[Federal Register Volume 80, Number 98 (Thursday, May 21, 2015)]
[Notices]
[Pages 29323-29325]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-12308]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Administration for Community Living
[CFDA Number: 84.133B-6]
Final Priority. National Institute on Disability, Independent
Living, and Rehabilitation Research--Rehabilitation Research and
Training Centers
AGENCY: Administration for Community Living, Department of Health and
Human Services.
ACTION: Final priority.
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SUMMARY: The Administrator of the Administration for Community Living
announces a priority for the Rehabilitation Research and Training
Center (RRTC) Program administered by the National Institute on
Disability, Independent Living, and Rehabilitation Research (NIDILRR).
Specifically, we announce a priority for an RRTC on Outcomes
Measurement for Home and Community Based Services. The Administrator of
the Administration for Community Living may use this priority for
competitions in fiscal year (FY) 2015 and later years. We take this
action to focus research attention on an area of national need. We
intend for this priority to contribute to improved home and community
based services for individuals with disabilities.
DATES: Effective Date: This priority is effective June 22, 2015.
FOR FURTHER INFORMATION CONTACT: Marlene Spencer, U.S. Department of
Health and Human Services, 400 Maryland Avenue SW., Room 5133, Potomac
Center Plaza (PCP), Washington, DC 20202-2700. Telephone: (202) 245-
7532 or by email: [email protected].
If you use a telecommunications device for the deaf (TDD) or a text
telephone (TTY), call the Federal Relay Service (FRS), toll free, at 1-
800-877-8339.
SUPPLEMENTARY INFORMATION:
Purpose of Program: The purpose of the Disability and
Rehabilitation Research Projects and Centers Program is to plan and
conduct research, demonstration projects, training, and related
activities, including international activities, to develop methods,
procedures, and rehabilitation technology that maximize the full
inclusion and integration into society, employment, independent living,
family support, and economic and social self-sufficiency of individuals
with disabilities, especially individuals with the most severe
disabilities, and to improve the effectiveness of services authorized
under the Rehabilitation Act of 1973, as amended (Rehabilitation Act).
Rehabilitation Research and Training Centers
The purpose of the RRTCs, which are funded through the Disability
and Rehabilitation Research Projects and Centers Program, is to achieve
the goals of, and improve the effectiveness of, services authorized
under the Rehabilitation Act through well-designed research, training,
technical assistance, and dissemination activities in important topical
areas as specified by NIDILRR. These activities are designed to benefit
rehabilitation service providers, individuals with disabilities, family
members, policymakers and other research stakeholders. Additional
information on the RRTC program can be found at: http://www2.ed.gov/programs/rrtc/index.html#types.
Program Authority: 29 U.S.C. 762(g) and 764(b)(2)(A).
Applicable Program Regulations: 34 CFR part 350.
We published a notice of proposed priority (NPP) for this program
in the Federal Register on February 25, 2015 (80 FR 10099). That notice
contained background information and our reasons for proposing the
particular priority.
There are differences between the proposed priority and this final
priority.
Public Comment: In response to our invitation in the notice of
proposed priority, one party submitted comments on the proposed
priority.
Generally, we do not address technical and other minor changes. In
addition, we do not address general comments that raised concerns not
directly related to the proposed priority.
Analysis of the Comments and Changes: An analysis of the comments
and of any changes in the priority since publication of the NPP
follows.
Comment: One commenter asked whether the RRTC's work should apply
to elderly users of home and community based services (HCBS), as well
as people with disabilities who use HCBS.
Discussion: NIDILRR's priority does not specify the age range of
people with disabilities who are to be the focus of the RRTC's work.
Throughout the priority we refer to people with disabilities, or people
with disabilities who use or receive HCBS. NIDILRR's ultimate intent is
to build HCBS outcomes measurement capacity that is relevant to HCBS
recipients of all ages. Given the early stage of outcomes development
work in this area, the limited resources of this RRTC, and the broad
populations served by HCBS, it is up to applicants to describe their
target population(s) of HCBS users. The peer review process will
determine the merits of each application.
Changes: None.
Comment: One commenter agreed with the priority's requirement that
measures to be developed by the RRTC should minimize data collection
burden on HCBS recipients. At the same time, the commenter noted the
critical importance of gathering information directly from HCBS users
to determine the impact of those services on the quality of their
lives. The commenter cautioned NIDILRR and the eventual RRTC against
minimizing data collection burden to such an extent that data on HCBS
users' experiences and outcomes aren't available for such quality
improvement purposes.
Discussion: NIDILRR agrees with the commenter that gathering
outcomes information directly from HCBS recipients is critically
important. The priority consistently emphasizes the importance of
creating outcome measurement tools that focus on HCBS users'
experiences and outcomes. By requiring the RRTC to minimize data
collection burden on HCBS end users, NIDILRR is simply recognizing the
potential for lengthy, duplicative, and overly burdensome data
collection methods. With this requirement we are also highlighting the
existence of advanced item-scaling and person-centered measurement
techniques such as computerized adaptive tests, as well as the
existence of administrative data that can be relevant to the
measurement of person-centered outcomes.
Changes: None.
Comment: One commenter noted that different groups of HCBS users
have different needs, and that the importance placed on different
outcome domains may vary across subgroups of HCBS users. The commenter
questioned whether the measures developed by the RRTC should be
tailored to the needs of subgroups of HCBS users.
Discussion: NIDILRR agrees with the commenter that different
subgroups of HCBS users may have outcome domains
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that are particularly important to them. Given the early stage of
outcomes development work in this area, the limited resources of this
RRTC, and the broad populations served by HCBS, it is up to applicants
to describe their target population(s) of HCBS users. It is also up to
applicants to describe the extent to which their proposed outcomes
development work will address potential variation in how subgroups
prioritize different HCBS outcome domains. The peer review process will
determine the merits of each application.
Changes: None.
Comment: One commenter asked whether NIDILRR intends the RRTC to
evaluate interventions to determine whether they are associated with
positive HCBS outcomes.
Discussion: NIDILRR does not intend the RRTC to evaluate
interventions to determine whether they are associated with positive
HCBS outcomes. The primary intent of the research requirements under
paragraph (a) is the development and testing of HCBS outcome measures--
which will serve as infrastructure for future testing of interventions.
Changes: NIDILRR has made minor modifications to paragraph (a) to
clarify that our intent for this RRTC is the development and testing of
HCBS outcome measures--and not the testing of HCBS interventions.
Comment: One commenter recommended that the RRTC be required to
provide technical assistance to a range of stakeholders, with the aim
of promoting the use of new HCBS outcomes measures and resulting data
for HCBS system improvement.
Discussion: NIDILRR agrees that technical assistance toward
promoting the use of new HCBS outcomes measures is an important task
for the RRTC. In the opening paragraph of the priority we state that
``Ultimately, the RRTC's development of non-medical, person-centered
outcome measures is intended to inform the design, implementation, and
continuous improvement of Federal and state policies and programs
related to the delivery of HCBS to people with disabilities.''
Paragraph (b)(3) requires direct collaboration with a wide range of
stakeholder groups to develop, evaluate, or implement strategies to
increase the use of new HCBS outcomes measures. Similarly, paragraph
(c)(1) requires the provision of technical assistance related to HCBS
outcome and measurement.
Changes: None.
Comment: One commenter recommended that the RRTC develop data
formats that are accessible to a range of stakeholders.
Discussion: The primary aim of this priority is the development and
testing of person-centered HCBS outcome measures that generate data
that is reliable, valid, and usable. This foundational work of creating
reliable and valid HCBS outcomes measures precedes the development of
databases and multiple data formats. While some applicants may choose
to specify the formats of data that new outcomes measures can generate,
the RRTC has no basis for requiring all applicants to take this step.
Changes: None.
Final Priority
The Administrator of the Administration for Community Living
establishes a priority for the RRTC on Outcomes Measurement for Home
and Community Based Services. The RRTC will engage in research,
development, and testing of measures to assess the quality of HCBS in
terms of the person-centered outcomes achieved by people with
disabilities who use the services in home and community settings. The
RRTC will also engage in knowledge translation, development of
informational products, and dissemination to enhance the field's
capacity to measure the extent to which HCBS leads to improved outcomes
in community living and independent living areas that are important to
people with disabilities and other stakeholders.
Ultimately, the RRTC's development of non-medical, person-centered
outcome measures is intended to inform the design, implementation, and
continuous improvement of Federal and state policies and programs
related to the delivery of HCBS to people with disabilities. The RRTC
must contribute to these outcomes by:
(a) Identifying or developing measures, and then testing the
reliability, validity, and usability of those proposed measures to
assess the person-centered outcomes of individuals with disabilities
who are receiving home and community-based services. HCBS measures
developed under this priority must be non-medical and must focus on the
end-users' experience of community living, independent living, social
integration, community participation, and other similar outcomes. The
measures developed under this priority must also be designed to
minimize data collection burden on HCBS recipients. Possible methods
for minimizing this burden include, but are not limited to, use of
relevant administrative data, modifying administrative data to include
person-centered goals as well as fields to assess progress toward those
goals, and use of advanced item-scaling and person-centered measurement
techniques that can be implemented as computerized adaptive tests
(CAT).
(b) Increasing incorporation of the RRTC's HCBS outcome measures
into practice and policy. The RRTC must contribute to this outcome by--
(1) Working closely with NIDILRR and the Administration for
Community Living (ACL) at each stage of the measure development and
testing processes to ensure that its activities are informing and
informed by other HCBS quality initiatives taking place within ACL and
other relevant Federal and state agencies. This specifically includes
the work taking place under the National Quality Forum's work with the
Department of Health and Human Services (http://www.qualityforum.org/ProjectDescription.aspx?projectID=77692).
(2) Developing procedures and mechanisms for applying HCBS outcome
measures in policy and service delivery settings to maximize quality
and appropriateness of HCBS from the end-user perspective.
(3) Collaborating with stakeholder groups to develop, evaluate, or
implement strategies to increase utilization of new HCBS outcome
measures. Stakeholder groups include but, are not limited to, people
with disabilities, Federal- and state-level policymakers; home and
community based service providers; advocacy organizations; and Centers
for Independent Living.
(4) Collaborating with relevant NIDILRR-sponsored knowledge
translation grantees to help promote the uptake of RRTC products by
relevant stakeholders and embed the outcome measures into the overall
health care measurement system.
(c) Serving as a national resource center related to person-
centered measurement of HCBS outcomes:
(1) Disseminating information and providing technical assistance
related to HCBS outcome and quality measurement to policymakers,
service providers, people with disabilities and their representatives,
and other key stakeholders; and
(2) Providing relevant and appropriate training, including
graduate, pre-service, and in-service training, to HCBS providers,
researchers and quality-measurement personnel, and other disability
service providers, to facilitate more effective delivery of HCBS to
people with disabilities. This training may be provided through
conferences, workshops, public education programs,
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in-service training programs, and similar activities.
Types of Priorities
When inviting applications for a competition using one or more
priorities, we designate the type of each priority as absolute,
competitive preference, or invitational through a notice in the Federal
Register. The effect of each type of priority follows:
Absolute priority: Under an absolute priority, we consider only
applications that meet the priority (34 CFR 75.105(c)(3)).
Competitive preference priority: Under a competitive preference
priority, we give competitive preference to an application by (1)
awarding additional points, depending on the extent to which the
application meets the priority (45 CFR part 75); or (2) selecting an
application that meets the priority over an application of comparable
merit that does not meet the priority (45 CFR part 75).
Invitational priority: Under an invitational priority, we are
particularly interested in applications that meet the priority.
However, we do not give an application that meets the priority a
preference over other applications (45 CFR part 75).
This notice does not preclude us from proposing additional
priorities, requirements, definitions, or selection criteria, subject
to meeting applicable rulemaking requirements.
Note: This notice does not solicit applications. In any year in
which we choose to use this priority, we invite applications through
a notice in the Federal Register.
Executive Orders 12866 and 13563
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by the Department.
Dated: May 18, 2015.
John Tschida,
Director, National Institute on Disability, Independent Living, and
Rehabilitation Research.
[FR Doc. 2015-12308 Filed 5-20-15; 8:45 am]
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