[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]
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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.
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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
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Number of
Data collection Number of respondents Number of responses per Hours per Total burden
states respondent response hours
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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
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Total................................................. 45 na na na 855
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Exhibit 2--Estimated Annualized Cost Burden
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Number of Total burden Average Total cost
Data collection Number of respondents states hours hourly wage * burden
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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
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Total................................................. 45 na 855 na 32,914
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* 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
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Cost component Total cost Annual cost
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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
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Total............................... 8,258,311 1,651,662
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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]
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