Notice2024-25894
Notice of Request for Information on the Department of Veterans Affairs Dental Hygienist 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
November 7, 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 Dental Hygienists. 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 216 (Thursday, November 7, 2024)</title>
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[Federal Register Volume 89, Number 216 (Thursday, November 7, 2024)]
[Notices]
[Pages 88349-88351]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2024-25894]
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DEPARTMENT OF VETERANS AFFAIRS
Notice of Request for Information on the Department of Veterans
Affairs Dental Hygienist 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 Dental Hygienists. 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 January 6, 2025.
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, or 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 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,
[[Page 88350]]
registration, certification, or other requirement, and 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 through policy.
Preemption of State Requirements
The national standard of practice will preempt any State laws,
rules, regulations, or other requirements that are both listed and
unlisted in the national standard as conflicting, but that do conflict
with the tasks and duties as authorized in VA's national standard of
practice. The term State, as applied here, means each of the several
States, territories, and possessions of the United States and is
consistent with the definition in 38 U.S.C. 101(20). If 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, develop 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 through policy. The overarching directive to describe
Veterans Health Administration (VHA) policy on national standards of
practice is VHA Directive 1900(3), 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 is 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, Federalism, 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 dental hygienists was held on September 7, 2023.
No comments were provided on the dental hygienists 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 the following offices: 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
[[Page 88351]]
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 that provides comments through the Federal Register--will
be reviewed. VA will make appropriate revisions in light of the
comments, including those that present evidence-based practices 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. The 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 Dental Hygienist
The format for the proposed national standards of practice when
there are State licenses is as follows. The first paragraph provides
general information about the profession and what the VA health care
professionals can do. For this national standard, Dental Hygienists
perform oral prophylaxis and other therapeutic or preventive procedures
for periodontal disease, caries control, or other dental problems. 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, or other
requirement, needed to practice this profession at VA. Qualification
Standards for employment of health care professionals by VA are
available at: <a href="https://www.va.gov/OHRM/QualificationStandards/">https://www.va.gov/OHRM/QualificationStandards/</a>. VA
follows the requirements outlined in its qualification standards even
if the requirements conflict with or differ from a State requirement.
The national standards of practice do not affect those requirements.
For dental hygienists, VA requires an active, current, full, and
unrestricted State license, and that the dental hygienists meet
credentialing standards in 42 CFR part 75, Standards for the
Accreditation of Educational Programs for the Credentialing of
Radiologic Personnel. The dental hygienists VA qualification standards
are available at: <a href="https://www.va.gov/OHRM/QualificationStandards/HT38/0682-DentalHygienist.pdf">https://www.va.gov/OHRM/QualificationStandards/HT38/0682-DentalHygienist.pdf</a>.
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 the requirements prior to
revisions of 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. VA dental hygienists have
grandfathering provisions included within their qualification
standards, and VA proposes to have those individuals authorized to
follow the dental hygienists 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 would any other VA dental hygienist 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
professional can practice all duties covered by their license. For
dental hygienists, VA proposes that VA dental hygienists can practice
all duties covered by their license and the credentialing standards. VA
reviewed State laws and practice acts for dental hygienists in March
2024 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 dental hygienists to perform any tasks
or duties not already authorized under their State license 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 Dental Hygienists
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. Dental hygienists perform oral prophylaxis and other therapeutic
or preventive procedures for periodontal disease, caries control, or
other dental problems.
2. Dental Hygienists in the Department of Veterans Affairs (VA)
possess the education, license, and certification required by VA
qualification standards, available at: https://www.va.gov/OHRM/
QualificationStandards/HT38/0682-dentalhygienist.pdf.
3. VA Dental Hygienists can practice all duties covered by their
license, and practice in accordance with the credentialing standards in
42 CFR part 75, Standards for the Accreditation of Educational Programs
for the Credentialing of Radiologic Personnel, available at: <a href="https://www.ecfr.gov/">https://www.ecfr.gov/</a>. VA reviewed State laws and practice acts for Dental
Hygienists in March 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 your State permits and prohibits
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 October 22, 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 (00REG), Office of General Counsel, Department of Veterans
Affairs.
[FR Doc. 2024-25894 Filed 11-6-24; 8:45 am]
BILLING CODE 8320-01-P
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</html>Indexed from Federal Register on November 7, 2024.
This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.