Notice2024-16944
Notice of Request for Information on the Department of Veterans Affairs Massage 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
August 1, 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 Massage 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 148 (Thursday, August 1, 2024)</title>
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[Federal Register Volume 89, Number 148 (Thursday, August 1, 2024)]
[Notices]
[Pages 62868-62870]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2024-16944]
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DEPARTMENT OF VETERANS AFFAIRS
Notice of Request for Information on the Department of Veterans
Affairs Massage 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 Massage 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 30, 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, or
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
considered.
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 requirements that unduly interfere with their
practice. 38 CFR 17.419; 85 FR 71838. Specifically, this rulemaking
confirmed VA's current practice of permitting 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 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 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 perform
the same type of tasks and duties regardless of the state where they
are located or the state license, registration, certification, or other
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 62869]]
Preemption of State Requirements
The national standard of practice will preempt any state laws,
rules, regulations, or other 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 permits 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 requirement permits a practice
that is not included in a national standard of practice, the individual
may continue that practice so long as it is permissible under Federal
law and VA policy, is not explicitly restricted 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, VHA Directive 1900(5), VA National Standards of Practice,
August 30, 2023. The directive is accessible on VHA's publications
website at <a href="https://www.va.gov/vhapublications/">https://www.va.gov/vhapublications/</a>. As each individual
national standard of practice is finalized, it is published as an
appendix to the directive and accessible at the same website.
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. For each health care 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 and any internal stakeholder feedback received. The
workgroup may consult with internal or external stakeholders at any
point throughout the process.
The process to develop VA national standards of practice includes
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 Massage Therapists was held on August 31, 2023.
No professional associations presented comments on the Massage
Therapist standard of practice.
After the proposed standard is developed, it is first internally
reviewed. This includes a review from 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.
After the internal review, 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>.
The national standard of practice is then finalized, approved, and
published in VHA policy. Any tasks or duties included in the national
standard will be properly incorporated into individual VA 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 Massage Therapist
The format for the proposed national standards of practice when
there are state licenses, registrations, or certifications is as
follows. The first paragraph provides general information
[[Page 62870]]
about the profession and what the VA health care professionals can do.
For this national standard, Massage Therapists skillfully assess and
manipulate the soft tissues of the human body for therapeutic purposes.
Massage Therapists assess patients, develop evidence-based,
individualized massage therapy treatment plans, and participate as
members of interdisciplinary health care teams. 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 practice within VA.
The second paragraph references the education and license,
registration, or 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 July 8, 2024.
VA follows the requirements outlined in its qualification standards
even if the requirements conflict with or differ from a state
requirement. National standards of practice do not affect those
requirements. For Massage Therapists, VA qualification standards
require an active, current, full, and unrestricted state license,
registration, or certification.
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. Massage Therapists have
grandfathering provisions included within their qualification
standards, and VA proposes to have those individuals authorized to
follow the Massage 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 national standard as any other VA Massage Therapist who meets the
current qualification standards.
The third paragraph establishes what the national standard of
practice will be for the occupation in VA. It includes whether the
profession can practice all duties covered by their license,
certification, or registration. For Massage Therapists, they can
perform all tasks and duties authorized under their applicable license,
registration, or certification. VA reviewed the state laws and practice
acts for Massage Therapists on November 2023 and did not identify any
conflicts that impact practice of this profession in VA.
This national standard of practice does not address training
because it will not authorize VA Massage Therapists to perform any
tasks or duties not already authorized under their state license,
registration, or certification.
Following public and VA employee comments and revisions, each
national standard of practice that is published in 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 Massage Therapist
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. Massage Therapists skillfully assess and manipulate the soft
tissues of the human body for therapeutic purposes. Massage Therapists
assess patients, develop evidence-based, individualized massage therapy
treatment plans, and participate as members of interdisciplinary health
care teams. They use their hands, arms, knees, and feet to perform soft
tissue manipulation. Massage Therapists incorporate active and passive
range of motion exercise. They also utilize devices and tools to mimic
or enhance manual therapy; incorporate adjunctive modalities; educate
patients in health promotion, disease prevention and holistic self-care
methods; and facilitate mind-body awareness to achieve healing.
2. Massage Therapists in the Department of Veterans Affairs (VA)
possess the education and license, registration, or certification
required by VA qualification standards. See VA Handbook 5005, Staffing,
Part II, Appendix G56, dated March 12, 2019.
3. VA Massage Therapists can practice all duties covered by their
license, local registration, or local certification; or practice in
accordance with the National Certification Board for Therapeutic
Massage and Bodywork certification, available at: <a href="https://ncbtmb.org/">https://ncbtmb.org/</a>.
VA reviewed the state laws and practice acts for Massage Therapists on
November 2023 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 permit and restrict accurate?
2. Are there any areas of variance between state licenses,
certification, registration, or other requirement 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 July 17, 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. 2024-16944 Filed 7-31-24; 8:45 am]
BILLING CODE 8320-01-P
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</html>Indexed from Federal Register on August 1, 2024.
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