Notice of Request for Information on the Department of Veterans Affairs; Marriage and Family Therapist Standard of Practice, 32527-32529 [2024-09033]
Download as PDF
Federal Register / Vol. 89, No. 82 / Friday, April 26, 2024 / Notices
Estimated Number of Respondents:
2700.
Estimated Number of Responses per
Respondent: 1.
Estimated Time per Response: 6 hours
30 minutes.
Estimated Total Annual Burden
Hours: 2,700.
2. Title: Revenue Procedure 2024–4
(and successor guidance).
OMB Number: 1545–1520.
Revenue Procedure Number: 2024–4.
Abstract: Internal Revenue Code (IRC)
§ 601.201(a)(1)) provides that it is the
practice of the Internal Revenue Service
(IRS) to answer inquiries of individuals
and organizations, whenever
appropriate in the interest of sound tax
administration, as to their status for tax
purposes and as to the tax effects of
their acts or transactions. Under this
revenue procedure 2024–4 (and
successor guidance), taxpayers can
request determination letters and letter
rulings from the Commissioner, Tax
Exempt and Government Entities,
Employee Plans Office (‘‘Employee
Plans’’) on how the tax laws apply to
them. Employee Plans requires
information from taxpayers in order to
process these requests.
Current Actions: There is no change to
the burden previously approved.
Type of Review: Reinstatement
without change of a previously
approved collection.
Affected Public: Individuals or
households, business or other for-profit
organizations, not-for-profit institutions,
farms, and state, local or tribal
governments.
Estimated Number of Respondents:
12,733.
Estimated Number of Responses per
Respondent: 1.
Estimated Time per Response: 6 hrs.
for the Letter Ruling and 3 hrs. for the
Determination Letter.
Estimated Total Annual Burden
Hours: 38,836.
Authority: 44 U.S.C. 3501 et seq.
Melody Braswell,
Treasury PRA Clearance Officer.
[FR Doc. 2024–08980 Filed 4–25–24; 8:45 am]
ddrumheller on DSK120RN23PROD with NOTICES1
BILLING CODE 4830–01–P
DEPARTMENT OF VETERANS
AFFAIRS
Notice of Request for Information on
the Department of Veterans Affairs;
Marriage and Family Therapist
Standard of Practice
Department of Veterans Affairs.
Request for information.
AGENCY:
ACTION:
VerDate Sep<11>2014
20:31 Apr 25, 2024
Jkt 262001
The Department of Veterans
Affairs (VA) is requesting information to
assist in developing a national standard
of practice for VA Marriage and Family
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 June 25, 2024.
ADDRESSES: Comments must be
submitted through https://
www.regulations.gov Except as provided
below, comments received before the
close of the comment period will be
available at https://
www.regulations.gov/ 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: https://
www.regulations.gov/. VA will not post
on https://www.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 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:
SUMMARY:
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
PO 00000
Frm 00137
Fmt 4703
Sfmt 4703
32527
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
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,
E:\FR\FM\26APN1.SGM
26APN1
32528
Federal Register / Vol. 89, No. 82 / Friday, April 26, 2024 / Notices
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.
ddrumheller on DSK120RN23PROD with NOTICES1
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 https://
vaww.va.gov/vhapublications/ (internal)
and https://www.va.gov/
vhapublications/ (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
VerDate Sep<11>2014
20:31 Apr 25, 2024
Jkt 262001
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 Marriage and
Family Therapists was held on
September 21, 2023. At the listening
session, there was one presenter who
represented the American Association
of Marriage and Family Therapy. The
presenter supported the Marriage and
Family Therapy national standard of
practice and urged VA to allow all
providers to practice to the full extent
of their license and education. The
presenter stated that maximizing
utilization of provider skills would
make access to care more efficient and
would lower costs. VA appreciates the
thoughtful presentation and considers
the information presented at the
listening session when drafting the
PO 00000
Frm 00138
Fmt 4703
Sfmt 4703
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 evidencebased practice and alternatives that help
VA meet our mission and goals. VA 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 properly incorporated
into individual 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 Marriage and Family
Therapist
The format for the proposed national
standards of practice when there are
E:\FR\FM\26APN1.SGM
26APN1
ddrumheller on DSK120RN23PROD with NOTICES1
Federal Register / Vol. 89, No. 82 / Friday, April 26, 2024 / Notices
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, Marriage and
Family Therapists are licensed
professionals who provide
psychotherapy to couples, families,
individuals, and groups. 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 State license, or other
requirement, 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 VA
qualification standards even if the
requirements conflict with or differ from
a State requirement. National standards
of practice do not affect those
requirements. For Marriage and Family
Therapists, VA qualification standards
require an active, current, full, and
unrestricted State license.
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. Marriage
and Family Therapists have
grandfathering provisions included
within its qualification standards, and
VA proposes to have those individuals
be authorized to follow the Marriage
and Family 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 same standard as any
other VA Marriage and Family Therapist
who meets the current qualification
standards.
The third paragraph describes what
tasks and duties the profession will be
able to perform within the scope of their
VA employment. It includes whether
the profession can practice all duties
covered by their State license. For
VerDate Sep<11>2014
20:31 Apr 25, 2024
Jkt 262001
Marriage and Family Therapists, VA
reviewed State license requirements and
found no variance in how VA Marriage
and Family Therapists practice in any
State.
This national standard of practice
does not address training because it will
not authorize VA Marriage and Family
Therapists to perform any tasks or
duties not already authorized under
their 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 Marriage and Family Therapist
1. Marriage and Family Therapists
provide psychotherapy to couples,
families, individuals, and groups. These
professionals are licensed to diagnose
and treat mental health disorders such
as depression, post-traumatic stress
disorder, anxiety, and other mental
health disorders. Marriage and Family
Therapists have specialized training in
family systems theory and are well
qualified to treat relationships issues,
including marriage or couples
counseling, and child-parent challenges.
2. Marriage and Family Therapists in
the Department of Veterans Affairs (VA)
possess the education and license
required by VA qualification standards.
See VA Handbook 5005, Staffing, Part II,
Appendix G44, dated April 18, 2018.
3. VA Marriage and Family Therapists
can practice all duties covered by their
license. VA reviewed license
requirements for this occupation in
February 2024 and confirmed there is
no variance in how VA Marriage and
Family Therapists practice in any State.
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,
certification, or registration 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 April 5, 2024, and
authorized the undersigned to sign and
submit the document to the Office of the
Federal Register for publication
PO 00000
Frm 00139
Fmt 4703
Sfmt 4703
32529
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. 2024–09033 Filed 4–25–24; 8:45 am]
BILLING CODE 8320–01–P
DEPARTMENT OF VETERANS
AFFAIRS
[OMB Control No. 2900–0209]
Agency Information Collection Activity
Under OMB Review: Application for
Work Study Allowance, Student Work
Study Agreement-Advance Payment,
Extended Student Work Study
Agreement, Student Work Study
Agreement
Veterans Benefits
Administration, Department of Veterans
Affairs.
ACTION: Notice.
AGENCY:
In compliance with the
Paperwork Reduction Act (PRA) of
1995, this notice announces that the
Veterans Benefits Administration
(VBA), Department of Veterans Affairs,
will submit the collection of
information abstracted below to the
Office of Management and Budget
(OMB) for review and comment. The
PRA submission describes the nature of
the information collection and its
expected cost and burden, and it
includes the actual data collection
instrument.
DATES: Written comments and
recommendations for the proposed
information collection should be sent
within 30 days of publication of this
notice by clicking on the following link
www.reginfo.gov/public/do/PRAMain,
select ‘‘Currently under Review—Open
for Public Comments’’, then search the
list for the information collection by
Title or ‘‘OMB Control No. 2900–0209.’’
FOR FURTHER INFORMATION CONTACT:
Maribel Aponte, Office of Enterprise
and Integration, Data Governance
Analytics (008), 810 Vermont Ave. NW,
Washington, DC 20420, (202) 266–4688
or email Maribel.aponte@va.gov. Please
refer to ‘‘OMB Control No. 2900–0209’’
in any correspondence.
SUPPLEMENTARY INFORMATION:
Authority: 38 U.S.C. 3485; 38 CFR
21.4145.
Title: Application for Work Study
Allowance [VA Form 22–8691]; Student
Work Study Agreement-Advance
Payment [VA Form 22–8692]; Extended
Student Work Study Agreement [VA
SUMMARY:
E:\FR\FM\26APN1.SGM
26APN1
Agencies
[Federal Register Volume 89, Number 82 (Friday, April 26, 2024)]
[Notices]
[Pages 32527-32529]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-09033]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF VETERANS AFFAIRS
Notice of Request for Information on the Department of Veterans
Affairs; Marriage and Family Therapist Standard of Practice
AGENCY: Department of Veterans Affairs.
ACTION: Request for information.
-----------------------------------------------------------------------
SUMMARY: The Department of Veterans Affairs (VA) is requesting
information to assist in developing a national standard of practice for
VA Marriage and Family 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 June 25, 2024.
ADDRESSES: Comments must be submitted through https://www.regulations.gov Except as provided below, comments received before
the close of the comment period will be available at https://www.regulations.gov/ 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: https://www.regulations.gov/.
VA will not post on https://www.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 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 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 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,
[[Page 32528]]
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 https://vaww.va.gov/vhapublications/ (internal) and https://www.va.gov/vhapublications/ (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 Marriage and Family Therapists
was held on September 21, 2023. At the listening session, there was one
presenter who represented the American Association of Marriage and
Family Therapy. The presenter supported the Marriage and Family Therapy
national standard of practice and urged VA to allow all providers to
practice to the full extent of their license and education. The
presenter stated that maximizing utilization of provider skills would
make access to care more efficient and would lower costs. VA
appreciates the thoughtful presentation 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 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 properly incorporated into
individual 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 Marriage and Family
Therapist
The format for the proposed national standards of practice when
there are
[[Page 32529]]
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, Marriage and Family Therapists are
licensed professionals who provide psychotherapy to couples, families,
individuals, and groups. 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 State license, or
other requirement, 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 VA qualification standards
even if the requirements conflict with or differ from a State
requirement. National standards of practice do not affect those
requirements. For Marriage and Family Therapists, VA qualification
standards require an active, current, full, and unrestricted State
license.
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. Marriage and Family
Therapists have grandfathering provisions included within its
qualification standards, and VA proposes to have those individuals be
authorized to follow the Marriage and Family 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 same standard as any other VA
Marriage and Family Therapist who meets the current qualification
standards.
The third paragraph describes what tasks and duties the profession
will be able to perform within the scope of their VA employment. It
includes whether the profession can practice all duties covered by
their State license. For Marriage and Family Therapists, VA reviewed
State license requirements and found no variance in how VA Marriage and
Family Therapists practice in any State.
This national standard of practice does not address training
because it will not authorize VA Marriage and Family Therapists to
perform any tasks or duties not already authorized under their 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 Marriage and Family
Therapist
1. Marriage and Family Therapists provide psychotherapy to couples,
families, individuals, and groups. These professionals are licensed to
diagnose and treat mental health disorders such as depression, post-
traumatic stress disorder, anxiety, and other mental health disorders.
Marriage and Family Therapists have specialized training in family
systems theory and are well qualified to treat relationships issues,
including marriage or couples counseling, and child-parent challenges.
2. Marriage and Family Therapists in the Department of Veterans
Affairs (VA) possess the education and license required by VA
qualification standards. See VA Handbook 5005, Staffing, Part II,
Appendix G44, dated April 18, 2018.
3. VA Marriage and Family Therapists can practice all duties
covered by their license. VA reviewed license requirements for this
occupation in February 2024 and confirmed there is no variance in how
VA Marriage and Family Therapists practice in any State.
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,
certification, or registration 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 April 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 &
Management, Office of General Counsel, Department of Veterans Affairs.
[FR Doc. 2024-09033 Filed 4-25-24; 8:45 am]
BILLING CODE 8320-01-P