[Federal Register Volume 76, Number 149 (Wednesday, August 3, 2011)]
[Notices]
[Pages 46809-46811]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-19391]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Agency for Healthcare Research and Quality, HHS.

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: This notice announces the intention of the Agency for 
Healthcare Research and Quality (AHRQ) to request that the Office of 
Management and Budget (OMB) approve the proposed information collection 
project: ``Evaluation of the Children's Health Insurance Program 
Reauthorization Act of 2009 (CHIPRA) Quality Demonstration Grant 
Program.'' In accordance with the Paperwork Reduction Act, 44 U.S.C. 
3501-3521, AHRQ invites the public to comment on this proposed 
information collection.

DATES: Comments on this notice must be received by October 3, 2011.

ADDRESSES: Written comments should be submitted to: Doris Lefkowitz, 
Reports Clearance Officer, AHRQ, by e-mail at 
doris.lefkowitz@AHRQ.hhs.gov.
    Copies of the proposed collection plans, data collection 
instruments, and specific details on the estimated burden can be 
obtained from the AHRQ Reports Clearance Officer.

FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports 
Clearance Officer, (301) 427-1477, or by e-mail at 
doris.lefkowitz@AHRQ.hhs.gov.

SUPPLEMENTARY INFORMATION: 

Proposed Project

Evaluation of the Children's Health Insurance Program Reauthorization 
Act of 2009 (CHIPRA) Quality Demonstration Grant Program

    Section 401(a) of the Children's Health Insurance Program 
Reauthorization Act of 2009 (CHIPRA), Public Law 111-3, amended the 
Social Security Act (the Act) to enact section 1139A (42 U.S.C. 1320b-
9a). AHRQ is requesting approval from the Office of Management and 
Budget (OMB) for data collection to support a national evaluation of 
the quality demonstration grants authorized under section 1139A(d) of 
the Act. Evaluating whether the CHIPRA demonstration grants improve the 
quality of care received by children in Medicaid and CHIP aligns with 
AHRQ's mission of improving the quality and effectiveness of health 
care in the United States.
    CHIPRA included funding for five-year grants so that states can 
demonstrate effective, replicable strategies for improving the quality 
of children's health care in Medicaid and CHIP. In February 2010, the 
U.S. Department of Health and Human Services announced the award of 10 
demonstration grants. Six of the grantee states are partnering with 
other states, for a total of 18 demonstration states. The demonstration 
states are: Colorado (partnering with New Mexico); Florida (with 
Illinois); Maine (with Vermont); Maryland (with Wyoming and Georgia); 
Massachusetts; North Carolina; Oregon (with Alaska and West Virginia); 
Pennsylvania; South Carolina; and Utah (with Idaho).
    These demonstration states are implementing 48 distinct projects in 
at least one of five possible grant categories, A to E. Category A 
grantees are experimenting with and/or evaluating the use of new 
pediatric quality measures. Category B grantees are promoting health 
information technology (HIT) for improved care delivery and patient 
outcomes. Category C grantees are expanding person-centered medical 
homes or other provider-based levels of service delivery. Category D 
grantees will evaluate the impact of a model pediatric electronic 
health record. Category E grantees are testing other state-designed 
approaches to quality improvement in Medicaid and CHIP.
    This research has the following goals:
    (1) To identify CHIPRA state activities that measurably improve the 
nation's health care, especially as it pertains to children.
    (2) To develop a deep, systematic understanding of how CHIPRA 
demonstration states carried out their grant-funded projects.
    (3) To understand why the CHIPRA demonstration states pursued 
certain strategies.
    (4) To understand whether and how the CHIPRA demonstration states' 
efforts affected outcomes related to knowledge and behavior change in 
targeted providers and/or consumers of health care.
    This study is being conducted by AHRQ through its contractor, 
Mathematica Policy Research, and two subcontractors, pursuant to AHRQ's 
statutory authority to conduct and support research on healthcare and 
on systems for the delivery of such care, including activities with 
respect to the quality, effectiveness, efficiency, appropriateness and 
value of healthcare services and with respect to quality measurement 
and improvement, 42 U.S.C. 299a(a)(1) and (2).

Method of Collection

    To achieve the goals of this project the following data collections 
will be implemented:
    (1) Key Staff Interviews--two rounds of semi-structured interviews 
with key staff directly involved in the design and oversight of grant-
funded activities in each of the 18 demonstration states. Key staff 
includes the project director, project manager, and principal 
investigator and/or medical director. The purpose of these interviews 
is to gain insight into the implementation of demonstration projects, 
to understand contextual factors, and to identify lessons and 
implications for the broad application and sustainability of projects. 
Because key staff have the most knowledge of project design and 
implementation, they will be interviewed annually. This request for OMB 
approval covers the first two annual interviews with key staff.
    (2) Implementation Staff Interviews--semi-structured interviews 
with staff involved in the day-to-day implementation of grant-funded 
projects in each of the 18 demonstration states. These staff members 
include state agency employees, provider trainers or coaches, health IT 
vendors, and/or project consultants. The purpose of these interviews is 
to gain insight into the opportunities and challenges related to key 
technical aspects of project implementation.

[[Page 46810]]

    (3) Stakeholder Interviews--semi-structured interviews with 
external stakeholders that have a direct interest in children's care 
quality in Medicaid and CHIP in each of the 18 demonstration states. 
Stakeholders include representatives of managed care organizations, 
state chapters of the American Academy of Pediatrics, advocacy 
organizations for children and families, and social service agencies. 
These stakeholders will be familiar with the CHIPRA projects and may 
serve on advisory panels or workgroups related to one or more projects. 
The interviews will gather insight into the opportunities and 
challenges related to project implementation, stakeholder satisfaction 
with their project involvement, and contextual factors.
    (4) Health Care Provider Interviews--semi-structured interviews 
with health care providers who are, or are not, participating in 
demonstration grant activities (participating and comparison providers, 
respectively) in each of the 18 demonstration states. Providers can 
include clinicians from private practices, public clinics, federally 
qualified health centers, care management entities, or school based 
health centers. The interviews with participating providers will 
capture information about project-related activities, providers' 
perceptions of the likelihood of achieving intended outcomes, and 
providers' involvement in other quality-improvement initiatives. The 
interviews with comparison providers will ask about the provider's 
experiences providing care to children in Medicaid and CHIP, 
coordinating with other providers, use of HIT, and provision of 
patient-centered care.
    (5) Non-demonstration States Interviews--semi-structured interviews 
with knowledgeable Medicaid or CHIP personnel including the Medicaid/
CHIP director, the Medicaid health-IT coordinator, and/or project 
directors for state medical home initiatives in 9 non-demonstration 
states. The purpose of these interviews is to enrich AHRQ's 
understanding of how the CHIPRA quality grants contribute to improved 
care quality above and beyond other quality-related initiatives 
happening at the same time. Examples of other quality-related 
initiatives include those funded by the HITECH Act, the Pediatric 
Quality Measures Program, and various medical home initiatives.
    The information collected through the semi-structured interviews 
will be a key source of evidence for the national evaluation of the 
demonstration. Collecting high-quality, timely interview data from a 
wide range of knowledgeable respondents directly serves AHRQ's goal of 
understanding project implementation and the selection and execution of 
strategies, and of identifying the particular activities and resources 
that contributed most to any observed improvement in children's care 
quality. The products that will result from this project include 
practice profiles, replication guides, case studies, and peer-reviewed 
journal articles.

Estimated Annual Respondent Burden

    Exhibit 1 shows the estimated annualized burden hours for the 
respondent's time to participate in this evaluation. Key Staff 
Interviews will be conducted twice with 4 persons from each of the 18 
CHIPRA demonstration States and will last for about 1-2 hours. 
Implementation Staff Interviews will include 16 persons from each of 
the 18 CHIPRA demonstration States and take an hour to complete. 
Stakeholder Interviews will include 8 persons from each of the 18 
CHIPRA demonstration States and also take an hour to complete. Health 
Care Provider Interviews will be conducted with 12 persons from each of 
the 18 CHIPRA demonstration States and will last 45 minutes. Non-
demonstration States Interviews will be conducted with 5 persons from 9 
non-demonstration States and will take about 1 hour to complete. The 
total burden for this evaluation is estimated to be 855 hours.
    Exhibit 2 shows the estimated annualized cost burden associated 
with the respondent's time to participate in this evaluation. The total 
cost burden is estimated to be $32,914.

                                                      Exhibit 1--Estimated Annualized Burden Hours
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                             Number of
                      Data collection                          Number of  respondents        Number of     responses per     Hours per     Total burden
                                                                                              states        respondent       response          hours
--------------------------------------------------------------------------------------------------------------------------------------------------------
Key Staff Interviews: Implementation......................                             4              18               2             1.5             216
Staff Interviews: Stakeholder.............................                            16              18               1               1             288
Interviews: Health Care...................................                             8              18               1               1             144
Provider Interviews: Non-demonstration....................                            12              18               1           45/60             162
States Interviews.........................................                             5               9               1               1              45
                                                           ---------------------------------------------------------------------------------------------
    Total.................................................                            45              na              na              na             855
--------------------------------------------------------------------------------------------------------------------------------------------------------


                                                       Exhibit 2--Estimated Annualized Cost Burden
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                             Number of     Total burden       Average       Total cost
                      Data collection                          Number of  respondents         states           hours       hourly wage *      burden
--------------------------------------------------------------------------------------------------------------------------------------------------------
Key Staff Interviews: Implementation......................                             4              18             216          $36.35          $7,852
Staff Interviews: Stakeholder.............................                            16              18             288           34.67           9,985
Interviews: Health Care Provider..........................                             8              18             144           18.68           2,690
Interviews: Non-demonstration.............................                            12              18             162           62.50          10,125
States Interviews.........................................                             5               9              45           50.26           2,262
                                                           ---------------------------------------------------------------------------------------------
    Total.................................................                            45              na             855              na          32,914
--------------------------------------------------------------------------------------------------------------------------------------------------------
* Based upon the mean of the average wages, National Compensation Survey: Occupational wages in the United States May 2009, ``U.S. Department of Labor,
  Bureau of Labor Statistics.'' Key project staff are state government workers who are general managers. Other implementation personnel are state
  workers who are managers of social and community services. External stakeholders are civilian workers who are in community and social services
  occupations. Participant providers are civilian pediatric physicians. Medicaid/CHIP personnel are federal employees in a medical and health service
  management role.


[[Page 46811]]

Estimated Annual Costs to the Federal Government

    Exhibit 3 shows the total and annualized cost for this evaluation. 
The total cost to the government of the entire evaluation contract is 
$8,258,311 (including a base period and four option periods); the 
annualized cost is $1,651,662 per year (Exhibit 3). These costs will be 
incurred from 2010 to 2012.

               Exhibit 3--Estimated Total and Annual Cost
------------------------------------------------------------------------
             Cost component                 Total cost      Annual cost
------------------------------------------------------------------------
Administration..........................        $571,422        $114,284
Coordination............................          38,003           7,601
Stakeholder Feedback....................         201,637          40,327
Technical Expert Panel..................         359,276          71,855
Evaluation Design & Implementation......       3,981,390         796,278
Technical Assistance Plan...............         934,440         186,888
Data Collection Instruments.............         138,997          27,799
OMB Clearance...........................          35,617          17,808
Section 508 Compliance..................          13,883           2,777
Data and Analysis Reports...............         735,426         147,085
Interim Evaluation Reports..............         408,803          81,761
Dissemination...........................         736,149         184,037
Final Report............................         103,269         103,269
                                         -------------------------------
    Total...............................       8,258,311       1,651,662
------------------------------------------------------------------------

Request for Comments

    In accordance with the Paperwork Reduction Act, comments on AHRQ's 
information collection are requested with regard to any of the 
following: (a) Whether the proposed collection of information is 
necessary for the proper performance of AHRQ healthcare research and 
healthcare information dissemination functions, including whether the 
information will have practical utility; (b) the accuracy of AHRQ's 
estimate of burden (including hours and costs) of the proposed 
collection(s) of information; (c) ways to enhance the quality, utility, 
and clarity of the information to be collected; and (d) ways to 
minimize the burden of the collection of information upon the 
respondents, including the use of automated collection techniques or 
other forms of information technology.
    Comments submitted in response to this notice will be summarized 
and included in the Agency's subsequent request for OMB approval of the 
proposed information collection. All comments will become a matter of 
public record.

    Dated: July 21, 2011.
Carolyn M. Clancy,
Director.
[FR Doc. 2011-19391 Filed 8-2-11; 8:45 am]
BILLING CODE 4160-90-M