National Standards of Practice
On June 30, 2022, the VA published in the Federal Register, the first of 50 draft National Standards of Practice.
According to the press release, the National Standards of Practice are “a standardized set of services that all health care professionals in a given occupation can perform within VA, regardless of what is permitted by state licensure, certification or registration per the Authority of VA Professionals to Practice Health Care”.
The summary of the Act states, “The Department of Veterans Affairs (VA) is issuing this interim final rule to confirm that its 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. Specifically, this rulemaking confirms 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. This rulemaking also confirms VA's authority to establish national standards of practice for health care professionals which will standardize a health care professional's practice in all VA medical facilities.”
This will be a multi-year endeavor to develop the standards for the 50 health care professions. The standards will allow VA clinicians to deliver the services in their specialties in regions other than where the clinic is licensed, registered, or certified so that veterans can get the care that they need where and when they need it. Included amongst the 50 professions are Physicians and Dentists. By developing these national standards, VA will be able to move its’ healthcare professionals throughout the enterprise increasing support of VA’s Fourth Mission – providing support during national crises and disasters. The standards will also support and protect those clinicians practicing across state lines or utilizing telehealth modalities.
Steve Lieberman, MD, the Deputy Under Secretary for Health, Performing the Delegable Duties of the Under Secretary for Health issued the following statement, “To protect our dedicated VA workforce and address concerns regarding State Licensing Boards taking action against VA employees, I issued a memorandum that states: VA and the Department of Justice will protect VA health care professionals if a State Licensing Board takes action against a VA health care professional for performing a service covered in their national standard; absent misconduct, negligence, or inappropriate conduct from the professional.”
“To protect our dedicated VA workforce and address concerns regarding State Licensing Boards taking action against VA employees, I issued a memorandum that states: VA and the Department of Justice will protect VA health care professionals if a State Licensing Board takes action against a VA health care professional for performing a service covered in their national standard; absent misconduct, negligence, or inappropriate conduct from the professional.”
The development of the National Standards of Practice will follow a proscribed process. The development process for each standard includes:
1. Understanding State Variances: VA reviews variances in states licensing, certification, or registration to identify tasks and duties that would enhance the practice and efficiency of the profession throughout VA
2. Develop proposed draft of national standards: National standards are drafted with practices that enhance the profession at VA and identify training needs
3. VA Review: Standards are reviewed by VA executive, General Counsel and a cross functional advisory board
4. Engage Labor Unions et al: VA provides informational briefings to unions and others such as VSO’s and professional associations
5. State Board Input: Every state will receive notification and have an opportunity to provide input on the standard
6. Post within VA and on the Federal Register for Feedback: National Standards will be posted for 60 days for comment
7. Revision of the Standard: Standards will be revised based on feedback
8. Publication of the Standard: Standards will go through VA policy review and concurrence processes and then will be published as a new VA Healthcare Directive
9. Implementation: Impacted employees are then notified, and processes, software and training will be updated to reflect VA national standards.
Duties and tasks outlined in the National Standards will then be incorporated in an individual health care professional’s privileges, scope of practice, or functional statement if the facility performs those services and the individual has the proper education, training, and skill. All providers affected must still maintain State Licensure as a condition of employment. Licensees who allow their license to be revoked, lapse, or relinquish their license in lieu of revocation my be immediately terminated from VA employment.
NAVAPD strongly supports the development, and implementation of National Standards of Practice as quickly as possible for our Physician and Dentist members. We believe this will ensure high quality medical and dental care for our veterans regardless of the where the veteran is located eliminating inconsistencies in care delivered across state lines. We highly encourage our members to pay attention to notifications from VA and from state boards so that you can provide your feedback on the standard that will affect your profession.
As always NAVAPD is here to support your during this process. Please feel free to email us with your comments at opscoord@navapd.org.