[Federal Register Volume 76, Number 195 (Friday, October 7, 2011)]
[Pages 62410-62412]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-25691]

[[Page 62410]]



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.
    This proposed information collection was previously published in 
the Federal Register on August 3rd, 2011 and allowed 60 days for public 
comment. One comment was 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 November 7, 2011.

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 
e-mail at [email protected] (attention: AHRQ's desk 
    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.

Clearance Officer, (301) 427-1477, or by e-mail at 
[email protected].


Proposed Project

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

    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 and appropriated funding 
under subsection (d) of Sec. 401(a) of the Children's Health Insurance 
Program Reauthorization Act of 2009 (CHIPRA) (Attachment A). 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 
    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.
    (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,

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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 providers' 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\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       Number of     responses per     Hours per     Total burden
                                    respondents       States        respondent       response          hours
Key Staff Interviews............               4              18               2             1.5             216
Implementation Staff Interviews.              16              18               1               1             288
Stakeholder Interviews..........               8              18               1               1             144
Health Care Provider Interviews.              12              18               1           45/60             162
Non-demonstration States                       5               9               1               1              45
    Total.......................              45              na              na              na             855

                                   Exhibit 2--Estimated Annualized Cost Burden
                                     Number of       Number of     Total burden   Average hourly    Total cost
         Data collection            respondents       States           hours          wage *          burden
Key Staff Interviews............               4              18             216          $36.35          $7,852
Implementation Staff Interviews.              16              18             288           34.67           9,985
Stakeholder Interviews..........               8              18             144           18.68           2,690
Health Care Provider Interviews.              12              18             162           62.50          10,125
Non-demonstration States                       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.

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     cost
Administration..................................    $571,422    $114,284

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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: September 26, 2011.
Carolyn M. Clancy,
[FR Doc. 2011-25691 Filed 10-6-11; 8:45 am]