[Federal Register Volume 87, Number 126 (Friday, July 1, 2022)]
[Notices]
[Pages 39595-39598]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-14033]


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DEPARTMENT OF VETERANS AFFAIRS


Notice of Request for Information on the Department of Veterans 
Affairs Blind Rehabilitation Specialist and Visual Impairment Services 
Team Coordinator 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 Blind Rehabilitation Specialists (BRS) and Visual Impairment 
Services Team (VIST) Coordinators. 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 August 30, 2022.

ADDRESSES: Comments may be submitted through www.regulations.gov. 
Comments received will be available at www.regulations.gov for public 
viewing, inspection or copies.

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, at 
202-461-0500. This is not a toll-free number.

SUPPLEMENTARY INFORMATION:

Authority

    Chapters 73 and 74 of the title 38 of the 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.
    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

[[Page 39596]]

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 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 COVID-19 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's policy and 
have each individual national standard of practice as an appendix to 
the directive. The directive and all appendices will be accessible on 
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 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 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 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, 
to include by an interdisciplinary workgroup consisting of 
representatives from Quality Management; Field Chief of Staff; Academic 
Affiliates; Associate Director Patient Care Services; Ethics; Workforce 
Management and Consulting; Surgery; Credentialing and Privileging; 
Field Chief Medical Office; and Electronic Health Record 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 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 our 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 national standard of practice may be phased in across all 
medical facilities, with limited exemptions for health care 
professionals as needed.

National Standard for BRS and VIST Coordinators

    The proposed format for national standards of practice when there 
is a national certifying body 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, certification, license, registration, or other requirement 
needed to practice this profession at VA

[[Page 39597]]

and confirms that this profession follows the standard of practice set 
by the national certifying body. A final statement confirms that as of 
the date of the workgroup's research into requirements, all individuals 
in this profession follow the same standard of practice.
    We note that 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.
    VA qualification standards require BRSs to have at least one 
active, current, full, and unrestricted certification granted by the 
Academy for Certification of Vision Rehabilitation and Education 
Professionals (ACVREP). The following four national certifications from 
the ACVREP correspond with four distinct specialties within the 
occupation:
    1. Certified Low Vision Therapist (CLVT);
    2. Certified Orientation and Mobility Specialist (COMS);
    3. Certified Assistive Technology Instructional Specialist for 
People with Visual Impairments (CATIS); and
    4. Certified Vision Rehabilitation Therapist (CVRT).
    BRSs can practice under any of these four ACVREP certifications. 
BRSs who provide orientation and mobility training, communication and 
daily living therapy, low vision therapy, or assistive technology must 
possess the corresponding ACVREP certification for the type of service 
they provide. For example, a BRS who provides low vision therapy must 
be certified as a CLVT. VA reviewed whether there are any alternative 
certifications or requirements from any State that could be required 
for a BRS and found that there were none. Therefore, VA proposes to 
adopt a standard of practice consistent with these four national 
certifications; therefore, VA BRSs in each of these four specialties 
will continue to follow the same standard as set by their national 
certifications. Standards of practice for each of the four 
certifications can be found at the following websites:
    <bullet> CLVT: https://www.acvrep.org/certifications/clvt-scope;
    <bullet> COMS: https://www.acvrep.org/certifications/coms-scope;
    <bullet> CATIS: https://www.acvrep.org/certifications/catis-scope; 
and
    <bullet> CVRT: https://www.acvrep.org/certifications/cvrt-scope.
    This national standard of practice for BRSs includes VIST 
Coordinator because all VIST Coordinator positions are appointed as 
BRSs. BRS VIST Coordinators may be drawn from traditional blind/vision 
rehabilitation backgrounds or from counseling backgrounds. There is no 
national or State license or certification for VIST Coordinators; 
therefore, there is no variance with a State in the standard of 
practice for VIST Coordinators. VA VIST Coordinators must be licensed, 
certified, or registered as BRSs, Social Workers, Certified 
Rehabilitation Counselors, or other health care professionals. VIST 
Coordinators who are licensed, certified, or registered as BRSs, Social 
Workers, Certified Rehabilitation Counselors, or in other health care 
occupations must adhere to the VA national standard of practice for 
that specific occupation.
    Because the practice of Blind Rehabilitation Specialists and VIST 
Coordinators is not changing, there will be no impact on the practice 
of this occupation when this national standard of practice is 
implemented. However, national standards of practice for other 
occupations may impact practice of those occupations at VA once they 
are implemented.

Proposed National Standard of Practice for BRSs

    BRSs use assessments, therapies and technologies to improve the 
independent function, quality of life and adjustment for Veterans who 
are blind or visually impaired. BRSs evaluate Veterans through 
interviews, tests and measurements and use such findings either solely 
or as a part of an interdisciplinary team to develop and implement 
blind and vision rehabilitation programs for individual Veterans. 
Instructional activities are directed toward achieving therapeutic 
objectives for Veterans who are blind or visually impaired. These 
activities include effective communication and visual skills; 
instruction on optical low vision devices; orientation to and 
management of the environment; safe ambulation and travel; access to 
information through the use of assistive technologies; manual skills; 
proficiency and understanding in activities of daily living; pursuit of 
avocational and vocational skills; and education and adjustment to 
visual impairment.
    BRSs in VA possess the required education and certification from 
ACVREP in accordance with VA qualification standards, as more 
specifically described in VA Handbook 5005, Staffing, Part II, Appendix 
G41. This national standard of practice confirms BRSs practice in 
accordance with the ACVREP standards based on the certification they 
hold, including CLVT, COMS, CATIS and CVRT, available at: 
www.acvrep.org. As of August 2021, BRSs in all States follow these 
national certifications.

Proposed National Standard of Practice for VIST Coordinators

    VIST Coordinators provide adjustment counseling, coordination of 
services, assure adequate compensation and benefits and conduct complex 
negotiations with the medical and benefit systems as well as non-VA 
service delivery systems for Veterans who are blind or visually 
impaired.
    There is no national or State license or certification for VIST 
Coordinators; therefore, there is no variance with a State in the 
standard of practice for VIST Coordinators. VA VIST Coordinators must 
be licensed, certified, or registered as BRSs, Social Workers, 
Certified Rehabilitation Counselors, or other health care professionals 
as outlined in VA Handbook 5005, Staffing, Part II, Appendix G41. More 
specifically, VIST Coordinators must be credentialed or certified 
through the following:
    a. Any certification via ACVREP, including CLVT, COMS, CATIS and 
CVRT;
    b. License or certification by a State to independently practice 
social work at the master's degree level;
    c. Certification via the Commission on Rehabilitation Counselor 
Certification, Certified Rehabilitation Counselor; or
    d. License or certification by a State to independently practice in 
other health care occupations.
    VIST Coordinators licensed, certified, or registered as BRSs, 
Social Workers and Certified Rehabilitation Counselors, or in other 
health care occupations, must adhere to the VA national standard of 
practice for that specific occupation.

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?

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    5. Is there anything else you would like to share with us about 
these national standards of practice?

Signing Authority

    Denis McDonough, Secretary of Veterans Affairs, approved this 
document on June 14, 2022, 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.

Jeffrey M. Martin,
Assistant Director, Office of Regulation Policy & Management, Office of 
General Counsel, Department of Veterans Affairs.
[FR Doc. 2022-14033 Filed 6-30-22; 8:45 am]
BILLING CODE 8320-01-P