80 FR 10106 - Proposed Priority-National Institute on Disability, Independent Living, and Rehabilitation Research-Rehabilitation Research and Training Centers

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Administration for Community Living

Federal Register Volume 80, Issue 37 (February 25, 2015)

The Administrator of the Administration for Community Living proposes 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, this notice proposes a priority for an RRTC on Self- Directed Care to Promote Recovery, Health, and Wellness for Individuals with Serious Mental Illness. We take this action to focus research attention on an area of national need. We intend this priority to contribute to improved employment for individuals with serious mental illness (SMI) and co-occurring conditions.

[Federal Register Volume 80, Number 37 (Wednesday, February 25, 2015)]
[Notices]
[Pages 10106-10111]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2015-03880]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration for Community Living

[CFDA Number: 84.133B-4]


Proposed Priority--National Institute on Disability, Independent 
Living, and Rehabilitation Research--Rehabilitation Research and 
Training Centers

AGENCY: Administration for Community Living.

ACTION: Notice of proposed priority.

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SUMMARY: The Administrator of the Administration for Community Living 
proposes 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, this notice proposes a priority for an RRTC on Self-
Directed Care to Promote Recovery, Health, and Wellness for Individuals 
with Serious Mental Illness. We take this action to focus research 
attention on an area of national need. We intend this priority to 
contribute to improved employment for individuals with serious mental 
illness (SMI) and co-occurring conditions.

DATES: We must receive your comments on or before March 27, 2015.

ADDRESSES: Submit your comments through the Federal eRulemaking Portal 
or via postal mail, commercial delivery, or hand delivery. We will not 
accept comments submitted by fax or by email or those submitted after 
the comment period. To ensure that we do not receive duplicate copies, 
please submit your comments only once. In addition, please include the 
Docket ID at the top of your comments.
     Federal eRulemaking Portal: Go to www.regulations.gov to 
submit your comments electronically. Information on using 
Regulations.gov, including instructions for accessing agency documents, 
submitting comments, and viewing the docket, is available on the site 
under ``Are you new to the site?''
     Postal Mail, Commercial Delivery, or Hand Delivery: If you 
mail or deliver your comments about these proposed regulations, address 
them to Patricia Barrett, U.S. Department of Health and Human Services, 
400 Maryland Avenue SW., Room 5142, Potomac Center Plaza (PCP), 
Washington, DC 20202-2700.

    Privacy Note:  The Department's policy is to make all comments 
received from members of the public available for public viewing in 
their entirety on the Federal eRulemaking Portal at 
www.regulations.gov. Therefore, commenters should be careful to 
include in their comments only information that they wish to make 
publicly available.


FOR FURTHER INFORMATION CONTACT: Patricia Barrett. Telephone: (202) 
245-6211 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: This notice of proposed priority is in 
concert with NIDRR's currently approved Long-Range Plan (Plan). The 
Plan, which was published in the Federal Register on April 4, 2013 (78 
FR 20299), can be accessed on the Internet at the following site: 
www.ed.gov/about/offices/list/osers/nidrr/policy.html.
    The Plan identifies a need for research and training regarding 
employment of individuals with disabilities. To address this need, 
NIDILRR seeks to: (1) Improve the quality and utility of disability and

[[Page 10107]]

rehabilitation research; (2) foster an exchange of research findings, 
expertise, and other information to advance knowledge and understanding 
of the needs of individuals with disabilities and their family members, 
including those from among traditionally underserved populations; (3) 
determine effective practices, programs, and policies to improve 
community living and participation, employment, and health and function 
outcomes for individuals with disabilities of all ages; (4) identify 
research gaps and areas for promising research investments; (5) 
identify and promote effective mechanisms for integrating research and 
practice; and (6) disseminate research findings to all major 
stakeholder groups, including individuals with disabilities and their 
family members in formats that are appropriate and meaningful to them.
    This notice proposes one priority that NIDILRR intends to use for 
one or more competitions in fiscal year (FY) 2015 and possibly later 
years. NIDILRR is under no obligation to make an award under this 
priority. The decision to make an award will be based on the quality of 
applications received and available funding. NIDILRR may publish 
additional priorities, as needed.
    Invitation to Comment: We invite you to submit comments regarding 
this proposed priority. To ensure that your comments have maximum 
effect in developing the final priority, we urge you to identify 
clearly the specific topic within the priority that each comment 
addresses.
    We invite you to assist us in complying with the specific 
requirements of Executive Orders 12866 and 13563 and their overall 
requirement of reducing regulatory burden that might result from this 
proposed priority. Please let us know of any further ways we could 
reduce potential costs or increase potential benefits while preserving 
the effective and efficient administration of the program.
    During and after the comment period, you may inspect all public 
comments by following the instructions found under the ``Are you new to 
the site?'' portion of the Federal eRulemaking Portal at 
wwww.regulations.gov. Any comments sent to NIDILRR via postal mail, 
commercial deliver, or hand delivery can be viewed in room 5142, 550 
12th Street SW., PCP, Washington, DC, between the hours of 8:30 a.m. 
and 4:00 p.m., Washington, DC time, Monday through Friday of each week 
except Federal holidays.
    Assistance to Individuals With Disabilities in Reviewing the 
Rulemaking Record: On request we will provide an appropriate 
accommodation or auxiliary aid to an individual with a disability who 
needs assistance to review the comments or other documents in the 
public rulemaking record for this notice. If you want to schedule an 
appointment for this type of accommodation or auxiliary aid, please 
contact the person listed under FOR FURTHER INFORMATION CONTACT.
    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).
    Applicable Program Regulations: 34 CFR part 350.
    Proposed Priority: This notice contains one proposed priority.

RRTC on Self-Directed Care To Promote Recovery, Health, and Wellness 
for Individuals With Serious Mental Illness

Background

    Mental health disorders are one of the leading causes of disability 
in the United States. In 2012, there were an estimated 9.6 million 
adults aged 18 or older in the U.S. with serious mental illness, 
representing 4.1 percent of all U.S. adults (U.S. Department of Health 
and Human Services, 2012a). Most individuals with mental illness today 
live in community settings--a result of the deinstitutionalization 
movement of the 1960s to 1980s, the Americans with Disabilities Act of 
1990, and the 1999 U.S. Supreme Court Olmstead decision (National 
Council on Disability, 2008; Olmstead v. L.C., 527 U.S. 581 (1999); 
Salzer, Kaplan, & Atay, 2006). Individuals with mental illness are less 
likely to achieve successful employment outcomes than individuals 
without mental illness (Cook, 2006). For those who are employed, mental 
illness is associated with decreased productivity and lower levels of 
job retention (Cook, 2006; Lerner et al., 2012). In addition, 
individuals with mental illness experience higher mortality rates and 
poorer physical health than individuals without mental illness (Banham 
& Gilbody, 2010). This disparity in general health is exacerbated by 
barriers to healthcare delivery services for individuals with mental 
illness, at both the system and the individual levels (Kelly et al., 
2014). Furthermore, employment outcomes and health are related in this 
population. At the individual level, mental illness symptoms and 
comorbid medical conditions are associated with poorer employment 
outcomes (Cook et al., 2007; Frey et al., 2008). At the system level, 
the relations among health care systems, and those between employment 
service systems and health care systems, are complex (Frey et al., 
2008; Kelly et al., 2014).
    Over the last few decades, the concept of self-determination has 
become more widespread in the design and conceptualization of services 
for individuals with mental illness. In this context, self-
determination refers to individuals' rights to direct their own 
services, to be involved in decisions that impact their wellbeing, to 
be meaningfully involved in the design, delivery and evaluation of 
services and supports, and to develop and use their own personal goals 
to guide their lives and actions (Cook & Jonikas, 2002). Self-
determination is a central component of the Substance Abuse and Mental 
Health Services Administration's definition of recovery (U.S. 
Department of Health and Human Services, 2012b) and has become an 
important component of recovery-oriented mental health treatment and 
services. It is closely related to the guiding principle of informed 
choice in vocational rehabilitation and supported employment (Drake, 
Bond & Becker, 2012; Workforce Innovation and

[[Page 10108]]

Opportunity Act of 2014). In the field of general health care, self-
determination principles are reflected in the concept of self-direction 
(e.g., Centers for Medicare and Medicaid Services, no date). Principles 
of self-determination can be incorporated into many types of services 
and supports for individuals with mental illness and into efforts to 
address system and individual-level barriers to health and employment 
services.
    At the system level, the self-determination approach in health care 
has informed systems in which individuals with disabilities control the 
services they receive. These systems are known by a variety of names, 
(e.g., person-centered funding, person-directed services, participant-
directed services, cash and counseling) (Barczyk & Lincove, 2010; 
O'Brien et al., 2005; Powers & Sowers, 2006; Robert Wood Johnson 
Foundation, 2006). When the system is designed for individuals with 
serious mental illness, this type of service is frequently referred to 
as self-directed care. It uses public funds to provide individuals with 
the cash value of services and allows individuals to choose, organize, 
and purchase services (Alakeson, 2008), thereby providing both self-
direction and a mechanism to purchase services and goods traditionally 
covered by different funding sources. Individuals may choose services 
and supports that are not traditionally provided in the mental health 
system, such as wellness services, transportation, medical or dental 
services, and tangible items that support community participation (Cook 
et al., 2008). Individuals are provided with assistance to help them 
develop their own individual service plans and budgets. The mechanism 
involved can vary, (e.g., direct payments, individual budgets, flexible 
funds). Early data on the effectiveness of this approach for 
individuals with mental illness suggest that self-directed care can 
yield positive results for a variety of outcomes, including employment, 
quality of life, and service use (Alakeson, 2008; Cook et al., 2008; 
O'Brien et al., 2005; Webber et al., 2014). However, self-directed care 
has been implemented in few States, and very little is known about the 
effectiveness of this approach for many recovery-oriented outcomes, 
such as employment.
    Other system-level approaches to improving both access to health 
care and the health of individuals with mental illness have 
incorporated principles of care coordination to integrate mental health 
services with general medical services (Barry & Huskamp, 2014; Croft & 
Parish, 2012; Druss et al., 2010; Kelly et al., 2014; Mechanic, 2014). 
Services provided through care coordination models can bridge the gap 
between mental health and general health services and improve outcomes 
both in mental and in general medical health (Woltmann et al., 2012). 
Although care coordination organizations do not necessarily incorporate 
self-determination features, they can do so. For example, care 
coordination models may include illness self management programs, which 
train individuals on how to manage their symptoms and improve their 
functioning and quality of life. In fact, the Improving Chronic Illness 
Care Initiative includes illness self-management as a core feature 
(Kelly et al., 2014; McDonald et al., 2007; Woltmann et al., 2012). 
Illness self-management interventions can be effective for people with 
mental illness dealing with general medical problems (Kelly et al., 
2014) or mental illness (Roe et al., 2009). In addition, there is 
preliminary evidence that mental illness self-management may have 
positive effects on employment outcomes (Michon, 2011).
    However, coordinated care systems can be complex for consumers to 
negotiate. Therefore, many systems provide staff who serve as 
navigators to help guide clients through the barriers of complex health 
care systems and provide support for consumers in such self-directed 
activities as developing plans and making choices. Early research 
indicates that provision of navigator services can improve health 
outcomes and use of medical services for individuals with mental 
illness (Griswold et al., 2010; Kelly et al., 2013). In addition, 
having peers serve either as navigators or to deliver mental or general 
healthcare interventions can be effective for individuals with mental 
illness (Brekke et al., 2013; Chinman et al., 2014; Kelly et al, 2014; 
Pitt et al., 2013).
    Research on the use of self-directed services and supports, and 
self-directed care, for individuals with mental illness is in 
preliminary stages. There is a need for better understanding of the 
optimal use of self-directed strategies in the integration of general 
health care and mental health care, as well as the optimal involvement 
of peer supports for people with serious mental illness.
    References:

Alakeson, V., (2008). Let patients control the purse strings. 
British Medical Journal, 336, 807-809.
Banham, L., & Gilbody, S. (2010). Smoking cessation in severe mental 
illness: What works? Addiction, 105(7), 1176-1189.
Barczyk, A.N., & Lincove, J.A. (2010). Cash and counseling: A model 
for self-directed care programs to empower individuals with serious 
mental illnesses. Social Work in Mental Health, 8(3), 209-224.
Barry, C.L., & Huskamp, H.A. (2011). Moving beyond parity--mental 
health and addiction care under the ACA. New England Journal of 
Medicine, 365(11), 973-975.
Brekke, J.S., Siantz, E., Pahwa, R., Kelly, E., Tallen, L., & 
Fulginiti, A. (2013). Reducing Health Disparities for People with 
Serious Mental Illness. Best Practices in Mental Health, 9(1), 62-
82.
Centers for Medicaid and Medicare Services. (no date). Self directed 
services. Retrieved from:  http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Self-Directed-Services.html.
Chinman, M., George, P., Dougherty, R.H., Daniels, A.S., Ghose, 
S.S., Swift, A., & Delphin-Rittmon, M.E. (2014). Peer support 
services for individuals with serious mental illnesses: assessing 
the evidence. Psychiatric Services, 65(4), 429-441.
Cook, J. (2006). Employment barriers for persons with psychiatric 
disabilities: Update of a report for the President's Commission. 
Psychiatric Services, 57(10), 1391-1405.
Cook, J.A., & Jonikas, J.A. (2002). Self-Determination Among Mental 
Health Consumers/Survivors Using Lessons From the Past to Guide the 
Future. Journal of Disability Policy Studies, 13(2), 88-96.
Cook, J.A., Razzano, L.A., Burke-Miller, J.K., Blyler, C.R., Leff, 
H.S., Mueser, K.T.,Gold, P.B., Goldberg, R.W., Shafer, M.S., Onken, 
S.J., McFarlane, W.R., Donegan, K., Carey, M.A., Kauffmann, C., & 
Grey, D.D. (2007). Effects of co-occurring disorders on employment 
outcomes in a multisite randomized study of supported employment for 
people with severe mental illness. Journal of Rehabilitation 
Research and Development, 44(6), 837.
Cook, J., Russell, C., Grey, D., & Jonikas, J. (2008). Economic 
grand rounds: A self-directed care model for mental health recovery. 
Psychiatric Services, 59(6), 600-602.
Croft, B., & Parish, S.L. (2013). Care integration in the patient 
protection and affordable care act: Implications for behavioral 
health. Administration and Policy in Mental Health and Mental Health 
Services Research, 40(4), 258-263.
Drake, R.E., Bond, G. R., & Becker, D. R. (2012). Individual 
placement and support: An evidence-based approach to supported 
employment. Oxford University Press.
Druss, B.G., Zhao, L., von Esenwein, S.A., Bona, J.R., Fricks, L., 
Jenkins-Tucker, S., Sterling, E., DiClemente, R., & Lorig, K. 
(2010). The Health and Recovery Peer (HARP) Program: a peer-led 
intervention to improve medical self-management for persons with 
serious mental illness. Schizophrenia Research, 118(1), 264-

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270.
Frey, W.D., Azrin, S.T., Goldman, H.H., Kalasunas, S., Salkever, 
D.S., Miller, A.L., Bond, G.R., & Drake, R.E. (2008). The mental 
health treatment study. Psychiatric Rehabilitation Journal, 31(4), 
306.
Griswold, K.S., Homish, G.G., Pastore, P.A., & Leonard, K.E. (2010). 
A randomized trial: Are care navigators effective in connecting 
patients to primary care after psychiatric crisis? Community Mental 
Health Journal, 46(4), 398-402.
Kelly, E.L., Fenwick, K.M., Barr, N., Cohen, H., & Brekke, J.S. 
(2014). A Systematic Review of Self-Management Health Care Models 
for Individuals With Serious Mental Illnesses. Psychiatric Services, 
65(11), 1300-1310.
Kelly, E., Fulginiti, A., Pahwa, R., Tallen, L., Duan, L., & Brekke, 
J.S. (2013). A pilot test of a peer navigator intervention for 
improving the health of individuals with serious mental illness. 
Community Mental Health Journal, 50(4), 435-446.
Lerner, D., Adler, D., Hermann, R.C., Chang, H., Ludman, E.J., 
Greenhill, A., Perch, K., McPeck, W.C., & Rogers, W.H. (2012). 
Impact of a work-focused intervention on the productivity and 
symptoms of employees with depression. Journal of Occupational and 
Environmental Medicine, 54(2), 128.
Mechanic, D. (2014). Seizing opportunities under the Affordable Care 
Act for transforming the mental and behavioral health system. Health 
Affairs, 31(2), 376-382.
Michon, H.W., Van Weeghel, J., Kroon, H., & Schene, A.H. (2011). 
Illness self-management assessment in psychiatric vocational 
rehabilitation. Psychiatric Rehabilitation Journal, 35(1), 21.
National Council on Disability (2008). Inclusive livable communities 
for people with psychiatric disabilities. Washington, DC: National 
Council on Disability. Retrieved from www.ncd.gov/publications/2008/03172008.
O'Brien, D., Ford, L., & Malloy, J. M. (2005). Person centered 
funding: Using vouchers and personal budgets to support recovery and 
employment for people with psychiatric disabilities. Journal of 
Vocational Rehabilitation, 23, 71-79.
Pitt, V., Lowe, D., Hill, S., Prictor, M., Hetrick, S.E., Ryan, R., 
& Berends, L. (2013). Consumer-providers of care for adult clients 
of statutory mental health services. Cochrane Database Systematic 
Reviews, 3.
Powers L.E., & Sowers, J. (2006). A cross-disability analysis of 
person-directed, long-term services. Journal of Disability Policy 
Studies, 17, 66-76.
Robert Wood Johnson Foundation (2006). Choosing independence: An 
overview of the cash and counseling model of self-directed personal 
assistance services. Princeton NJ: Robert Wood Johnson Foundation.
Roe, D., Hasson-Ohayon, I., Salyers, M.P., & Kravetz, S. (2009). A 
one year follow-up of illness management and recovery: Participants' 
accounts of its impact and uniqueness. Psychiatric Rehabilitation 
Journal, 32(4), 285-291.
Salzer, M., Kaplan, K., & Atay, J. (2006). State psychiatric 
hospital census after the 1999 Olmstead decision: Evidence of 
decelerating deinstitutionalization. Psychiatric Services, 57(10), 
1501-1504.
U.S. Department of Health and Human Services, Substance Abuse and 
Mental Health Services Administration (2012a). Results from the 2012 
National Survey on Drug Use and Health: Mental Health Findings. 
Retrieved from: http://www.samhsa.gov/data/sites/default/files/2k12MH_Findings/2k12MH_Findings/NSDUHmhfr2012.htm#sec2-2.
U.S. Department of Health and Human Services, Substance Abuse and 
Mental Health Services Administration (2012b). SAMHSA's Working 
Definition of Recovery. Retrieved from: http://store.samhsa.gov/shin/content//PEP12-RECDEF/PEP12-RECDEF.pdf.
Webber, M., Treacy, S., Carr, S., Clark, M., & Parker, G. (2014). 
The effectiveness of personal budgets for people with mental health 
problems: A systematic review. Journal of Mental Health, 23(3), 146-
155.
Woltmann, E., Grogan-Kaylor, A., Perron, B., Georges, H., Kilbourne, 
A.M., & Bauer, M.S. (2012). Comparative effectiveness of 
collaborative chronic care models for mental health conditions 
across primary, specialty, and behavioral health care settings: 
Systematic review and meta-analysis. American Journal of Psychiatry, 
169(8), 790-804.
Workforce Innovation and Opportunity Act of 2014. Public Law 113-
128.

Definitions

    The research that is proposed under this priority must be focused 
on one or more stages of research. If the RRTC is to conduct research 
that can be categorized under more than one research stage, or research 
that progresses from one stage to another, those research stages must 
be clearly specified. For purposes of this priority, the stages of 
research are from the notice of final priorities and definitions 
published in the Federal Register on June 7, 2013 (78 FR 34261).
    (a) Exploration and Discovery means the stage of research that 
generates hypotheses or theories by conducting new and refined analyses 
of data, producing observational findings, and creating other sources 
of research-based information. This research stage may include 
identifying or describing the barriers to and facilitators of improved 
outcomes of individuals with disabilities, as well as identifying or 
describing existing practices, programs, or policies that are 
associated with important aspects of the lives of individuals with 
disabilities. Results achieved under this stage of research may inform 
the development of interventions or lead to evaluations of 
interventions or policies. The results of the exploration and discovery 
stage of research may also be used to inform decisions or priorities.
    (b) Intervention Development means the stage of research that 
focuses on generating and testing interventions that have the potential 
to improve outcomes for individuals with disabilities. Intervention 
development involves determining the active components of possible 
interventions, developing measures that would be required to illustrate 
outcomes, specifying target populations, conducting field tests, and 
assessing the feasibility of conducting a well-designed interventions 
study. Results from this stage of research may be used to inform the 
design of a study to test the efficacy of an intervention.
    (c) Intervention Efficacy means the stage of research during which 
a project evaluates and tests whether an intervention is feasible, 
practical, and has the potential to yield positive outcomes for 
individuals with disabilities. Efficacy research may assess the 
strength of the relationships between an intervention and outcomes, and 
may identify factors or individual characteristics that affect the 
relationship between the intervention and outcomes. Efficacy research 
can inform decisions about whether there is sufficient evidence to 
support ``scaling-up'' an intervention to other sites and contexts. 
This stage of research can include assessing the training needed for 
wide-scale implementation of the intervention, and approaches to 
evaluation of the intervention in real world applications.
    (d) Scale-Up Evaluation means the stage of research during which a 
project analyzes whether an intervention is effective in producing 
improved outcomes for individuals with disabilities when implemented in 
a real-world setting. During this stage of research, a project tests 
the outcomes of an evidence-based intervention in different settings. 
It examines the challenges to successful replication of the 
intervention, and the circumstances and activities that contribute to 
successful adoption of the intervention in real-world settings. This 
stage of research may also include well-designed studies of an 
intervention that has been widely adopted in practice, but that lacks a 
sufficient evidence-base to demonstrate its effectiveness.

Proposed Priority

    The Administrator of the Administration for Community Living 
proposes a priority for the Rehabilitation Research and Training Center 
(RRTC) Program administered by

[[Page 10110]]

the National Institute on Disability, Independent Living, and 
Rehabilitation Research (NIDILRR). Specifically, this notice proposes a 
priority on Self-Directed Care to Promote Recovery, Health, and 
Wellness for Individuals with Serious Mental Illness. This RRTC will be 
jointly funded by NIDILRR and the Substance Abuse and Mental Health 
Services Administration. The RRTC will conduct research to develop, 
adapt, and enhance self-directed models of general medical, mental 
health, and nonmedical services that are designed to improve health, 
recovery, and employment outcomes for individuals with serious mental 
illness. The RRTC must conduct research, knowledge translation, 
training, dissemination, and technical assistance within a framework of 
consumer-directed services and self-management. Under this priority, 
the RRTC must contribute to the following outcomes:
    (1) Increased knowledge that can be used to enhance the health and 
well-being of individuals with serious mental illness and co-occurring 
conditions. The RRTC must contribute to this outcome by:
    (a) Conducting research to develop a better understanding of the 
barriers to and facilitators of implementing models that integrate 
general medical and mental health care for individuals with SMI. These 
models must incorporate self-management and self-direction strategies. 
This research must specifically examine models that incorporate peer-
provided services and supports along with research-based service 
integration strategies such as health navigation and care coordination.
    (b) Conducting research to identify or develop and then test 
interventions that use individual budgets or flexible funds to increase 
consumer choice. The RRTC must design this research to determine the 
extent to which the consumer-choice intervention improves health 
outcomes and promotes recovery among individuals living with SMI. In 
carrying out this activity, the grantee must investigate the 
applicability of strategies that have proven successful with the 
general population or other subpopulations to determine if they are 
effective with individuals with SMI and co-occurring conditions.
    (2) Improved employment outcomes among individuals with SMI. The 
RRTC must contribute to this outcome by:
    (a) Conducting research to develop a better understanding of the 
barriers to and facilitators of implementing vocational service and 
support models that incorporate self management and self-direction 
features. These features must include self-directed financing and 
flexible funding of services that support mental health treatment and 
recovery, general health, and employment. These services may include 
services and supports not traditionally supplied by mental health or 
general medical systems.
    (3) Increased incorporation of research findings related to SMI, 
self-directed care, health management, and employment into practice or 
policy.
    (a) Developing, evaluating, or implementing strategies to increase 
utilization of research findings related to SMI, co-occurring 
conditions, health management, and employment.
    (b) Conducting training, technical assistance, and dissemination 
activities to increase utilization of research findings related to 
self-directed care of individuals living with SMI to promote and co-
occurring conditions, health management, and employment.

Final Priority

    We will announce the final priority in a notice in the Federal 
Register. We will determine the final priority after considering 
responses to this notice and other information available to the 
Department. 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 or in a Funding Opportunity 
Announcement posted at www.grants.gov.

Executive Orders 12866 and 13563

Regulatory Impact Analysis

    Under Executive Order 12866, the Secretary must determine whether 
this regulatory action is ``significant'' and, therefore, subject to 
the requirements of the Executive Order and subject to review by the 
Office of Management and Budget (OMB). Section 3(f) of Executive Order 
12866 defines a ``significant regulatory action'' as an action likely 
to result in a rule that may--
    (1) Have an annual effect on the economy of $100 million or more, 
or adversely affect a sector of the economy, productivity, competition, 
jobs, the environment, public health or safety, or State, local, or 
tribal governments or communities in a material way (also referred to 
as an ``economically significant'' rule);
    (2) Create serious inconsistency or otherwise interfere with an 
action taken or planned by another agency;
    (3) Materially alter the budgetary impacts of entitlement grants, 
user fees, or loan programs or the rights and obligations of recipients 
thereof; or
    (4) Raise novel legal or policy issues arising out of legal 
mandates, the President's priorities, or the principles stated in the 
Executive Order.
    This proposed regulatory action is not a significant regulatory 
action subject to review by OMB under section 3(f) of Executive Order 
12866.
    We have also reviewed this regulatory action under Executive Order 
13563, which supplements and explicitly reaffirms the principles, 
structures, and definitions governing regulatory review established in 
Executive Order 12866. To the extent permitted by law, Executive Order 
13563 requires that an agency--
    (1) Propose or adopt regulations only upon a reasoned determination 
that their benefits justify their costs (recognizing that some benefits 
and costs are difficult to quantify);
    (2) Tailor its regulations to impose the least burden on society, 
consistent with obtaining regulatory objectives and taking into 
account--among other things and to the extent practicable--the costs of 
cumulative regulations;
    (3) In choosing among alternative regulatory approaches, select 
those approaches that maximize net benefits (including potential 
economic, environmental, public health and safety, and other 
advantages; distributive impacts; and equity);
    (4) To the extent feasible, specify performance objectives, rather 
than the behavior or manner of compliance a regulated entity must 
adopt; and
    (5) Identify and assess available alternatives to direct 
regulation, including economic incentives--such as user fees or 
marketable permits--to encourage the desired behavior, or provide 
information that enables the public to make choices.
    Executive Order 13563 also requires an agency ``to use the best 
available techniques to quantify anticipated present and future 
benefits and costs as accurately as possible.'' The Office of 
Information and Regulatory Affairs of OMB has emphasized that these 
techniques may include ``identifying changing future compliance costs 
that might result from technological innovation or anticipated 
behavioral changes.''
    We are issuing this proposed priority only upon a reasoned 
determination that its benefits would justify its costs. In choosing 
among alternative regulatory approaches, we selected those approaches 
that would maximize net benefits. Based on the analysis that follows, 
the Department believes that

[[Page 10111]]

this proposed priority is consistent with the principles in Executive 
Order 13563.
    We also have determined that this regulatory action would not 
unduly interfere with State, local, and tribal governments in the 
exercise of their governmental functions.
    In accordance with both Executive Orders, the Department has 
assessed the potential costs and benefits, both quantitative and 
qualitative, of this regulatory action. The potential costs are those 
resulting from statutory requirements and those we have determined as 
necessary for administering the Department's programs and activities.
    The benefits of the Disability and Rehabilitation Research Projects 
and Centers Program have been well established over the years. Projects 
similar to one envisioned by the proposed priority have been completed 
successfully, and the proposed priority would generate new knowledge 
through research. The new RRTC would generate, disseminate, and promote 
the use of new information that would improve recovery, health, and 
wellness outcomes for individuals with serious mental illness (SMI) and 
co-occurring conditions.
    Intergovernmental Review: This program is not subject to Executive 
Order 12372.
    Electronic Access to This Document: The official version of this 
document is the document published in the Federal Register. Free 
Internet access to the official edition of the Federal Register and the 
Code of Federal Regulations is available via the Federal Digital System 
at: www.thefederalregister.org/fdsys. At this site you can view this document, as well 
as all other documents of this Department published in the Federal 
Register, in text or Adobe Portable Document Format (PDF). To use PDF 
you must have Adobe Acrobat Reader, which is available free at the 
site.
    You may also access documents of the Department published in the 
Federal Register by using the article search feature at: 
www.federalregister.gov. Specifically, through the advanced search 
feature at this site, you can limit your search to documents published 
by the Department.

    Dated: February 19, 2015.
Kathy Greenlee,
Administrator.
[FR Doc. 2015-03880 Filed 2-24-15; 8:45 am]
BILLING CODE 4151-01-P