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Veterans Administration Final Rule - SUCCESS

  • 1.  Veterans Administration Final Rule - SUCCESS

    Posted 12-13-2016 16:14
    Edited by Jim Flanigan 12-13-2016 16:22

    ASCLS Members,

    It is my great pleasure to inform you that the efforts you made to alert the Veterans Administration to problems with the agency's rule expanding the authority for APRNs has met with success. Tomorrow, the VA will publish the final personnel regulations in the Federal Register.

    We have successfully convinced the VA to adjust the language to better protect patients while expanding access to care for our nation’s veterans. Further, the VA calls out the "crucial role" laboratorians play in the care of VA patients. The key language explaining this change is below (with emphasis added by me).

    “Several commenters stated that they were concerned with proposed
    § 17.415(d)(1)(i)(B), where we stated that a Certified Nurse Practitioner (CNP) may
    order, perform, or supervise laboratory studies. The commenters stated that the
    proposed language does not “adequately appreciate the levels of complexity involved in
    laboratory testing” and that there are rigid standards for laboratory tests that require
    rigorous academic and practical training, which are not part of the training for APRNs.
    Another commenter stated, “While the VHA uses the word ‘interpret’ in reference to
    laboratory and imaging studies,” the commenter “…infers that the VA’s intent is to grant
    the ability for CNPs to interpret laboratory and imaging results, not to interpret or report
    raw images or data.” The commenter suggested that VA amend the term “‘interpret’
    and recommends instead to use ‘integrate results into clinical decision making,’ or some
    other phrase” in order to avoid confusion between the duties of an APRN and those of a
    laboratory specialist. We agree with the commenter in that the proposed language
    might be construed as allowing CNPs the ability to perform laboratory studies. It is not
    VA’s intent to have APRNs take over the role of laboratory specialists. These
    specialists perform a crucial role at VA medical facilities and are skillfully trained in
    performing the various testing techniques that allow health care professionals to
    properly treat a veteran’s medical condition. We are amending proposed
    § 17.415(d)(1)(i)(B) to now state that a CNP may be granted full practice authority to
    ‘Order laboratory and imaging studies and integrate the results into clinical decision

    The draft final rule can be found at:

    Congratulations to everyone who worked so hard and with so much passion to address this issue!


    Jim Flanigan, CAE
    Executive Vice President
    American Society for Clinical Laboratory Science (ASCLS)
    1861 International Drive, #200 McLean, VA 22102
    o: 571-748-3746 | m: 708-359-5721 | @jimflanigancae

  • 2.  RE: Veterans Administration Final Rule - SUCCESS

    Posted 12-14-2016 08:04

    Very good news. Now-- where does CMS stand?

    Norma Erickson
    Indianapolis IN
    (317) 924-9430

  • 3.  RE: Veterans Administration Final Rule - SUCCESS

    Posted 12-18-2016 19:11


    The issues with CMS, similar in that those regulations potentially put nurses in inappropriate positions best handled by laboratorians, are unique and will take longer to resolve. CMS has allowed nurses to take on laboratorian roles for years, but it was not widely known. New administrators at CMS wanted to make the "internal policy" transparent to their surveyors. That is what occurred on April 1. 

    CMS is beginning the process of updating the decades old personnel regulations, of which this is part. ASCLS will be working closely with administrators at CMS to push for upgrades to the regulations. 

    In my interactions with CMS, I've found the administrators to be very open to hearing our concerns. 

    In the case of the VA, we were fighting a rule before it was in place, which is much easier process. Changing an existing rule takes far more time.

    This will be one of ASCLS's top priorities in the coming Congress and with the new administration. 

    Jim Flanigan, CAE
    Executive Vice President
    American Society for Clinical Laboratory Science (ASCLS)
    1861 International Drive, #200 McLean, VA 22102
    o: 571-748-3746 | m: 708-359-5721 | @jimflanigancae

  • 4.  RE: Veterans Administration Final Rule - SUCCESS

    Posted 12-14-2016 08:27

    This is an exciting success!  Thanks to Jim and the team for amazing work on this.  A holiday gift for all laboratorians! 


    Kathy Doig, PhD, MLS(ASCP)CMSHCM

    Professor Emeritus, Biomedical Laboratory Diagnostics

    Michigan State University


  • 5.  RE: Veterans Administration Final Rule - SUCCESS

    Posted 12-14-2016 08:38
    Fantastic! Kudos to ASCLS and all others who wrote the agency with our concerns. It's nice win!
    Dennis J. Ernst MT(ASCP)
    Center for Phlebotomy Education, Inc.
    866-657-9857 (toll free)

    See our latest video: A Tribute to Phlebotomists.

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  • 6.  RE: Veterans Administration Final Rule - SUCCESS

    Posted 12-14-2016 12:01
    This excellent news. Thanks for sharing

    Janice M. Conway-Klaassen, PhD, MT(ASCP)SM, FACSc
    Director, Medical Laboratory Sciences Program
    Mildred King Rohwer Chair in Medical Technology
    University of Minnesota
    420 Delaware St. SE, MMC 711
    Minneapolis, MN  55455
    Office: 612-626-9408 

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