[Federal Register Volume 78, Number 211 (Thursday, October 31, 2013)]
[Notices]
[Pages 65318-65321]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-25839]
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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: Qualitative Data Collection.'' In accordance with the
Paperwork Reduction Act, 44 U.S.C. 3501-3521, AHRQ invites the public
to comment on this proposed information collection.
This proposed information collection was previously published in
the Federal Register on July 31st, 2013 and allowed 60 days for public
comment. No comments were received. The purpose of this notice is to
allow an additional 30 days for public comment.
DATES: Comments on this notice must be received by December 2, 2013.
ADDRESSES: Written comments should be submitted to: AHRQ's OMB Desk
Officer by fax at (202) 395-6974 (attention: AHRQ's desk officer) or by
email at [email protected] (attention: AHRQ's desk officer).
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 email at
[email protected].
SUPPLEMENTARY INFORMATION:
Proposed Project
Evaluation of the Children's Health Insurance Program Reauthorization
Act of 2009 (CHIPRA) Quality Demonstration Grant Program: Qualitative
Data Collection
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 the collection of qualitative data through site visit
interviews and focus groups to support a comprehensive, mixed-methods
evaluation of the quality demonstration grants authorized under section
1139A(d) of the Act. AHRQ's mission of improving the quality and
effectiveness of health care in the United States aligns with
evaluating whether, and through what mechanism, projects funded by the
CHIPRA demonstration grants improve the quality of care received by
children in Medicaid and the Children's Health Insurance Program
(CHIP).
CHIPRA included funding for five-year grants so that States can
experiment with and evaluate several promising ideas related to
improving
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the quality of children's health care in Medicaid and CHIP. In February
2010, the Centers for Medicare & Medicaid Services (CMS) announced the
award of 10 demonstration grants to States that convincingly
articulated an achievable vision of what they could accomplish by the
end of the five-year grant period, described strategies they would use
to achieve the objectives, and explained how the strategies would
achieve the objectives. Applicants were encouraged by CMS to address
multiple grant categories (described below) and to partner with other
States in designing and implementing their projects.
Of the 10 grantee States selected, six 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 have implemented 51 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 pediatric quality
measures, including those in the initial core set of children's health
care quality measures (a group of measures developed for state Medicaid
and CHIP agencies to report in a standardized fashion to CMS). Category
B grantees are promoting health information technologies for improved
care delivery and patient outcomes. Category C grantees are
implementing the patient-centered medical home (PCMH) model of primary
care, working with school-based health centers (SBHCs) to improve care,
or using other provider-based service delivery models aimed at
improving care quality. 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 phase of the project will use qualitative
techniques such as in-depth interviews and focus groups.
The first round of interviews for the project was completed in an
earlier phase of the project in August of 2012 under an information
collection request approved by OMB on February 17th, 2012 (OMB Control
No. 0935-0190). While the first round of interviews focused on
demonstration goals and early strategies, the second round of
interviews described in this information collection request will focus
on demonstration outcomes and lessons learned. These interviews are
designed to build on the information gathered in the first round to
develop a complete picture of demonstration implementation.
AHRQ's goal in performing this evaluation of the CHIPRA Quality
Demonstration Grant Program is to produce insights into how best to
implement quality improvement programs as well as information on how
successful programs can be replicated to improve children's health care
quality in Medicaid and CHIP. The specific goals of this project are as
follows:
1. Develop a deep, systematic understanding of how CHIPRA
demonstration States carried out their grant-funded projects.
2. Understand why the CHIPRA demonstration States pursued certain
strategies.
3. 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.
4. Identify CHIPRA State activities that measurably improve the
nation's health care, especially as it pertains to children.
This study is being conducted by AHRQ through its contractor,
Mathematica Policy Research Inc., and their subcontractors, the Urban
Institute and AcademyHealth, pursuant to AHRQ's statutory authority to
conduct and support research on health care 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 meet the project goals AHRQ will implement the following data
collections:
1. Key Staff Interviews--Key staff members are staff directly
involved in the design and oversight of grant-funded activities. 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. Semi-structured interviews will be
conducted with up to 4 key staff members per state.
2. Implementation Staff Interviews--Other implementation staff are
staff involved in the day-to-day implementation of grant-funded
projects. 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. Semi-structured interviews will be conducted with up to
16 other implementation staff members per state.
3. Stakeholder Interviews--External stakeholders have a direct
interest in children's care quality in Medicaid and CHIP. 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. Semi-structured interviews will be
conducted with up to 8 external stakeholders per state.
4. Health Care Organization Staff Interviews--Depending on the
projects a state is implementing, health care organizations
participating in demonstration activities can include private
practices, public clinics, federally qualified health centers, care
management entities, or school based health centers. Interviews will
capture information about project-related activities, staff perceptions
of outcomes and impacts, and the organizations involvement in other
quality-improvement initiatives. Semi-structured interviews will be
conducted with up to 12 staff members per state.
5. Parent Focus Groups--We will hold in-person focus groups with
parents, guardians, or other caregivers of children who are enrolled in
Medicaid or CHIP and are served by the medical practices involved in
the CHIPRA demonstration. There will be four focus groups in four of
the twelve states implementing patient-centered medical home
demonstration projects. The number of participants per focus group will
range from 8 to 10, resulting in a maximum of 160 adults participating.
They will be conducted in English, and also in Spanish in states with
high proportions of Hispanic individuals covered by Medicaid.
6. Adolescent Focus Groups--We will hold in-person focus groups
with adolescents who are enrolled in Medicaid or CHIP and are served by
school-based health centers involved in the CHIPRA demonstration. There
will be four focus groups in one of the two
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states implementing school-based health center projects. The number of
participants per focus group will range from 8 to 10, resulting in a
maximum of 40 adolescents participating.
This evaluation is designed to develop a rich understanding of
States' implementation activities (goal 1), document the rationale for
the selection of particular strategies (goal 2), document provider and
parent reported behavior change (goal 3), and assess the perceived
impact of those changes on access, quality, and cost of care (goal 4).
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated annualized burden hours for the
respondents' time to participate in this evaluation. Key staff
interviews will be conducted with up to four persons from each of the
18 CHIPRA demonstration States (72 total) and will last for about 1\1/
2\ hours. Implementation staff interviews will include up to 16 persons
from each of the 18 CHIPRA demonstration States (288 total) and take an
hour to complete. Stakeholder interviews will include up to 8 persons
from each of the 18 CHIPRA demonstration States (144 total) and also
take an hour to complete. Health care provider interviews will be
conducted with up to 12 persons from each of the 18 CHIPRA
demonstration States and will last 45 minutes (216 total). About 229
parents will be screened to get a maximum of 160 parents to participate
in 16 focus groups across 4 States implementing PCMH-focused
demonstration projects. The screener takes 25 minutes to complete and
the focus group will last one and a half hours; the burden estimate of
2.5 hours includes one hour for travel time to and from the focus group
site.
About 57 adolescents will be screened to get up to 40 adolescents
to participate in four focus groups completed in one State with SBHC
demonstration projects. The screener takes 25 minutes to complete and
the focus group will last one and a half hours (travel time does not
apply because the focus groups will be held on school premises). The
total burden for the qualitative evaluation is estimated to be 1,281
hours.
Exhibit 1--Estimated Annualized Burden Hours
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Number of
Form name Number of responses per Hours per Total burden
respondents * respondent response hours
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Key Staff Interviews........................... 72 1 1.5 108
Implementation Staff Interviews................ 288 1 1 288
Stakeholder Interviews......................... 144 1 1 144
Health Care Provider Interviews................ 216 1 45/60 162
Parent Focus Group Screener.................... ** 229 1 25/60 95
Parent Focus Groups............................ 160 1 2.5 400
Adolescent Focus Group Screener................ ** 57 1 25/60 24
Adolescent Focus Groups........................ 40 1 1.5 60
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Total...................................... 1,206 na na 1,281
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* The number of respondents that will be interviewed in each state will vary depending on the number, scope,
complexity, and nature of the projects implemented. This table reflects upper bound estimates of total burden
hours and the number of respondents per type per state.
** Based on an expected 70% screen-in rate.
Exhibit 2 shows the estimated annualized cost burden associated
with the respondent's time to participate in this evaluation. The total
cost burden for the interviews and focus groups is estimated to be
$43,303.
Exhibit 2--Estimated Annualized Cost Burden
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Number of Total burden Average hourly Total cost
Form name respondents hours wage rate * burden
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Key Staff Interviews............................ 72 108 a $55.22 $5,964
Implementation Staff Interviews................. 288 288 b 30.99 8,925
Stakeholder Interviews.......................... 144 144 b 30.99 4,463
Health Care Provider Interviews................. 216 162 c 80.59 13,056
Parent Focus Group Screener..................... 229 95 d 22.01 2,091
Parent Focus Groups............................. 160 400 d 22.01 8,804
Adolescent Focus Group Screener................. 57 24 e 0 0.00
Adolescent Focus Groups......................... 40 60 e 0 0.00
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Total....................................... 1,206 1,281 na 43,303
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* National Compensation Survey: Occupational wages in the United States May 2012, ``U.S. Department of Labor,
Bureau of Labor Statistics.''
\a\ Based on the mean wages for general and operations manager (11-1021).
\b\ Based on the mean wages for social and community service managers (11-9151).
\c\ Based on the mean wages for general pediatricians (29-1065).
\d\ Based on the mean wages for all occupations.
\e\ Wage rates for adolescents are assumed to be zero.
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 health care research and
health care information dissemination functions, including whether the
information will have practical utility; (b) the accuracy of
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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: October 1, 2013.
Richard Kronick,
Director.
[FR Doc. 2013-25839 Filed 10-30-13; 8:45 am]
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