics, Workforce Management and Consulting,
Surgery, Credentialing and Privileging, VISN Chief Medical Officer, and
Electronic Health Record Modernization.
Externally, VA hosts listening sessions for members of the public,
professional associations, and VA employees to provide comments on the
variance between State practice acts for a specific occupation and what
should be included in the national standard of practice for that
occupation. The Listening Session for Peer Specialists was held on
September 21, 2023. No professional associations presented comments on
the Peer Specialist scope of practice.
VA has developed a robust process to engage with partners, members
of the public, States, and employees on the proposed national standard
of practice. VA provides the proposed national standard of practice to
our DoD partners as an opportunity to flag inconsistencies with DoD
standards. VA also engages labor partners informally as part of a pre-
decisional collaboration. Consistent with E.O. 13132, VA sends a letter
to each State board and certifying organization or registration
organization, as appropriate, which includes the proposed national
standard and offers the recipient an opportunity to discuss the
national standard with VA. After the State boards, certifying
organizations, or registration organizations have received
notification, the proposed national standard of practice is posted in
the Federal Register for 60 days to obtain feedback from the public,
professional associations, and any other interested parties. At the
same time, the proposed national standard is posted to an internal VA
site to obtain feedback from VA employees. Responses received through
all vehicles--from State boards, professional associations, unions, VA
employees, and any other individual or organization who 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. 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 properly incorporated into
individual health care professionals' privileges, scope of practice, or
functional statement once it has been determined by their VA medical
facility that the individual has the proper education, training, and
skills to perform the task or duty. Implementation of the national
standard of practice may be phased in across all VA medical facilities,
with limited exemptions for health care professionals as needed.
Format for National Standard for Peer Specialists
The proposed format for national standards of practice when there
are State certifications is as follows. The first paragraph provides
general information about the profession and a broad list of tasks and
duties these health care professionals can do. For this national
standard, Peer Specialists are United States military veterans who
self-identify with a lived experience of recovery from a mental health
condition and have been professionally trained to help other veterans
with similar experiences to identify and achieve specific life and
recovery goals. This is an evolving profession both in and outside of
VA. We reiterate that the proposed standard of practice does not
contain an exhaustive list of every task and duty that each VA health
care professional can perform. Rather, it is designed to highlight
generally what tasks and duties the health care professionals perform
and how this they will be able to practice within VA notwithstanding
their State license, certification, registration, or other State
requirements.
[[Page 17900]]
The second paragraph references the training and certification
needed to practice this profession at VA. Qualification standards for
employment of health care professionals by VA are outlined in VA
Handbook 5005, Staffing, dated November 8, 2023. VA follows the
requirements outlined in the VA qualification standards even if the
requirements conflict with or otherwise differ from a State
requirement. National standards of practice do not affect those
requirements. This includes, but is not limited to, when a State
requires a license to practice a specific occupation, but VA does not
require a State license as part of the qualification standards. For
Peer Specialists, VA qualification standards require an active,
current, full, and unrestricted certification from a State or a not-
for-profit entity with Peer Specialist training.
The third paragraph confirms that this profession can perform all
the duties set by the State certification bodies. For Peer Specialists,
VA reviewed State certification requirements and State-recognized non-
profit organization certification requirements. VA found that 48 States
certify Peer Specialists through a State certification or a non-profit
entity and seven States do not regulate Peer Specialists. However, VA
found no variance in how Peer Specialists practice in any State. VA
thus proposes to adopt a national standard of practice for Peer
Specialists that is consistent with what is permitted in all States. As
previously noted, this VA national standard of practice is the first
attempt at creating a comprehensive standard for Peer Specialists.
This national standard of practice does not address training
because it will not authorize VA Peer Specialists to perform any tasks
or duties not already authorized under their State certifications.
Following public and VA employee comments and revisions, each
national standard of practice that is published into policy will also
include the date for recertification of the standard of practice and a
point of contact for questions or concerns.
Proposed National Standard of Practice for Peer Specialists
1. Peer Specialists are United States military Veterans who self-
identify with a lived experience of recovery from a mental health
condition and have been professionally trained to help other Veterans
with similar experiences to identify and achieve specific life and
recovery goals. Peer Specialist is an evolving profession both in and
outside of VA, and a national scope of practice for this profession has
not been previously developed or implemented. VA is the largest single
employer of Peer Specialists in the United States. This VA national
standard of practice is the first uniform set of guidelines to which
Peer Specialists practice. Peer Specialists are actively engaged in
their own recovery and wellness and provide individual and group-based
peer support services to other veterans who use VA health care
services. Peer Specialists share aspects of their personal recovery
story and wellness strategies, when and where it is appropriate to do
so, to be of help to others. They collaborate with other health care
professionals on interdisciplinary treatment teams as the teams work
toward shared goals to provide quality health care services for
Veterans. Peer Specialists' tasks and duties include, but are not
limited to:
a. Assisting Veterans to explore, identify, and make progress on
their self-directed personal recovery and wellness goals.
b. Being role models and sharing elements of their personal
experience, including their recovery stories, coping techniques, and
self-help strategies to be of service to others.
c. Collaborating with Veterans and their treatment providers to
identify and cultivate Veterans' skills and strengths that support
their recovery goals.
d. Helping Veterans to learn new coping skills and self-help
strategies to overcome fears and barriers that could inhibit the
Veteran's personal recovery. This does not include facilitating
psychotherapy protocols.
e. Advocating for Veterans when needed and supporting Veterans in
learning to self-advocate for their own needs and interests.
f. Supporting Veterans in distress and collaborating with
colleagues to connect Veterans with clinical providers' services and
community services when needed.
g. Assisting Veterans to connect to available VA and community
resources, including conducting outreach calls to educate and engage
Veterans to connect with available VA services.
h. Facilitating peer support groups and co-facilitating with
clinicians on other types of health and personal wellness groups. This
does not include facilitating or co-facilitating psychotherapy groups.
i. Assisting Veterans with integration activities into their
community, as consistent with Veterans' stated goals.
2. Peer Specialists in the Department of Veterans Affairs (VA)
possess the training and peer specialist certification required by VA
qualification standards. See VA Handbook 5005, Staffing Part II,
Appendix F3, dated July 17, 2012.
3. VA Peer Specialists can, in collaboration with their
supervisors, practice all duties covered by their peer specialist
certification. VA reviewed certification requirements for this
occupation in May 2023 and confirmed there is no variance in what is
permitted by the state-issued peer specialist certifications. As of May
2023, the VA standard of practice is consistent with what is permitted
in any state.
Request for Information
1. Are there any factors that would inhibit or delay the
implementation of the aforementioned tasks and duties for VA health
care professionals in any states?
2. Is VA's assessment of what tasks or duties States allow and do
not allow accurate?
3. Are there any areas of variance between State certifications
that VA should preempt that are not listed?
4. Is there anything else you would like to share with us about
this VA national standard of practice?
Signing Authority
Denis McDonough, Secretary of Veterans Affairs, approved and signed
this document on February 13, 2024, 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. 2024-05237 Filed 3-11-24; 8:45 am]
BILLING CODE 8320-01-P
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