Notice2024-11411
Notice of Request for Information on the Department of Veterans Affairs Medical Technologist 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
May 24, 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 Medical Technologists. 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 102 (Friday, May 24, 2024)</title>
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[Federal Register Volume 89, Number 102 (Friday, May 24, 2024)]
[Notices]
[Pages 45940-45942]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2024-11411]
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DEPARTMENT OF VETERANS AFFAIRS
Notice of Request for Information on the Department of Veterans
Affairs Medical Technologist 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 Medical Technologists. 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 July 23, 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 consistently 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.
Need for National Standards of Practice
It is critical that VA, the Nation's largest integrated health care
system,
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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 our 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 Chiefs of
Staff; Academic Affiliates; Veterans Integrated Services Network (VISN)
Chief Nursing Officers; Ethics; Workforce Management and Consulting;
Surgery; Credentialing and Privileging; VISN Chief Medical Officers;
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 Medical Technologists was held on
September 7, 2023. No professional associations presented comments on
the Medical Technologist 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 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 an
individual health care professional's 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 Medical Technologists
The format for the proposed national standards of practice when
there are national certification bodies, and there are 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, Medical Technologists are highly skilled medical
laboratory professionals responsible for the testing of blood, other
body fluids, and tissue specimens, using a variety of manual and
automated methods. 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 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
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VA qualification standards even if the requirements conflict with or
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
Medical Technologists, VA qualification standards require an active,
current, full, and unrestricted certification from either the American
Society for Clinical Pathology (ASCP) or from American Medical
Technologists (AMT).
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. Medical Technologists have
grandfathering provisions included within their qualification
standards, and VA proposes to have those individuals be authorized to
follow the Medical Technologist 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 Medical Technologist who
meets the current qualification standards.
The third paragraph confirms which standard the profession will
follow under this VA national standard of practice. VA qualification
standards for Medical Technologists require a national certification
from either ASCP or AMT. VA proposes to adopt a standard of practice
consistent with ASCP. There is no variance between these two national
certifications; however, ASCP provides a more detailed scope of
practice for the Medical Technologist profession. Therefore, VA Medical
Technologists will follow the standard as set by this national
certification. The national certification body standard can be found at
<a href="https://www.ascp.org/content/docs/default-source/policy-statements/ascp-pdft-pp-personnel-standards.pdf?sfvrsn=2">https://www.ascp.org/content/docs/default-source/policy-statements/ascp-pdft-pp-personnel-standards.pdf?sfvrsn=2</a>. For Medical
Technologist, VA confirmed that all individuals follow the Medical
Technologist standards from ASCP.
The fourth paragraph defines if there are additional registrations,
regulations, certifications, licenses, or Federal exemptions for the
profession. It explains if VA is preempting any conflicting state laws,
rules, regulations, or requirements. VA found that 11 States also
require a State license for Medical Technologists, and seven of these
States exempt Federal employees from their State license requirements.
Furthermore, the tasks and duties set forth in the State license
requirements for all seven States are consistent with what is permitted
by the ASCP. Therefore, there is no variance in how Medical
Technologists practice in any State. VA thus proposes to adopt a
standard of practice consistent with the ASCP standards of practice. VA
Medical Technologists will continue to follow this standard.
This national standard of practice does not address training
because it will not authorize VA Medical Technologists to perform any
tasks or duties not already authorized under their national
certification and/or 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 Medical Technologists
1. Medical Technologists are highly skilled medical laboratory
professionals responsible for the testing of blood, other body fluids,
and tissue specimens using a variety of manual and automated methods.
Medical Technologists maintain laboratory testing instrumentation and
equipment and ensure accurate reporting of test results which aid
health care providers in the prevention (monitoring), diagnosis, and
treatment of disease.
2. Medical Technologists in the Department of Veterans Affairs (VA)
possess the education and certification required by VA qualification
standards. See VA Handbook 5005, Staffing, Part II, Appendix G24, dated
May 12, 2014.
3. VA Medical Technologists practice in accordance with the Medical
Technologist national certification standards from the American Society
for Clinical Pathology, available at: <a href="https://www.ascp.org/">https://www.ascp.org/</a>. VA
reviewed license and certification requirements for this occupation in
January 2024 and confirmed that all Medical Technologists in VA
followed this national certification.
4. Although VA only requires a certification, the following 11
states currently require a State license in order to practice as
Medical Technologists in that state: California, Florida, Hawaii,
Louisiana, Montana, Nevada, New York, North Dakota, Puerto Rico,
Tennessee, and West Virginia.
Of these, the seven following States exempt Federal employees from
their state license requirements: Florida, Louisiana, Montana, New
York, North Dakota, Tennessee, and West Virginia.
VA reviewed license and certification requirements for this
occupation in January 2024 and confirmed there was no variance in how
VA Medical Technologists practice in any state.
Request for Information
1. Are there any required or necessary trainings for Medical
Technologists that we should consider?
2. Are there any factors that would inhibit or delay the
implementation of the aforementioned tasks and duties for VA Medical
Technologists in any States?
3. Is there any variance in the license, certification, or the
tasks and duties that we have not listed?
4. Is there anything else you would like to share with us about
this national standard of practice for VA Medical Technologists?
Signing Authority
Denis McDonough, Secretary of Veterans Affairs, approved and signed
this document on May 10, 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.
Michael P. Shores,
Director, Office of Regulation Policy & Management, Office of General
Counsel, Department of Veterans Affairs.
[FR Doc. 2024-11411 Filed 5-23-24; 8:45 am]
BILLING CODE 8320-01-P
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