Title of Regulation: 18VAC150-20. Regulations Governing the Practice of Veterinary Medicine (amending 18VAC150-20-70, 18VAC150-20-75, 18VAC150-20-130, 18VAC150-20-172, 18VAC150-20-220).

Statutory Authority: § 54.1-2400 of the Code of Virginia.

Public Hearing Information: No public hearings are scheduled.

Public Comment Deadline: September 11, 2013.

Effective Date: September 26, 2013.

Agency Contact: Leslie L. Knachel, Executive Director, Board of Veterinary Medicine, 9960 Mayland Drive, Suite 300, Richmond, VA 23233, telephone (804) 367-4468, FAX (804) 527-4471, or email leslie.knachel@dhp.virginia.gov.

Basis: Section 54.1-2400 of the Code of Virginia provides the Board of Veterinary Medicine the authority to promulgate regulations to administer the regulatory system. The specific statutory mandate to regulate veterinary establishments is found in § 54.1-3804 of the Code of Virginia. The specific statutory mandate for licensure in order to practice veterinarian medicine is found in § 54.1-3805 of the Code of Virginia, and the statutory description of the practice of veterinary medicine is found in § 54.1-3800 of the Code of Virginia.

Purpose: Licensure and standards of practice for veterinary practitioners and establishments are necessary to protect the health and welfare of animal clients and their owners. The proposed amendments facilitate maintenance of licensure, which ensures continued oversight of veterinary practice.

Rationale for Using Fast-Track Process: The proposed amendments will result in a less restrictive regulation or a revision for clarity without any substantive change. There should be no controversy with any of the changes.

Substance: The only substantive change to the regulation is that licensees and registrants will be able to renew a lapsed license or registration by payment of the renewal and late fee for up to one year after the expiration date. Currently, a licensee or registrant who does not renew within 30 days of expiration has to reinstate his license.

Issues: There are no advantages or disadvantages to the public. Allowing renewal by payment of a late fee for one year after expiration may benefit a very small number of licensees and registrants. There are no advantages or disadvantages to the agency or the Commonwealth.

Small Business Impact Report of Findings: This regulatory action serves as the report of findings of the regulatory review pursuant to § 2.2-4007.1 of the Code of Virginia.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. The Board of Veterinary Medicine (Board) proposes to: 1) allow international conferences of veterinary medicine to be used for continuing education 2) change the required time frame for licensure reinstatement from 30 days after expiration to one year; and 3) revise the requirement for delegation of animal massage.

Result of Analysis. The benefits likely exceed the costs for all proposed changes.

Estimated Economic Impact. International conferences for continuing education. The current regulations specify that national or regional conferences of veterinary medicine are acceptable sponsors for continuing education courses or programs. The Board proposes to add international conferences of veterinary medicine to the list of accepted sponsors. As the Department of Health Professions points out, there are several high quality international conferences that the Board believes should be accepted. For those veterinarians with interest in international conferences, this proposed additional option for continuing education credit will be beneficial. Since there appears to be no cost or reduction in assurance of licensed veterinarians skills associated with the proposed amendment, it should create a net benefit.

Time frame for reinstatement. Currently, a license may be renewed up to 30 days after expiration by payment of a late fee and the renewal fee. After 30 days, the licensee must reinstate with payment of the reinstatement and renewal fees. For veterinarians, the reinstatement fee is $175. For veterinary technicians, the reinstatement fee is $50.

The Board proposes to allow late renewal up to one year after expiration; the late fee is $45 for veterinarians and $15 for veterinary technicians. Licensees who renew an expired license between 31 days and one year after the expiration date will therefore realize a saving of $130 for veterinarians and $35 for veterinarian technicians.

Reinstatement also requires submission of all documentation showing completion of continuing education. A late renewal only requires that the licensee attest to have completed the continuing education hours. Thus the proposal to allow late renewal up to one year after expiration will also save time in the assembling and transmitting of documents for licensees who renew an expired license between 31 days and one year after the expiration date.

Delegation of animal massage. Under the current regulations, animal massage or physical therapy may be delegated by a veterinarian to persons qualified by training and experience by an order from the veterinarian. The Board does not believe simple animal massage needs to be delegated by an order. Similar to human massage, it may be done in a spa-like facility. However, massage therapy is typically used to treat a medical condition and the Board believes it should continue to be delegated by an order. Therefore, the Board proposes to change the term animal massage to massage therapy in the quoted sentence above. In practice, this change just results in no longer needing a delegation order for simple massage. This will result in a small time savings for veterinary practices.

Businesses and Entities Affected. The proposed amendments affect the 272 restricted veterinary facilities and 736 full-service veterinary facilities in the Commonwealth;¹ all or most of which qualify as small businesses. The proposed amendments also directly affect the 3,771 licensed veterinarians, 1,613 licensed veterinary technicians and 22 registered equine dental technicians in Virginia.

Localities Particularly Affected. The proposed amendments do not disproportionately affect particular localities.

Projected Impact on Employment. The proposed amendments are unlikely to significantly affect employment.

Effects on the Use and Value of Private Property. The proposal to add international conferences of veterinary medicine to the list of accepted sponsors for continuing education courses and programs will increase the likelihood that veterinarians attend international conferences. The proposal to change the required time frame for reinstatement from 30 days after expiration to one year will decrease costs for veterinarians and veterinarian technicians who renew an expired license between 31 days and one year after the expiration date. The proposal to revise the requirement for delegation of animal massage will save a small amount of time for veterinary practices.

Small Businesses: Costs and Other Effects. The proposed amendments will not increase costs for small businesses. The proposal to change the required time frame for reinstatement from 30 days after expiration to one year will decrease costs for small veterinary practices where veterinarians or veterinarian technicians renew an expired license between 31 days and one year after the expiration date. The proposal to revise the requirement for delegation of animal massage will save a small amount of time for small veterinary practices.

Small Businesses: Alternative Method that Minimizes Adverse Impact. The proposed amendments do not adversely affect small businesses.

Real Estate Development Costs. The proposed amendments will not affect real estate development costs.

Legal Mandate. The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Administrative Process Act and Executive Order Number 14 (10). Section 2.2-4007.04 requires that such economic impact analyses include, but need not be limited to, a determination of the public benefit, the projected number of businesses or other entities to whom the regulation would apply, the identity of any localities and types of businesses or other entities particularly affected, the projected number of persons and employment positions to be affected, the projected costs to affected businesses or entities to implement or comply with the regulation, and the impact on the use and value of private property. Further, if the proposed regulation has an adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include (i) an identification and estimate of the number of small businesses subject to the regulation; (ii) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the regulation, including the type of professional skills necessary for preparing required reports and other documents; (iii) a statement of the probable effect of the regulation on affected small businesses; and (iv) a description of any less intrusive or less costly alternative methods of achieving the purpose of the regulation. The analysis presented above represents DPB's best estimate of these economic impacts.

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¹ Data source: Department of Health Professions

Agency's Response to Economic Impact Analysis: The Board of Veterinary Medicine concurs with the analysis of the Department of Planning and Budget for the proposed fast-track action on 18VAC150-20, Regulations Governing the Practice of Veterinary Medicine.

Summary:

The amendments (i) permit international conferences of veterinary medicine to qualify as acceptable sponsors for continuing education, (ii) change the required time frame for license or registration reinstatement from 30 days to one year after expiration, (iii) clarify the requirements for practical training in a preceptorship or externship, and (iv) revise the requirement for delegation of animal massage. This regulatory action is in response to the Governor's Regulatory Reform Initiative.

18VAC150-20-70. Licensure renewal requirements.

A. Every person licensed by the board shall, by January 1 of every year, submit to the board a completed renewal application and pay to the board a renewal fee as prescribed in 18VAC150-20-100. Failure to renew shall cause the license to lapse and become invalid, and practice with a lapsed license may subject the licensees to disciplinary action by the board. Failure to receive a renewal notice does not relieve the licensee of his responsibility to renew and maintain a current license.

B. Veterinarians shall be required to have completed a minimum of 15 hours, and veterinary technicians shall be required to have completed a minimum of six hours, of approved continuing education for each annual renewal of licensure. Continuing education credits or hours may not be transferred or credited to another year.

1. Approved continuing education credit shall be given for courses or programs related to the treatment and care of patients and shall be clinical courses in veterinary medicine or veterinary technology or courses that enhance patient safety, such as medical recordkeeping or compliance with requirements of the Occupational Health and Safety Administration (OSHA).

2. An approved continuing education course or program shall be sponsored by one of the following:

a. The AVMA or its constituent and component/branch associations, specialty organizations, and board certified specialists in good standing within their specialty board;

b. Colleges of veterinary medicine approved by the AVMA Council on Education;

c. National International, national, or regional conferences of veterinary medicine;

d. Academies or species specific interest groups of veterinary medicine;

e. State associations of veterinary technicians;

f. North American Veterinary Technicians Association;

g. Community colleges with an approved program in veterinary technology;

h. State or federal government agencies;

i. American Animal Hospital Association (AAHA) or its constituent and component/branch associations;

j. Journals or veterinary information networks recognized by the board as providing education in veterinary medicine or veterinary technology; or

k. An organization or entity approved by the Registry of Approved Continuing Education of the American Association of Veterinary State Boards.

3. A licensee is exempt from completing continuing education requirements and considered in compliance on the first renewal date following his initial licensure by examination.

4. The board may grant an exemption for all or part of the continuing education requirements due to circumstances beyond the control of the licensee, such as temporary disability, mandatory military service, or officially declared disasters.

5. The board may grant an extension for good cause of up to one year for the completion of continuing education requirements upon written request from the licensee prior to the renewal date. Such an extension shall not relieve the licensee of the continuing education requirement.

6. Licensees are required to attest to compliance with continuing education requirements on their annual license renewal and are required to maintain original documents verifying the date and subject of the program or course, the number of continuing education hours or credits, and certification from an approved sponsor. Original documents must be maintained for a period of two years following renewal. The board shall periodically conduct a random audit to determine compliance. Practitioners selected for the audit shall provide all supporting documentation within 10 days of receiving notification of the audit.

7. Continuing education hours required by disciplinary order shall not be used to satisfy renewal requirements.

C. A licensee who has requested that his license be placed on inactive status is not authorized to perform acts which that are considered the practice of veterinary medicine or veterinary technology and, therefore, shall not be required to have continuing education for annual renewal. To reactivate a license, the licensee is required to submit evidence of completion of continuing education hours as required by § 54.1-3805.2 of the Code of Virginia equal to the number of years in which the license has not been active for a maximum of two years.

18VAC150-20-75. Expired license; reinstatement; practice with an expired or lapsed license not permitted.

A. A license may be renewed up to 30 days one year after the expiration date, provided a late fee as prescribed in 18VAC150-20-100 is paid in addition to the required renewal fee.

B. Reinstatement of licenses expired for more than 30 days one year shall be at the discretion of the board. To reinstate a license, the licensee shall pay the renewal and reinstatement fees as prescribed in 18VAC150-20-100 and submit evidence of completion of continuing education hours as required by § 54.1-3805.2 of the Code of Virginia equal to the number of years in which the license has been expired, for a maximum of two years. The board may require additional documentation of clinical competency and professional activities.

18VAC150-20-130. Requirements for practical training in a preceptorship or externship.

A. The practical training and employment of qualified students of veterinary medicine or veterinary technology shall be governed and controlled as follows:

1. No A veterinary student shall be qualified to receive practical training unless such student shall be who is duly enrolled and in good standing in a veterinary college or school accredited or approved by the AVMA and in the final year of his training or after completion of an equivalent number of hours as approved by the board may be engaged in a preceptorship or externship. The student shall be engaged in a preceptorship or externship as defined by the board and authorized by his college or school. 2. A veterinary preceptee or extern may perform duties that constitute the practice of veterinary medicine for which he has received adequate instruction by the college or school and only under the on-premises supervision of a licensed veterinarian.

3. 2. A veterinary technician preceptee or extern student who is duly enrolled and in good standing in a veterinary technology program accredited or approved by the AVMA may be engaged in a preceptorship or externship. A veterinary technician preceptee or extern may perform duties that constitute the practice of veterinary technology for which he has received adequate instruction by the program and only under the on-premises supervision of a licensed veterinarian or licensed veterinary technician.

B. Prior to allowing a preceptee or extern in veterinary medicine to perform surgery on a patient unassisted by a licensed veterinarian, a licensed veterinarian shall receive written approval from the client.

18VAC150-20-172. Delegation of duties.

A. A licensed veterinarian may delegate the administration (including by injection) of schedule Schedule VI drugs to a properly trained assistant under his immediate and direct supervision. The prescribing veterinarian has a specific duty and responsibility to determine that the assistant has had adequate training to safely administer the drug in a manner prescribed. Injections involving anesthetic or chemotherapy drugs, subgingival scaling, or the placement of intravenous catheters shall not be delegated to an assistant.

B. Additional tasks that may be delegated by a licensed veterinarian to a properly trained assistant include but are not limited to the following:

1. Grooming;

2. Feeding;

3. Cleaning;

4. Restraining;

5. Assisting in radiology;

6. Setting up diagnostic tests;

7. Prepping for surgery;

8. Dental polishing and scaling of teeth above the gum line (supragingival);

9. Drawing blood samples; or

10. Filling of schedule Schedule VI prescriptions under the direction of a veterinarian licensed in Virginia.

C. A licensed veterinarian may delegate duties electronically, verbally, or in writing to appropriate veterinary personnel provided the veterinarian has physically examined the patient within the previous 36 hours.

D. Animal massage Massage therapy or physical therapy may be delegated by a veterinarian to persons qualified by training and experience by an order from the veterinarian.

E. The veterinarian remains responsible for the duties being delegated and remains responsible for the health and safety of the animal.

Part VI
Equine Dental Technicians

18VAC150-20-220. Requirements for registration as an equine dental technician.

A. A person applying for registration as an equine dental technician shall provide a recommendation from at least two veterinarians licensed in Virginia who attest that at least 50% of their practice is equine, and that they have observed the applicant within the past five years immediately preceding the attestation and can attest to his competency to be registered as an equine dental technician.

B. The qualifications for registration shall include documentation of one of the following:

1. Current certification from the International Association of Equine Dentistry;

2. Completion of a board-approved certification program or training program;

3. Completion of a veterinary technician program that includes equine dentistry in the curriculum; or

4. Evidence of equine dental practice for at least five years and proof of 16 hours of continuing education in equine dentistry completed within the five years immediately preceding application for registration.

C. In order to maintain an equine dental technician registration, a person shall renew such registration by January 1 of each year by payment of the renewal fee specified in 18VAC150-20-100 and attestation of obtaining 16 hours of continuing education relating to equine dentistry within the past three years.

1. Equine dental technicians shall be required to maintain original documents verifying the date and subject of the continuing education program or course, the number of continuing education hours, and certification of completion from a sponsor. Original documents shall be maintained for a period of two years following renewal. The board shall periodically conduct a random audit to determine compliance. Practitioners selected for the audit shall provide all supporting documentation within 10 days of receiving notification of the audit.

2. Registration may be renewed up to 30 days one year after the expiration date, provided a late fee as prescribed in 18VAC150-20-100 is paid in addition to the required renewal fee.

3. Reinstatement of registration expired for more than 30 days one year shall be at the discretion of the board. To reinstate a registration, the applicant shall pay the reinstatement fee as prescribed in 18VAC150-20-100 and submit evidence of completion of continuing education hours equal to the number of years in which the registration has been expired, for a maximum of two years. The board may require additional documentation of clinical competency and professional activities.