[Federal Register Volume 88, Number 94 (Tuesday, May 16, 2023)]
[Notices]
[Pages 31308-31310]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-10424]
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DEPARTMENT OF VETERANS AFFAIRS
Notice of Request for Information on the Department of Veterans
Affairs; Histopathology Technologists 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 Histopathology 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 17, 2023.
ADDRESSES: Comments must be submitted through www.regulations.gov.
Except as provided below, comments received before the close of the
comment period will be available at www.regulations.gov 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: http://www.regulations.gov. VA will not post on
Regulations.gov 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 is considered late and will not be considered in a
potential rulemaking.
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 the professional activities of 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.
[[Page 31309]]
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 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.
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 VA medical facility
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 necessary
education, training and skills to perform the tasks and duties detailed
in the national standard of practice and 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.
Need for National Standards of Practice
As the Nation's largest integrated health care system, it is
critical that VA develop national standards of practice to ensure
beneficiaries receive the same high-quality care regardless of where
they enter the system and to ensure 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 pandemic. With an
increased need for mobility in our workforce, including through VA's
Disaster Emergency Medical Personnel System, creating a uniform
standard of practice better supports VA health care professionals who
already frequently practice across state lines. In addition, the
development of national standards of practice aligns with VA's long-
term deployment of a new electronic health record (EHR). National
standards of practice are critical for optimal EHR implementation to
enable the specific roles for each health care profession in EHR to be
consistent across the Veterans Health Administration (VHA) and to
support increased interoperability between VA and the Department of
Defense (DoD). DoD has historically standardized practice for certain
health care professionals, and VHA closely partnered with DoD to learn
from their experience.
Process To Develop National Standards of Practice
Consistent with 38 CFR 17.419, VA is developing national standards
of practice via policy. There will be one overarching national standard
of practice directive that will generally describe VHA policy and have
each individual national standard of practice as an appendix to the
directive. The directive and all appendices will be accessible on the
VHA Publications website at: https://vaww.va.gov/vhapublications/
(internal) and https://www.va.gov/vhapublications/ (external) once
published.
To develop these national standards, VA is using a robust
interactive process that is consistent with the guidance outlined in
Executive Order (E.O.) 13132, Federalism, to preempt state law. 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 identified VA occupation, a workgroup comprised of
health care professionals conducts state variance 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 the agency. The workgroup
is comprised of VA employees who are health care professionals in the
identified occupation, and they may consult with internal stakeholders
at any point throughout the process. 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 a task or duty. The workgroup then drafts a proposed VA national
standard of practice using the data gathered during the state variance
research and incorporates internal stakeholder feedback to date.
The proposed national standard of practice is internally reviewed,
and which includes review by an interdisciplinary workgroup consisting
of representatives from Quality Management; Field Chief of Staff;
Academic Affiliates; Field Chief Nursing Officer; Ethics; Workforce
Management and Consulting; Surgery; Credentialing and Privileging;
Field Chief Medical Office; and EHR Modernization.
Externally, the proposed national standard of practice is provided
to our partners in DoD. In addition, VA labor partners are engaged
informally as part of a pre-decisional collaboration. Consistent with
E.O. 13132, a letter is sent to each state board and certifying
organization that includes the proposed national standard and an
opportunity to further discuss the national standard with VA. After the
states and certifying organization have received notification, the
proposed national standard of practice is published to the Federal
Register for 60 days to obtain feedback from the public, including
professional associations and unions. At the same time, the proposed
national standard is published on an internal VA site to obtain
feedback from VA employees. Feedback from state boards, professional
associations, unions, VA employees and any other person or organization
who informally 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 its mission and goals, and that are better for
Veterans or VA health care professionals. We will publish a collective
response to all comments at https://www.va.gov/standardsofpractice.
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 incorporated into an
individual health care professional's privileges, scope of practice or
functional statement following any training and education necessary for
the health care professional to perform those functions. Implementation
of the
[[Page 31310]]
national standard of practice may be phased in across all medical
facilities, with limited exemptions for health care professionals as
needed.
National Standard for Histopathology Technologists
The proposed format for national standards of practice when there
are state licenses and a national certification is as follows: The
first paragraph provides general information about the profession and
what the health care professionals can do. The second paragraph
references the education and certification needed to practice this
profession at VA. The third paragraph confirms that this profession
follows the standard set by the national certifying body. A final
statement explains that while VA only requires a national
certification, some states also require licensure for this profession.
The standard includes information on which states offer an exemption
for Federal employees and where VA will preempt state laws, if
applicable.
We note that the proposed standards of practice do not contain an
exhaustive list of every task and duty that each VA health care
professional can perform. Rather, it is designed to highlight whether
there are any areas of variance in how this profession can practice
across states and how this profession will be able to practice within
VA notwithstanding their state license, certification, registration and
other requirements.
Histopathology technologists, also referred to as
histotechnologists, are highly skilled medical laboratory professionals
who are responsible for the preanalytical processing of human tissue
and body fluid specimens. VA qualification standards require
histopathology technologists to have an active, current, full and
unrestricted histotechnologist (HTL) certification from the American
Society for Clinical Pathology. VA reviewed whether there are any
alternative registrations, certifications or state requirements that
could be required for histopathology technologists and found that eight
states require a license to practice as a histopathology technologist
in that state. Of those, six states exempt Federal employees from their
state license requirements. The standards set forth in the licensure
requirements for all eight states are consistent with what is permitted
under the national certification. Therefore, there is no variance in
how histopathology technologists practice in any State.
VA proposes to adopt a standard of practice consistent with the
national certification. Therefore, VA histopathology technologists will
continue to follow the same standard as set by their national
certification. The standard for the certification can be found here:
https://www.ascp.org/content/docs/default-source/policy-statements/ascp-pdft-pp-personnel-standards.pdf?sfvrsn=2.
Because the practice of Histopathology Technologists is not
changing, there will be no impact on the practice of this occupation
when this national standard of practice is implemented.
Proposed National Standard of Practice for Histopathology Technologist
Histopathology technologists are highly skilled medical laboratory
professionals who are responsible for the preanalytical processing of
human tissue and body fluid specimens. Through the utilization of a
broad range of specialized techniques and procedures, both manual and
automated, histopathology technologists preserve and prepare specimens
for pathologist review, interpretation, evaluation and diagnosis of
patient conditions or disease.
Histopathology technologists in VA possess the education and
certification required by VA qualification standards, as more
specifically described in VA Handbook 5005, Staffing, dated February 4,
2022.
This national standard of practice confirms that histopathology
technologists practice according to the HTL certification standards
from the American Society for Clinical Pathology (ASCP), available at:
www.ascp.org. As of March 2022, all histopathology technologists in VA
follow this national certification.
Although VA only requires a certification, the following eight
States require a State license in order to practice as a
histopathologist in that State: Florida, Louisiana, Montana, Nevada,
New York, Puerto Rico, Tennessee, and West Virginia. Of these, the
following States exempt Federal employees from their State license
requirements: Florida, Louisiana, Montana, New York, Tennessee and West
Virginia. As of October 2022, there is no variance in how VA
Histopathology Technologists practice in any State.
Request for Information
1. Are there any required trainings for the aforementioned
practices that we should consider?
2. Are there any factors that would inhibit or delay the
implementation of the aforementioned practices for VA health care
professionals in any States?
3. Is there any variance in practice that we have not listed?
4. What should we consider when preempting conflicting State laws,
regulations, or requirements regarding supervision of individuals
working toward obtaining their license or unlicensed personnel?
5. Is there anything else you would like to share with us about
this national standard of practice?
Signing Authority
Denis McDonough, Secretary of Veterans Affairs, approved this
document on April 28, 2023, 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. 2023-10424 Filed 5-15-23; 8:45 am]
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