Notice of Request for Information on the Department of Veterans Affairs Rehabilitation Counselor Standard of Practice, 106762-106765 [2024-31205]
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106762
Federal Register / Vol. 89, No. 249 / Monday, December 30, 2024 / Notices
Commission should consider beyond
those listed in the existing Background
Commentary to § 1B1.10? Are there
identifiable sources that the
Commission should consult that
highlight retroactivity criteria relied
upon by other legislative or rulemaking
bodies?
If the Commission continues to list
criteria relevant to determining whether
an amendment should apply
retroactively, should it adopt any brightline rules? Is there a different approach
that the Commission should consider
for these purposes?
2. The Commission seeks comment on
whether any listed criteria are more
appropriately addressed in the
Commission’s Rules of Practice and
Procedure rather than the Background
Commentary to § 1B1.10.
3. Rule 4.1A (Retroactive Application
of Amendments) of the Commission’s
Rules of Practice and Procedure
provides ‘‘[g]enerally, promulgated
amendments will be given prospective
application only.’’ The Commission
seeks comment on whether it should
retain this provision. If so, how should
the Commission ensure that any listed
criteria reflect this provision?
Authority: 28 U.S.C. 994(a), (o), (p),
(x); USSC Rules of Practice and
Procedure 2.2, 4.3, 4.4.
Carlton W. Reeves,
Chair.
[FR Doc. 2024–31278 Filed 12–27–24; 8:45 am]
BILLING CODE 2210–40–P
DEPARTMENT OF VETERANS
AFFAIRS
Enhanced-Use Lease of Department of
Veterans Affairs Real Property for the
Development of Permanent Supportive
Housing at the Charlie Norwood
Uptown Veterans Affairs Medical
Center, Augusta, Georgia Campus
Department of Veterans Affairs.
Notice of intent to enter into an
enhanced-use lease.
AGENCY:
ACTION:
Pursuant
to 38 U.S.C. 8161, et seq. as amended by
Public Law 117–168, the Secretary of
Veterans Affairs is authorized to enter
into an EUL, for a term of up to 99 years,
that (a) provides supportive housing for
Veterans and their families, or (b)
enhances the use of the leased property
by directly or indirectly benefitting
Veterans. In addition, the EUL must not
be inconsistent with and not adversely
affect VA’s mission or the operation of
VA’s facilities, programs, and services
in the area of the leased property.
Consistent with this authority, the
Secretary intends to enter into an EUL
for the purpose of outleasing Buildings
19 and 20 on approximately 2.46 acres
of underutilized land on the campus of
the Charlie Norwood Uptown VA
Medical Center, to develop
approximately 77 units of permanent
supportive housing for Veterans and
their families. The competitively
selected EUL lessee/developer,
Freedom’s Path Augusta III, LP will
finance, design, develop, renovate,
construct, manage, maintain, and
operate housing for eligible homeless
Veterans or Veterans at risk of
homelessness on a priority placement
basis. In addition, the lessee/developer
will be required to provide supportive
services that guide Veteran residents
towards long-term independence and
self-sufficiency.
SUPPLEMENTARY INFORMATION:
Signing Authority
Denis McDonough, Secretary of
Veterans Affairs, approved and signed
this document on December 19, 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. 2024–30961 Filed 12–27–24; 8:45 am]
BILLING CODE 8320–01–P
The purpose of this Federal
Register notice is to provide the public
with notice that the Secretary of
Veterans Affairs (VA) intends to enter
into an Enhanced-Use Lease (EUL) of
Buildings 19 and 20 on approximately
2.46 acres of underutilized land on the
campus of the Charlie Norwood Uptown
VA Medical Center.
FOR FURTHER INFORMATION CONTACT: C.
Brett Simms, Executive Director, Office
of Asset Enterprise Management, Office
of Management, 810 Vermont Avenue
NW, Washington, DC 20420, (202) 502–
0262. This is not a toll-free number.
ddrumheller on DSK120RN23PROD with NOTICES1
SUMMARY:
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DEPARTMENT OF VETERANS
AFFAIRS
Notice of Request for Information on
the Department of Veterans Affairs
Rehabilitation Counselor Standard of
Practice
Department of Veterans Affairs.
Request for Information.
AGENCY:
ACTION:
The Department of Veterans
Affairs is requesting information to
assist in developing a national standard
SUMMARY:
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of practice for VA Rehabilitation
Counselors. 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 February 28, 2025.
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, 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: 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 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
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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.
ddrumheller on DSK120RN23PROD with NOTICES1
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. The term state as applied here
means each of the several states,
territories, possessions of the United
States, and the district of Columbia, and
the Commonwealth of Puerto Rico and
is consistent with the definition in 38
U.S.C. 101(20). 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
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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 https://
www.va.gov/vhapublications/. As each
individual national standard of practice
is finalized, it is published as an
appendix to the directive and accessible
at the same website.
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106763
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 Rehabilitation
Counselors was held on September 21,
2023. No one provided comments on
Rehabilitation Counselors 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
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ddrumheller on DSK120RN23PROD with NOTICES1
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/.
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 Rehabilitation Counselors
The format for the proposed national
standards of practice when there is a
national certification body is as follows.
The first paragraph provides general
information about the profession and
what the health care professionals can
do. For this national standard,
Rehabilitation Counselors help patients
with disabilities to achieve their
personal career, independent living,
social, and psychological goals. 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.
The second paragraph references the
education and certification needed to
practice this profession at VA.
Qualification standards for employment
of health care professionals by VA are
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available at: https://www.va.gov/OHRM/
QualificationStandards/. 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 Rehabilitation
Counselors, VA qualification standards
require an active, current, full, and
unrestricted certification from the
Commission on Rehabilitation
Counselor Certification (CRCC). For
Rehabilitation Counselors, VA
qualification standards require an
active, current, full, and unrestricted
certification from the certification body:
complete qualifications standards
details for Rehabilitation Counselors are
found: https://www.va.gov/OHRM/
QualificationStandards/HT38/0101RehabilitationCounselor.pdf.
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. VA
Rehabilitation Counselors have
grandfathering provisions included
within their qualification standards, and
VA proposes to have those individuals
not be authorized to follow the
Rehabilitation Counselor national
standard of practice. Instead, VA
proposes its medical facilities will
determine the tasks and duties for
Rehabilitation Counselors who are
grandfathered under the qualification
standards. Such determinations are
determined at the VA medical facility
based on the Rehabilitation Counselor’s
education, training, and credentialing.
The third paragraph establishes what
the national standard of practice will be
for the occupation in VA. For this
national standard, VA Rehabilitation
Counselors follow the standard set by
the CRCC, found at: https://
crccertification.com, with the exception
of, the listed task or duty VA proposes
to restrict even though the certification
otherwise permits the profession to
perform those tasks or duties.
The final paragraph provides
justification for VA’s proposal to restrict
the specified tasks and duties. It
explains why VA is restricting those
tasks or duties and the clinical basis for
this proposed decision.
This national standard of practice
does not address training because it will
not authorize VA Rehabilitation
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Counselors to perform any tasks and
duties not already authorized under
their national 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 Rehabilitation Counselors
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. Rehabilitation Counselors are
professional counselors educated and
trained at the graduate level who
possess the specialized knowledge,
skills, and attitudes to work
collaboratively with patients with
disabilities. Through a professional
counseling process, Rehabilitation
Counselors help patients with
disabilities to achieve their personal
career, independent living, social, and
psychological goals.
2. Rehabilitation Counselors in the
Department of Veterans Affairs (VA)
possess the education and certification
required by VA qualification standards,
available at: https://www.va.gov/OHRM/
QualificationStandards/HT38/0101RehabilitationCounselor.pdf.
Note: This national standard of practice
does not apply to Rehabilitation Counselors
who were grandfathered into the position on
July 21, 2020, the effective date for the VA
qualification standards for Rehabilitation
Counselors. Tasks and responsibilities for
Rehabilitation Counselors who are
grandfathered under the qualification
standards are determined at the VA medical
facility based on their education, training,
and credentialing.
3. VA Rehabilitation Counselors
practice in accordance with the
Certified Rehabilitation Counselor scope
of practice from the Commission on
Rehabilitation Counselor Certification
(CRCC), available at: https://
crccertification.com/, except as noted in
paragraph 3.a. VA reviewed certification
requirements for this occupation in
October 2024 and confirmed that all
Rehabilitation Counselors in VA
followed this national certification.
a. VA Rehabilitation Counselors,
practicing within scope of their VA
employment and consistent with this
standard, cannot diagnose mental health
disorders (F Codes in the International
Classification of Diseases 11th Revision)
unless they have a license in a mental
health discipline, in addition to their
CRCC certification and qualify as
licensed providers through the Medical
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Staff Bylaws of their VA medical
facility.
Note: VA Rehabilitation Counselors meet
CRCC certification eligibility criteria of a
master’s degree in rehabilitation counseling
or a qualifying related mental health field
with additional graduate-level core
rehabilitation coursework and supervised
experience. All Rehabilitation Counselors
with CRCC certification can diagnose ‘‘Other
Conditions That May Be a Focus of Clinical
Attention’’ as outlined in the Diagnostic and
Statistical Manual of Mental Disorders Fifth
Edition (Z codes in the International
Classification of Diseases 11th Revision).
4. Justification
a. VA Rehabilitation Counselors who
only maintain a CRCC certification are
restricted from diagnosing mental health
disorders because VA has licensed
mental health personnel with the
specific education, training, and
expertise that VA would rely on to
diagnose. VA Rehabilitation Counselors
who possess a CRCC certification, hold
a state license in a mental health field
(e.g., Licensed Professional Counselor,
Licensed Clinical Professional
Counselor, Licensed Clinical Social
Worker, Licensed Independent Social
Worker, Licensed Psychologist), and
qualify as a licensed provider based on
the medical facility bylaws will be
permitted to diagnose mental health
disorders because their education,
training, and expertise provides the
necessary competency to diagnose.
Request for Information
1. Is VA’s assessment of what the state
and CRCC certification permits, and
prohibits, accurately represented?
2. Are there any other areas of
variance of any state license,
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?
ddrumheller on DSK120RN23PROD with NOTICES1
Signing Authority
Denis McDonough, Secretary of
Veterans Affairs, approved and signed
this document on December 6, 2024,
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Jkt 265001
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. 2024–31205 Filed 12–27–24; 8:45 am]
BILLING CODE 8320–01–P
DEPARTMENT OF VETERANS
AFFAIRS
[OMB Control No. 2900–0020]
Agency Information Collection Activity
Under OMB Review: Designation of
Beneficiary—Government Life
Insurance and Supplemental
Designation of Beneficiary—
Government Life Insurance
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,
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: Comments and
recommendations for the proposed
information collection should be sent by
January 29, 2025.
ADDRESSES: To submit comments and
recommendations for the proposed
information collection, please type the
following link into your browser:
www.reginfo.gov/public/do/PRAMain,
select ‘‘Currently under Review—Open
for Public Comments’’, then search the
SUMMARY:
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106765
list for the information collection by
Title or ‘‘OMB Control No. 2900–0020.’’
FOR FURTHER INFORMATION CONTACT: VA
PRA information: Maribel Aponte, (202)
461–8900, vacopaperworkreduact@
va.gov.
SUPPLEMENTARY INFORMATION:
Title: Designation of Beneficiary—
Government Life Insurance and
Supplemental Designation of
Beneficiary—Government Life
Insurance (VA Forms 29–336 and 29–
336a).
OMB Control Number: 2900–0020
https://www.reginfo.gov/public/do/
PRASearch.
Type of Review: Revision of a
currently approved collection.
Abstract: These forms are used by the
insured to designate beneficiaries and
select an optional settlement to be used
when the insurance matures by death.
The information is required to
determine the claimant’s eligibility to
receive the proceeds. The information
on the form is required by law, 38
U.S.C. 1917, 1949 and 1952.
An agency may not conduct or
sponsor, and a person is not required to
respond to a collection of information
unless it displays a currently valid OMB
control number. The Federal Register
Notice with a 60-day comment period
soliciting comments on this collection
of information was published at 89 FR
85009, October 24, 2024.
Affected Public: Individuals or
Households.
Estimated Annual Burden: 13,917
hours.
Estimated Average Burden per
Respondent: 10 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents:
83,500.
Authority: 44 U.S.C. 3501 et seq.
Dorothy Glasgow,
VA PRA Clearance Officer, (Alt).
Office of Enterprise and Integration, Data
Governance Analytics, Department of
Veterans Affairs.
[FR Doc. 2024–31327 Filed 12–27–24; 8:45 am]
BILLING CODE 8320–01–P
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Agencies
[Federal Register Volume 89, Number 249 (Monday, December 30, 2024)]
[Notices]
[Pages 106762-106765]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-31205]
-----------------------------------------------------------------------
DEPARTMENT OF VETERANS AFFAIRS
Notice of Request for Information on the Department of Veterans
Affairs Rehabilitation Counselor Standard of Practice
AGENCY: Department of Veterans Affairs.
ACTION: Request for Information.
-----------------------------------------------------------------------
SUMMARY: The Department of Veterans Affairs is requesting information
to assist in developing a national standard of practice for VA
Rehabilitation Counselors. 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 February 28, 2025.
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, 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: 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 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
[[Page 106763]]
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.
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. The term state as applied here means each of the several
states, territories, possessions of the United States, and the district
of Columbia, and the Commonwealth of Puerto Rico and is consistent with
the definition in 38 U.S.C. 101(20). 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 https://www.va.gov/vhapublications/. 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 Rehabilitation Counselors was held on September
21, 2023. No one provided comments on Rehabilitation Counselors
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
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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/.
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 Rehabilitation Counselors
The format for the proposed national standards of practice when
there is a national certification body is as follows. The first
paragraph provides general information about the profession and what
the health care professionals can do. For this national standard,
Rehabilitation Counselors help patients with disabilities to achieve
their personal career, independent living, social, and psychological
goals. 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.
The second paragraph references the education and certification
needed to practice this profession at VA. Qualification standards for
employment of health care professionals by VA are available at: https://www.va.gov/OHRM/QualificationStandards/. 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 Rehabilitation
Counselors, VA qualification standards require an active, current,
full, and unrestricted certification from the Commission on
Rehabilitation Counselor Certification (CRCC). For Rehabilitation
Counselors, VA qualification standards require an active, current,
full, and unrestricted certification from the certification body:
complete qualifications standards details for Rehabilitation Counselors
are found: https://www.va.gov/OHRM/QualificationStandards/HT38/0101-RehabilitationCounselor.pdf.
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. VA Rehabilitation Counselors
have grandfathering provisions included within their qualification
standards, and VA proposes to have those individuals not be authorized
to follow the Rehabilitation Counselor national standard of practice.
Instead, VA proposes its medical facilities will determine the tasks
and duties for Rehabilitation Counselors who are grandfathered under
the qualification standards. Such determinations are determined at the
VA medical facility based on the Rehabilitation Counselor's education,
training, and credentialing.
The third paragraph establishes what the national standard of
practice will be for the occupation in VA. For this national standard,
VA Rehabilitation Counselors follow the standard set by the CRCC, found
at: https://crccertification.com, with the exception of, the listed
task or duty VA proposes to restrict even though the certification
otherwise permits the profession to perform those tasks or duties.
The final paragraph provides justification for VA's proposal to
restrict the specified tasks and duties. It explains why VA is
restricting those tasks or duties and the clinical basis for this
proposed decision.
This national standard of practice does not address training
because it will not authorize VA Rehabilitation Counselors to perform
any tasks and duties not already authorized under their national
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 Rehabilitation Counselors
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. Rehabilitation Counselors are professional counselors educated
and trained at the graduate level who possess the specialized
knowledge, skills, and attitudes to work collaboratively with patients
with disabilities. Through a professional counseling process,
Rehabilitation Counselors help patients with disabilities to achieve
their personal career, independent living, social, and psychological
goals.
2. Rehabilitation Counselors in the Department of Veterans Affairs
(VA) possess the education and certification required by VA
qualification standards, available at: https://www.va.gov/OHRM/QualificationStandards/HT38/0101-RehabilitationCounselor.pdf.
Note: This national standard of practice does not apply to
Rehabilitation Counselors who were grandfathered into the position
on July 21, 2020, the effective date for the VA qualification
standards for Rehabilitation Counselors. Tasks and responsibilities
for Rehabilitation Counselors who are grandfathered under the
qualification standards are determined at the VA medical facility
based on their education, training, and credentialing.
3. VA Rehabilitation Counselors practice in accordance with the
Certified Rehabilitation Counselor scope of practice from the
Commission on Rehabilitation Counselor Certification (CRCC), available
at: https://crccertification.com/, except as noted in paragraph 3.a. VA
reviewed certification requirements for this occupation in October 2024
and confirmed that all Rehabilitation Counselors in VA followed this
national certification.
a. VA Rehabilitation Counselors, practicing within scope of their
VA employment and consistent with this standard, cannot diagnose mental
health disorders (F Codes in the International Classification of
Diseases 11th Revision) unless they have a license in a mental health
discipline, in addition to their CRCC certification and qualify as
licensed providers through the Medical
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Staff Bylaws of their VA medical facility.
Note: VA Rehabilitation Counselors meet CRCC certification
eligibility criteria of a master's degree in rehabilitation
counseling or a qualifying related mental health field with
additional graduate-level core rehabilitation coursework and
supervised experience. All Rehabilitation Counselors with CRCC
certification can diagnose ``Other Conditions That May Be a Focus of
Clinical Attention'' as outlined in the Diagnostic and Statistical
Manual of Mental Disorders Fifth Edition (Z codes in the
International Classification of Diseases 11th Revision).
4. Justification
a. VA Rehabilitation Counselors who only maintain a CRCC
certification are restricted from diagnosing mental health disorders
because VA has licensed mental health personnel with the specific
education, training, and expertise that VA would rely on to diagnose.
VA Rehabilitation Counselors who possess a CRCC certification, hold a
state license in a mental health field (e.g., Licensed Professional
Counselor, Licensed Clinical Professional Counselor, Licensed Clinical
Social Worker, Licensed Independent Social Worker, Licensed
Psychologist), and qualify as a licensed provider based on the medical
facility bylaws will be permitted to diagnose mental health disorders
because their education, training, and expertise provides the necessary
competency to diagnose.
Request for Information
1. Is VA's assessment of what the state and CRCC certification
permits, and prohibits, accurately represented?
2. Are there any other areas of variance of any state license,
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 December 6, 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. 2024-31205 Filed 12-27-24; 8:45 am]
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