Notice2024-15109
Notice of Request for Information on the Department of Veterans Affairs Registered Radiologist Assistant 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 10, 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 Registered Radiologist Assistants. 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 132 (Wednesday, July 10, 2024)</title>
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[Federal Register Volume 89, Number 132 (Wednesday, July 10, 2024)]
[Notices]
[Pages 56812-56815]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2024-15109]
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DEPARTMENT OF VETERANS AFFAIRS
Notice of Request for Information on the Department of Veterans
Affairs Registered Radiologist Assistant 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 Registered Radiologist Assistants. 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 9, 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 Governance,
Regulations, Appeals and Policy (10B-GRAP), 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.
[[Page 56813]]
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.
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 Registered Radiologist Assistant
on September 7, 2023, included one presenter representing the American
College of Radiology. The presenter shared the duties performed by a
Registered Radiologist Assistant should be well-defined and performed
under the supervision of a Radiologist to ensure the highest quality
patient care. VA appreciates the thoughtful presentations 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
[[Page 56814]]
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 National Standard for Registered Radiologist Assistants
The proposed format for national standards of practice when there
is a national certification body 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, Registered Radiologist Assistants are Diagnostic
Radiologic Technologists with advanced training, education, and
certification, who are responsible for the safe use of ionizing
radiation and magnetic fields for diagnostic, therapeutic, and research
purposes for selected invasive and non-invasive clinical imaging
procedures under the supervision of a Radiologist. 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 June 21, 2024. 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. 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 Registered Radiologist Assistants, who
are Diagnostic Radiologic Technologists with advanced training,
education, and certification, VA qualification standards require an
active, current, full, and unrestricted certification in Radiography
from the American Registry of Radiologic Technologists (ARRT).
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. Registered Radiologist
Assistants do not have grandfathering provisions within their
qualification standards.
The third paragraph confirms that this profession follows the
standard set by the American Society of Radiologic Technologists
(ASRT). ARRT, this profession's national certification body, follows
ASRT standards. The standard of practice for the certification can be
found at: <a href="https://www.asrt.org/main/standards-and-regulations/professional-practice/practice-standards">https://www.asrt.org/main/standards-and-regulations/professional-practice/practice-standards</a>. For Registered Radiologist
Assistants, VA confirmed that all individuals follow the standards from
ASRT.
The fourth paragraph notes that VA reviewed if there are any
required alternative registrations, certifications, licenses, or other
State requirements for Registered Radiologist Assistants. VA found that
18 States also require a State license for Registered Radiologic
Assistants.
The fourth paragraph also includes information on which States
offer an exemption for Federal employees and whether VA is preempting
any conflicting State laws, rules, regulations, or requirements. Of
those 18 States that require a license, 14 States exempt Federal
employees from their State license requirements. Furthermore, the tasks
and duties set forth in the State license requirements for all 18
States are consistent with what is permitted under the national
certification. Therefore, there is no variance in how Registered
Radiologist Assistants practice in any State. VA thus proposes to adopt
a standard of practice consistent with the standards from ASRT, as
followed by the ARRT, this profession's national certification body. VA
Registered Radiologist Assistants will continue to follow this
standard.
This national standard of practice does not address training
because it will not authorize VA Registered Radiologist Assistants to
perform any tasks or duties not already authorized under their national
certification and 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 Registered Radiologist
Assistants
Note: All references herein to VA and VHA documents incorporate
by reference subsequent VA and VHA documents on the same or similar
subject matter.
1. Registered Radiologist Assistants are Diagnostic Radiologic
Technologists with advanced education, training, and certification.
Under the supervision of a Radiologist, Registered Radiologist
Assistants are responsible for the safe use of ionizing radiation and
magnetic fields for diagnostic, therapeutic, and research purposes for
selected invasive and non-invasive clinical imaging procedures.
Registered Radiologist Assistants review patients' medical histories to
understand their illnesses, medical issues, and pending diagnostic or
treatment procedures; instruct patients before, during, and following
procedures; evaluate the satisfactory preparation of patients before
beginning procedures; perform patient assessment, management, and
medication administration; complete documentation within electronic
health records as necessary; and recognize and respond appropriately to
emergency situations. They make and communicate initial observations
only to the Radiologist.
2. Registered Radiologist Assistants 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 G54 dated May 21, 2019.
Note: Registered Radiologist Assistants are Diagnostic
Radiologic Technologists with advanced education, training, and
certification and, as such, they must maintain the American Registry
of Radiologic Technologists (ARRT), Radiographer (R) certification
as required for all VA Diagnostic Radiologic Technologists.
3. VA Registered Radiologist Assistants practice in accordance with
the Radiographer standards from the American Society of Radiologic
Technologists (ASRT), available at: <a href="https://www.asrt.org/">https://www.asrt.org/</a>. ARRT, the
national certifying body of Registered Radiologist Assistants, follows
the ASRT standards. VA reviewed certification requirements from ARRT
for this occupation in February 2024 and confirmed that all Registered
Radiologist Assistants in VA followed the Radiographer standards from
ASRT.
4. Although VA only requires certification, 18 states require a
state license in order to practice as a Registered Radiologist
Assistant in that
[[Page 56815]]
state: Arizona, Arkansas, Connecticut, Florida, Illinois, Iowa,
Massachusetts, Nevada, New Hampshire, Oklahoma, Oregon, Rhode Island,
Tennessee, Texas, Utah, Virginia, Washington, and West Virginia.
Of those, 14 states exempt Federal employees from its state license
requirements: Arizona, Florida, Illinois, Iowa, Massachusetts, Nevada,
New Hampshire, Oklahoma, Oregon, Texas, Utah, Virginia, Washington, and
West Virginia.
VA reviewed state laws, state practice acts, and certification
requirements for Registered Radiologist Assistants in February 2024 and
did not identify any conflicts that impact practice of this profession
in VA.
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,
certifications, or registrations 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 June 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 and
Management, Office of General Counsel, Department of Veterans Affairs.
[FR Doc. 2024-15109 Filed 7-9-24; 8:45 am]
BILLING CODE 8320-01-P
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