Notice2024-09033
Notice of Request for Information on the Department of Veterans Affairs; Marriage and Family Therapist 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
April 26, 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 Marriage and Family 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 89 Issue 82 (Friday, April 26, 2024)</title>
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[Federal Register Volume 89, Number 82 (Friday, April 26, 2024)]
[Notices]
[Pages 32527-32529]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2024-09033]
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DEPARTMENT OF VETERANS AFFAIRS
Notice of Request for Information on the Department of Veterans
Affairs; Marriage and Family Therapist 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 Marriage and Family 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 June 25, 2024.
ADDRESSES: Comments must be submitted through <a href="https://www.regulations.gov">https://www.regulations.gov</a> Except as provided below, comments received before
the close of the comment period will be available at <a href="https://www.regulations.gov/">https://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="https://www.regulations.gov/">https://www.regulations.gov/</a>.
VA will not post on <a href="https://www.regulations.gov/">https://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
considered.
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 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,
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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.
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 is one overarching directive to describe
Veterans Health Administration (VHA) policy on national standards of
practice. The directive is 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). As each individual national
standard of practice is finalized, it is published as an appendix to
the directive and accessible at the same websites.
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 specific occupations and what
should be included in the national standard of practice for that
occupation. The listening session for Marriage and Family Therapists
was held on September 21, 2023. At the listening session, there was one
presenter who represented the American Association of Marriage and
Family Therapy. The presenter supported the Marriage and Family Therapy
national standard of practice and urged VA to allow all providers to
practice to the full extent of their license and education. The
presenter stated that maximizing utilization of provider skills would
make access to care more efficient and would lower costs. VA
appreciates the thoughtful presentation and considers the information
presented at the listening session when drafting the proposed VA
national standard 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 with 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 the Proposed National Standard for Marriage and Family
Therapist
The format for the proposed national standards of practice when
there are
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State licenses is as follows. The first paragraph provides general
information about the profession and what the health care professionals
can do. For this national standard, Marriage and Family Therapists are
licensed professionals who provide psychotherapy to couples, families,
individuals, and groups. 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 they will be able to practice within VA
notwithstanding their State license, certification, registration, or
other State requirements.
The second paragraph references the education and State license, or
other requirement, 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 differ from a State
requirement. National standards of practice do not affect those
requirements. For Marriage and Family Therapists, VA qualification
standards require an active, current, full, and unrestricted State
license.
The second paragraph also notes whether the national standard of
practice explicitly excludes individuals who practice under
``grandfathering'' provisions. Qualification standards may include
provisions to permit employees who met all requirements prior to
revisions to the qualification standards to maintain employment at VA
even if they no longer meet the new qualification standards. This
practice is referred to as grandfathering. Marriage and Family
Therapists have grandfathering provisions included within its
qualification standards, and VA proposes to have those individuals be
authorized to follow the Marriage and Family Therapist national
standard of practice. Therefore, there would be no notation regarding
grandfathered employees in the national standard of practice as they
would be required to adhere to the same standard as any other VA
Marriage and Family Therapist who meets the current qualification
standards.
The third paragraph describes what tasks and duties the profession
will be able to perform within the scope of their VA employment. It
includes whether the profession can practice all duties covered by
their State license. For Marriage and Family Therapists, VA reviewed
State license requirements and found no variance in how VA Marriage and
Family Therapists practice in any State.
This national standard of practice does not address training
because it will not authorize VA Marriage and Family Therapists to
perform any tasks or duties not already authorized under their State
license.
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 Marriage and Family
Therapist
1. Marriage and Family Therapists provide psychotherapy to couples,
families, individuals, and groups. These professionals are licensed to
diagnose and treat mental health disorders such as depression, post-
traumatic stress disorder, anxiety, and other mental health disorders.
Marriage and Family Therapists have specialized training in family
systems theory and are well qualified to treat relationships issues,
including marriage or couples counseling, and child-parent challenges.
2. Marriage and Family Therapists in the Department of Veterans
Affairs (VA) possess the education and license required by VA
qualification standards. See VA Handbook 5005, Staffing, Part II,
Appendix G44, dated April 18, 2018.
3. VA Marriage and Family Therapists can practice all duties
covered by their license. VA reviewed license requirements for this
occupation in February 2024 and confirmed there is no variance in how
VA Marriage and Family Therapists practice in any State.
Request for Information
1. Is VA's assessment of what States allow and do not allow
accurate?
2. Are there any other areas of variance between State licenses,
certification, or registration that VA should preempt that are not
listed?
3. 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 April 5, 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.
Luvenia Potts,
Regulation Development Coordinator, Office of Regulation Policy &
Management, Office of General Counsel, Department of Veterans Affairs.
[FR Doc. 2024-09033 Filed 4-25-24; 8:45 am]
BILLING CODE 8320-01-P
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