80_FR_13619 80 FR 13569 - Proposed Priority-National Institute on Disability, Independent Living, and Rehabilitation Research-Rehabilitation Research and Training Centers

80 FR 13569 - 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 50 (March 16, 2015)

Page Range13569-13573
FR Document2015-05989

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 Outcomes Measurement for Home and Community Based Services. We take this action to focus research attention on an area of national need. We intend this priority to contribute to improved home and community based services for individuals with disabilities.

Federal Register, Volume 80 Issue 50 (Monday, March 16, 2015)
[Federal Register Volume 80, Number 50 (Monday, March 16, 2015)]
[Notices]
[Pages 13569-13573]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2015-05989]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration for Community Living


Proposed 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: Notice of Proposed Priority.

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CFDA Number: 84.133B-6.

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 Outcomes 
Measurement for Home and Community Based Services. We take this action 
to focus research attention on an area of national need. We intend this 
priority to contribute to improved home and community based services 
for individuals with disabilities.

DATES: We must receive your comments on or before April 15, 2015.

ADDRESSES: Address all comments about this notice to Carolyn Baron, 
U.S. Department of Health and Human Services, 550 12th Street SW., Room 
5134, PCP, Washington, DC 20202-2700.
    If you prefer to send your comments by email, use the following 
address: carolyn.baron@ed.gov. You must include the phrase ``Proposed 
Priorities for RRTCs'' and the priority title in the subject line of 
your electronic message.
    We will not accept comments submitted by fax or those submitted 
after the comment period. To ensure that we do not receive duplicate 
copies, please submit your comments only once.
     Postal Mail or Commercial Delivery: If you mail or deliver 
your comments about these proposed regulations, address them to Carolyn 
Baron, U.S. Department of Health and Human Services, 400 Maryland 
Avenue SW., Room 5134, 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. Therefore, commenters should be careful to include in 
their comments only information that they wish to make publicly 
available.

FOR FURTHER INFORMATION CONTACT: Carolyn Baron. Telephone: (202) 245-
7244 or by email: carolyn.baron@ed.gov.
    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 NIDILRR'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.

[[Page 13570]]

    The Plan identifies a need for research and training that can be 
used to improve outcomes of individuals with disabilities. To address 
this need, NIDILRR seeks to: (1) Improve the quality and utility of 
disability and 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 E.O. 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 sent to NIDILRR 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 Outcomes Measurement for Home and Community Based Services

Background
    Approximately $140 billion is spent nationally on Medicaid long-
term services and supports (LTSS) (Eiken et al., 2014). States continue 
to rebalance their LTSS expenditures to decrease the reliance on 
nursing homes and other institutional services for individuals of all 
ages with disabilities. Nearly half of Medicaid's LTSS expenditures go 
toward home and community-based services (HCBS) compared to only 18% in 
1995 (Eiken et al., 2014). The aging of the population and growing 
consumer demand to live in home-based settings will continue to 
increase the need for home and community-based services (HCBS). As more 
people receive LTSS in the community, there is a need for validated 
measures of consumer outcomes and experiences that can be used as 
indicators of HCBS quality (Commission on Long Term Care, 2013; 
Disability Rights Education & Defense Fund, 2013). Compared to 
measurement efforts in clinical settings, non-medical performance 
measures in HCBS are in the early stages of development and 
standardization (National Quality Forum, 2012). Accordingly, NIDILRR is 
sponsoring a Rehabilitation Research and Training Center on Outcomes 
Measurement for Home and Community Based Services.
    Efforts to measure the quality of a wide variety of services, 
including home- and community-based LTSS, may include structural 
measures (whether a particular mechanism is in place), process measures 
(which track the performance of a particular action) and outcomes 
measures (the results of actions and mechanisms) (Disability Rights 
Education & Defense Fund, 2013; Booth & Fralich, 2006). In the long-
term care context, structural indicators of quality may include the 
ratio of service providers to consumers, for example, and process 
indicators of quality may include the skill levels of providers and the 
timeliness of the services they deliver (Disability Rights Education & 
Defense Fund, 2013). User outcomes are also important indicators of 
service quality. In the HCBS context, health status and levels of 
community integration, participation, and inclusion among service 
recipients can be important markers of HCBS quality (Disability Rights 
Education & Defense Fund, 2013).
    For decades, efforts to measure and improve long-term care quality 
have focused on nursing homes. Historically, the assessment of quality 
in nursing homes and other institutional long-term care settings 
emphasized the protection and safety of residents. As the delivery of 
LTSS is increasingly taking place in home and community-based settings, 
these institution-based quality measurement efforts have not been 
translated into measures that are relevant and important to individuals

[[Page 13571]]

who are receiving services at home (Commission on Long-Term Care, 
2013). While protection and safety are important to HCBS recipients, 
other factors are important and relevant in these settings, including 
levels of community integration, participation, and inclusion.
    As states continue to rebalance their LTSS expenditures to decrease 
reliance on nursing homes and increase service delivery in home and 
community-based settings, they have begun the process of developing 
person-centered HCBS measures that assess outcomes from the perspective 
of service users. The State of Wisconsin, for example, has developed 
and implemented a set of measures that assess ``person-centered quality 
of life'' outcomes that are important to HCBS users (Karon & Schlaak, 
2012). By seeking extensive input from service users and other 
stakeholders, Wisconsin has developed quality of life concepts and 
measures that are used to assess the extent to which (1) individuals 
have choice over their living arrangements and services, (2) 
individuals have desired social relationships and participate in 
meaningful ways in society, and (3) individuals are healthy and safe 
(Wisconsin Department of Health Services, 2014). Within this person-
centered outcomes measurement system, service users are able to choose 
the specific outcomes that are the most important to them and describe 
the extent to which the long-term care services they are receiving 
support their achievement of those outcomes. With this outcomes 
assessment system Wisconsin has developed state-wide quality of life 
outcomes reports that aggregate findings for all of its HCBS users, as 
well as reports that provide comparisons of outcomes across different 
HCBS programs and subpopulations (Karon & Schlaak, 2012).
    Recent efforts at the Federal level have begun to address the need 
for HCBS quality measures. For example, the Administration for 
Community Living (ACL) is contracting with the National Quality Forum 
(NQF) to create a conceptual framework for HCBS quality measurement and 
to make recommendations for HCBS measure development efforts. Through 
this work, ACL aims to create a conceptual foundation for the 
development of measures that can be used to assess and ultimately 
support independence and community living outcomes of HCBS recipients 
(National Quality Forum, 2015). Much work remains to conceptualize and 
measure HCBS quality in terms of the outcomes that are important to 
long-term care recipients. These outcomes include adequacy and 
appropriateness of care, as well as the consumers' level of control, 
social integration, social participation, and general quality of life 
(Kaye, 2014).
    Another foundation for the development of person-centered HCBS 
outcomes measures is the ongoing work of rehabilitation researchers to 
create valid and reliable measures of community participation of people 
with disabilities (Walker, Mellick, Brooks, & Whiteneck, 2003; Hammel, 
Magasi, Heinemann, Whiteneck, Bogner & Rodriguez, 2012; Whiteneck & 
Dijkers, 2009; Heinemann, 2010). These research and development efforts 
include the application of advanced item-scaling and person-centered 
measurement techniques that can be implemented as computerized adaptive 
tests (CAT) (Haley et al., 2008), thus reducing data collection burden 
on people with disabilities. These efforts to develop participation 
outcome measures for people with disabilities are highly relevant to 
the applied efforts to develop person-centered HCBS outcome measures.
    These and other Federal and state efforts provide a strong 
foundation for further research on and development of person-centered 
HCBS outcomes measures and measurement systems that assess and promote 
community living, independent living and social integration of HCBS 
users. Accordingly, NIDILRR aims to support a Rehabilitation Research 
and Training Center on Outcomes Measurement for Home and Community 
Based Services. This RRTC will conduct research and development 
activities in this critical area and will serve as a national resource 
center on HCBS outcomes measurement for Federal and state-level 
policymakers, people with disabilities and other key stakeholders.

References

Booth, M., Fralich, J. (2006). Performance Measurement: Managing and 
Using Home and Community-Based Services Data for Quality 
Improvement. University of Southern Maine: Muskie School of Public 
Service. http://muskie.usm.maine.edu/Publications/DA/Performance-Measurement-HCBS.pdf.
Commission on Long Term Care. (September 30, 2013). Report to the 
Congress. http://ltccommission.lmp01.lucidus.net/wp-content/uploads/2013/12/Commission-on-Long-Term-Care-Final-Report-9-26-13.pdf.
Disability Rights Education & Defense Fund (2013). Identifying and 
Selecting Long Term Services and Supports Outcomes Measures. http://dredf.org/2013-documents/Guide-LTSS-Outcome-Measures.pdf.
Eiken, Steve, et al. (2014). Medicaid Expenditures for Long-Term 
Services and Supports for FFY 2012. http://www.medicaid.gov/medicaid-chip-program-information/by-topics/long-term-services-and-supports/downloads/ltss-expenditures-2012.pdf.
Haley, S., Gandek, B., Siebens, H., Black-Schaffer, R., Sinclair, 
S., Tao, W., Coster, W., Ni, P., & Jette, A. (2008). Computerized 
Adaptive Testing for Follow-Up After Discharge From Inpatient 
Rehabilitation: Participation Outcomes. Archives of Physical 
Medicine and Rehabilitation. 89(2): 275-283.
Hammel, J., Magasi, S., Heinemann, A., Whiteneck, G., Bogner, & 
Rodriguez, E. (2008). What Does Participation Mean? An Insider 
Perspective From People With Disabilities. Disability and 
Rehabilitation. 30(19): 1445-1460.
Heinemann, A. (2010). Measurement of Participation in Rehabilitation 
Research. Archives of Physical Medicine and Rehabilitation. 91(9): 
S1-S4.
Karon, S., and Schlaak, M. (2012). PEONIES Member Interviews, State 
Fiscal Year 2012, Final Report. Madison, WI: Center for Health 
Systems Research and Analysis. http://www.chsra.wisc.edu/peonies/documents/PEONIES%20Final%20Report%20SFY2012%20-%20rev%2011-9-2012.pdf.
Kaye, H. Stephen. Toward a Model Long-Term Services and Supports 
System: State Policy Elements. The Gerontologist. (October 2014). 
http://gerontologist.oxfordjournals.org/content/54/5/754.full.pdf+html.
National Quality Forum (2015). Home and Community Based Services 
Quality. http://www.qualityforum.org/ProjectDescription.aspx?projectID=77692.
National Quality Forum, ``Measuring Healthcare Quality for the Dual 
Eligible Beneficiary Population, Measure Application Partnership, 
Final Report to HHS,'' June, 2012.
Walker, N., Mellick, D., Brooks, CA, Whiteneck, G. (2003). Measuring 
Participation Across Impairment Groups Using the Craig Handicap 
Assessment Reporting Technique. American Journal of Physical 
Medicine and Rehabilitation. 82(12): 936-941.
Whiteneck, G., & Dijkers, M. (2009). Difficult to Measure 
Constructs. Conceptual and Methodological Issues Concerning 
Participation and Environmental Factors. Archives of Physical 
Medicine and Rehabilitation. 90(11) S22-S35.
Wisconsin Department of Health Services (2014). Measuring Person-
Centered Quality. November 11, 2014: https://www.dhs.wisconsin.gov/familycare/reports/peonies.htm.

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

[[Page 13572]]

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 the National Institute on Disability, 
Independent Living, and Rehabilitation Research (NIDILRR). 
Specifically, this notice proposes a priority for an 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 
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

[[Page 13573]]

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, in-service training 
programs, and similar activities.

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 E.O. 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 E.O. 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 
E.O.
    This proposed regulatory action is not a significant regulatory 
action subject to review by OMB under section 3(f) of E.O. 12866.
    We have also reviewed this regulatory action under E.O. 13563, 
which supplements and explicitly reaffirms the principles, structures, 
and definitions governing regulatory review established in E.O. 12866. 
To the extent permitted by law, E.O. 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.
    E.O. 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 this proposed priority is consistent with 
the principles in E.O. 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 outcomes for individuals 
with disabilities in the area of home and community based services.
    Intergovernmental Review: This program is not subject to E.O. 
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: March 11, 2015.
Kathy Greenlee,
Administrator.
[FR Doc. 2015-05989 Filed 3-13-15; 8:45 am]
 BILLING CODE 4154-01-P



                                                                                         Federal Register / Vol. 80, No. 50 / Monday, March 16, 2015 / Notices                                                                         13569

                                               competing Continuation Progress Report                                     Final Progress Report. iEdison allows                              Government. Type of Respondents:
                                               (PHS 2590), exists for a small group of                                    grantees and Federal agencies to meet                              University administrators and principal
                                               grantees. This collection also includes                                    statutory requirements for reporting                               professionals. The annual reporting
                                               other PHS post-award reporting                                             inventions and patents. The PHS 3734                               burden is as follows: Total Estimated
                                               requirements: PHS 416–7 NRSA                                               serves as the official record of grantee                           Number of Respondents: 112,986.
                                               Termination Notice, PHS 2271                                               relinquishment of a PHS award when an                              Estimated Number of Responses per
                                               Statement of Appointment, 6031–1                                           award is transferred from one grantee                              Respondent: 1. Average Burden Hours
                                               NRSA Annual Payback Activities                                             institution to another. Pre-award                                  per Response: 5.6. Estimated Total
                                               Certification, HHS 568 Final Invention                                     reporting requirements are                                         Annual Burden Hours Requested:
                                               Statement and Certification, Final                                         simultaneously consolidated under                                  640,677. The annualized cost to
                                               Progress Report instructions, iEdison,                                     0925–0001. Frequency of response:                                  respondents is estimated to be
                                               and PHS 3734 Statement                                                     Applicants may submit applications for                             $22,423,709. There are no Capital Costs
                                               Relinquishing Interests and Rights in a                                    published receipt dates. For NRSA                                  to report. There are no Operating or
                                               PHS Research Grant. The PHS 416–7,                                         awards, fellowships are activated and                              Maintenance Costs to report.
                                               2271, and 6031–1 are used by NRSA                                          trainees appointed. Affected Public:                                 OMB approval is requested for 3
                                               recipients to activate, terminate, and                                     Universities and other research                                    years. There are no costs to respondents
                                               provide for payback of a NRSA.                                             institutions; Business or other for-profit;                        other than their time. The total
                                               Closeout of an award requires a Final                                      Not-for-profit institutions; Federal                               estimated annualized burden hours are
                                               Invention Statement (HHS 568) and                                          Government; and State, Local or Tribal                             640,677.

                                                                                                                                   ESTIMATES OF HOUR BURDEN
                                                                                                                                                                                                                  Average time
                                                                                                                                                                      Number of         Frequency of                              Annual burden
                                                                               Information collection No. or title                                                                                                  (hrs) per
                                                                                                                                                                     respondents          response                                   hours
                                                                                                                                                                                                                   response

                                               RPPR (or 2590 or 416–9) .............................................................................                          40,569                        1              15           608,535
                                               PHS 416–7 ....................................................................................................                  3,371                        1           30/60             1,686
                                               PHS 2271 ......................................................................................................                15,500                        1           15/60             3,875
                                               PHS 6031–1 ..................................................................................................                   1,600                        1           20/60               528
                                               HHS 568 ........................................................................................................               22,681                        1            5/60             1,814
                                               Final Progress Report ....................................................................................                     22,681                        1               1            22,681
                                               iEdison ...........................................................................................................             6,000                        1           15/60             1,500
                                               PHS 3734 ......................................................................................................                   584                        1            6/60                58

                                                     Totals ......................................................................................................           112,986   ........................             5.6         640,677



                                                 Dated: March 9, 2015.                                                    notice proposes a priority for an RRTC                             about these proposed regulations,
                                               Lawrence A. Tabak,                                                         on Outcomes Measurement for Home                                   address them to Carolyn Baron, U.S.
                                               Deputy Director, National Institutes of Health.                            and Community Based Services. We                                   Department of Health and Human
                                               [FR Doc. 2015–05929 Filed 3–13–15; 8:45 am]                                take this action to focus research                                 Services, 400 Maryland Avenue SW.,
                                               BILLING CODE 4140–01–P
                                                                                                                          attention on an area of national need.                             Room 5134, Potomac Center Plaza
                                                                                                                          We intend this priority to contribute to                           (PCP), Washington, DC 20202–2700.
                                                                                                                          improved home and community based                                     Privacy Note: The Department’s
                                               DEPARTMENT OF HEALTH AND                                                   services for individuals with                                      policy is to make all comments received
                                               HUMAN SERVICES                                                             disabilities.                                                      from members of the public available for
                                                                                                                          DATES:  We must receive your comments                              public viewing in their entirety.
                                               Administration for Community Living                                                                                                           Therefore, commenters should be
                                                                                                                          on or before April 15, 2015.
                                                                                                                                                                                             careful to include in their comments
                                               Proposed Priority—National Institute                                       ADDRESSES: Address all comments about                              only information that they wish to make
                                               on Disability, Independent Living, and                                     this notice to Carolyn Baron, U.S.                                 publicly available.
                                               Rehabilitation Research—                                                   Department of Health and Human
                                                                                                                                                                                             FOR FURTHER INFORMATION CONTACT:
                                               Rehabilitation Research and Training                                       Services, 550 12th Street SW., Room
                                               Centers                                                                    5134, PCP, Washington, DC 20202–                                   Carolyn Baron. Telephone: (202) 245–
                                                                                                                          2700.                                                              7244 or by email: carolyn.baron@ed.gov.
                                               AGENCY:  Administration for Community                                         If you prefer to send your comments                                If you use a telecommunications
                                               Living, Department of Health and                                           by email, use the following address:                               device for the deaf (TDD) or a text
                                               Human Services.                                                            carolyn.baron@ed.gov. You must                                     telephone (TTY), call the Federal Relay
                                               ACTION: Notice of Proposed Priority.                                       include the phrase ‘‘Proposed Priorities                           Service (FRS), toll free, at 1–800–877–
                                                                                                                          for RRTCs’’ and the priority title in the                          8339.
                                               CFDA Number: 84.133B–6.                                                    subject line of your electronic message.                           SUPPLEMENTARY INFORMATION:      This
                                               SUMMARY:  The Administrator of the                                            We will not accept comments                                     notice of proposed priority is in concert
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                                               Administration for Community Living                                        submitted by fax or those submitted                                with NIDILRR’s currently approved
                                               proposes a priority for the                                                after the comment period. To ensure                                Long-Range Plan (Plan). The Plan,
                                               Rehabilitation Research and Training                                       that we do not receive duplicate copies,                           which was published in the Federal
                                               Center (RRTC) Program administered by                                      please submit your comments only                                   Register on April 4, 2013 (78 FR 20299),
                                               the National Institute on Disability,                                      once.                                                              can be accessed on the Internet at the
                                               Independent Living, and Rehabilitation                                        • Postal Mail or Commercial Delivery:                           following site: www.ed.gov/about/
                                               Research (NIDILRR). Specifically, this                                     If you mail or deliver your comments                               offices/list/osers/nidrr/policy.html.


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                                               13570                         Federal Register / Vol. 80, No. 50 / Monday, March 16, 2015 / Notices

                                                  The Plan identifies a need for research              provide an appropriate accommodation                  their LTSS expenditures to decrease the
                                               and training that can be used to improve                or auxiliary aid to an individual with a              reliance on nursing homes and other
                                               outcomes of individuals with                            disability who needs assistance to                    institutional services for individuals of
                                               disabilities. To address this need,                     review the comments or other                          all ages with disabilities. Nearly half of
                                               NIDILRR seeks to: (1) Improve the                       documents in the public rulemaking                    Medicaid’s LTSS expenditures go
                                               quality and utility of disability and                   record for this notice. If you want to                toward home and community-based
                                               rehabilitation research; (2) foster an                  schedule an appointment for this type of              services (HCBS) compared to only 18%
                                               exchange of research findings, expertise,               accommodation or auxiliary aid, please                in 1995 (Eiken et al., 2014). The aging
                                               and other information to advance                        contact the person listed under FOR                   of the population and growing
                                               knowledge and understanding of the                      FURTHER INFORMATION CONTACT.                          consumer demand to live in home-based
                                               needs of individuals with disabilities                     Purpose of Program: The purpose of                 settings will continue to increase the
                                               and their family members, including                     the Disability and Rehabilitation                     need for home and community-based
                                               those from among traditionally                          Research Projects and Centers Program                 services (HCBS). As more people receive
                                               underserved populations; (3) determine                  is to plan and conduct research,                      LTSS in the community, there is a need
                                               effective practices, programs, and                      demonstration projects, training, and                 for validated measures of consumer
                                               policies to improve community living                    related activities, including                         outcomes and experiences that can be
                                               and participation, employment, and                      international activities, to develop                  used as indicators of HCBS quality
                                               health and function outcomes for                        methods, procedures, and rehabilitation               (Commission on Long Term Care, 2013;
                                               individuals with disabilities of all ages;              technology that maximize the full                     Disability Rights Education & Defense
                                               (4) identify research gaps and areas for                inclusion and integration into society,               Fund, 2013). Compared to measurement
                                               promising research investments; (5)                     employment, independent living, family                efforts in clinical settings, non-medical
                                               identify and promote effective                          support, and economic and social self-                performance measures in HCBS are in
                                               mechanisms for integrating research and                 sufficiency of individuals with                       the early stages of development and
                                               practice; and (6) disseminate research                  disabilities, especially individuals with             standardization (National Quality
                                               findings to all major stakeholder groups,               the most severe disabilities, and to                  Forum, 2012). Accordingly, NIDILRR is
                                               including individuals with disabilities                 improve the effectiveness of services                 sponsoring a Rehabilitation Research
                                               and their family members in formats                     authorized under the Rehabilitation Act               and Training Center on Outcomes
                                               that are appropriate and meaningful to                  of 1973, as amended (Rehabilitation                   Measurement for Home and Community
                                               them.                                                   Act).                                                 Based Services.
                                                  This notice proposes one priority that                                                                        Efforts to measure the quality of a
                                               NIDILRR intends to use for one or more                  Rehabilitation Research and Training                  wide variety of services, including
                                               competitions in fiscal year (FY) 2015                   Centers                                               home- and community-based LTSS, may
                                               and possibly later years. NIDILRR is                      The purpose of the RRTCs, which are                 include structural measures (whether a
                                               under no obligation to make an award                    funded through the Disability and                     particular mechanism is in place),
                                               under this priority. The decision to                    Rehabilitation Research Projects and                  process measures (which track the
                                               make an award will be based on the                      Centers Program, is to achieve the goals              performance of a particular action) and
                                               quality of applications received and                    of, and improve the effectiveness of,                 outcomes measures (the results of
                                               available funding. NIDILRR may publish                  services authorized under the                         actions and mechanisms) (Disability
                                               additional priorities, as needed.                       Rehabilitation Act through well-                      Rights Education & Defense Fund, 2013;
                                                  Invitation to Comment: We invite you                 designed research, training, technical                Booth & Fralich, 2006). In the long-term
                                               to submit comments regarding this                       assistance, and dissemination activities              care context, structural indicators of
                                               proposed priority. To ensure that your                  in important topical areas as specified               quality may include the ratio of service
                                               comments have maximum effect in                                                                               providers to consumers, for example,
                                                                                                       by NIDILRR. These activities are
                                               developing the final priority, we urge                                                                        and process indicators of quality may
                                                                                                       designed to benefit rehabilitation
                                               you to identify clearly the specific topic                                                                    include the skill levels of providers and
                                                                                                       service providers, individuals with
                                               within the priority that each comment                                                                         the timeliness of the services they
                                                                                                       disabilities, family members,
                                               addresses.                                                                                                    deliver (Disability Rights Education &
                                                                                                       policymakers and other research
                                                  We invite you to assist us in                                                                              Defense Fund, 2013). User outcomes are
                                                                                                       stakeholders. Additional information on
                                               complying with the specific                                                                                   also important indicators of service
                                                                                                       the RRTC program can be found at:
                                               requirements of E.O. 12866 and 13563                                                                          quality. In the HCBS context, health
                                                                                                       http://www2.ed.gov/programs/rrtc/
                                               and their overall requirement of                                                                              status and levels of community
                                                                                                       index.html#types.
                                               reducing regulatory burden that might                                                                         integration, participation, and inclusion
                                               result from this proposed priority.                       Program Authority: 29 U.S.C. 762(g) and             among service recipients can be
                                               Please let us know of any further ways                  764(b)(2).                                            important markers of HCBS quality
                                               we could reduce potential costs or                                                                            (Disability Rights Education & Defense
                                                                                                         Applicable Program Regulations: 34
                                               increase potential benefits while                                                                             Fund, 2013).
                                                                                                       CFR part 350.                                            For decades, efforts to measure and
                                               preserving the effective and efficient
                                               administration of the program.                          Proposed Priority                                     improve long-term care quality have
                                                  During and after the comment period,                                                                       focused on nursing homes. Historically,
                                                                                                         This notice contains one proposed
                                               you may inspect all public comments                                                                           the assessment of quality in nursing
                                                                                                       priority.
                                               sent to NIDILRR in Room 5142, 550 12th                                                                        homes and other institutional long-term
                                               Street SW., PCP, Washington, DC,                        RRTC on Outcomes Measurement for                      care settings emphasized the protection
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                                               between the hours of 8:30 a.m. and 4:00                 Home and Community Based Services                     and safety of residents. As the delivery
                                               p.m., Washington, DC time, Monday                                                                             of LTSS is increasingly taking place in
                                                                                                       Background                                            home and community-based settings,
                                               through Friday of each week except
                                               Federal holidays.                                          Approximately $140 billion is spent                these institution-based quality
                                                  Assistance to Individuals With                       nationally on Medicaid long-term                      measurement efforts have not been
                                               Disabilities in Reviewing the                           services and supports (LTSS) (Eiken et                translated into measures that are
                                               Rulemaking Record: On request we will                   al., 2014). States continue to rebalance              relevant and important to individuals


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                                                                             Federal Register / Vol. 80, No. 50 / Monday, March 16, 2015 / Notices                                                  13571

                                               who are receiving services at home                      These outcomes include adequacy and                   Eiken, Steve, et al. (2014). Medicaid
                                               (Commission on Long-Term Care, 2013).                   appropriateness of care, as well as the                   Expenditures for Long-Term Services
                                               While protection and safety are                         consumers’ level of control, social                       and Supports for FFY 2012. http://
                                               important to HCBS recipients, other                     integration, social participation, and                    www.medicaid.gov/medicaid-chip-
                                                                                                                                                                 program-information/by-topics/long-
                                               factors are important and relevant in                   general quality of life (Kaye, 2014).                     term-services-and-supports/downloads/
                                               these settings, including levels of                        Another foundation for the                             ltss-expenditures-2012.pdf.
                                               community integration, participation,                   development of person-centered HCBS                   Haley, S., Gandek, B., Siebens, H., Black-
                                               and inclusion.                                          outcomes measures is the ongoing work                     Schaffer, R., Sinclair, S., Tao, W., Coster,
                                                 As states continue to rebalance their                 of rehabilitation researchers to create                   W., Ni, P., & Jette, A. (2008).
                                               LTSS expenditures to decrease reliance                  valid and reliable measures of                            Computerized Adaptive Testing for
                                               on nursing homes and increase service                   community participation of people with                    Follow-Up After Discharge From
                                               delivery in home and community-based                    disabilities (Walker, Mellick, Brooks, &                  Inpatient Rehabilitation: Participation
                                               settings, they have begun the process of                Whiteneck, 2003; Hammel, Magasi,                          Outcomes. Archives of Physical
                                               developing person-centered HCBS                         Heinemann, Whiteneck, Bogner &                            Medicine and Rehabilitation. 89(2): 275–
                                               measures that assess outcomes from the                                                                            283.
                                                                                                       Rodriguez, 2012; Whiteneck & Dijkers,
                                                                                                                                                             Hammel, J., Magasi, S., Heinemann, A.,
                                               perspective of service users. The State of              2009; Heinemann, 2010). These research                    Whiteneck, G., Bogner, & Rodriguez, E.
                                               Wisconsin, for example, has developed                   and development efforts include the                       (2008). What Does Participation Mean?
                                               and implemented a set of measures that                  application of advanced item-scaling                      An Insider Perspective From People
                                               assess ‘‘person-centered quality of life’’              and person-centered measurement                           With Disabilities. Disability and
                                               outcomes that are important to HCBS                     techniques that can be implemented as                     Rehabilitation. 30(19): 1445–1460.
                                               users (Karon & Schlaak, 2012). By                       computerized adaptive tests (CAT)                     Heinemann, A. (2010). Measurement of
                                               seeking extensive input from service                    (Haley et al., 2008), thus reducing data                  Participation in Rehabilitation Research.
                                               users and other stakeholders, Wisconsin                 collection burden on people with                          Archives of Physical Medicine and
                                               has developed quality of life concepts                                                                            Rehabilitation. 91(9): S1–S4.
                                                                                                       disabilities. These efforts to develop
                                               and measures that are used to assess the                                                                      Karon, S., and Schlaak, M. (2012). PEONIES
                                                                                                       participation outcome measures for                        Member Interviews, State Fiscal Year
                                               extent to which (1) individuals have                    people with disabilities are highly                       2012, Final Report. Madison, WI: Center
                                               choice over their living arrangements                   relevant to the applied efforts to develop                for Health Systems Research and
                                               and services, (2) individuals have                      person-centered HCBS outcome                              Analysis. http://www.chsra.wisc.edu/
                                               desired social relationships and                        measures.                                                 peonies/documents/PEONIES%20Final
                                               participate in meaningful ways in                          These and other Federal and state                      %20Report%20SFY2012%20-%20
                                               society, and (3) individuals are healthy                efforts provide a strong foundation for                   rev%2011-9-2012.pdf.
                                               and safe (Wisconsin Department of                       further research on and development of                Kaye, H. Stephen. Toward a Model Long-
                                               Health Services, 2014). Within this                     person-centered HCBS outcomes                             Term Services and Supports System:
                                               person-centered outcomes measurement                                                                              State Policy Elements. The Gerontologist.
                                                                                                       measures and measurement systems that
                                               system, service users are able to choose                                                                          (October 2014). http://gerontologist.
                                                                                                       assess and promote community living,                      oxfordjournals.org/content/54/5/754.
                                               the specific outcomes that are the most                 independent living and social                             full.pdf+html.
                                               important to them and describe the                      integration of HCBS users. Accordingly,               National Quality Forum (2015). Home and
                                               extent to which the long-term care                      NIDILRR aims to support a                                 Community Based Services Quality.
                                               services they are receiving support their               Rehabilitation Research and Training                      http://www.qualityforum.org/Project
                                               achievement of those outcomes. With                     Center on Outcomes Measurement for                        Description.aspx?projectID=77692.
                                               this outcomes assessment system                         Home and Community Based Services.                    National Quality Forum, ‘‘Measuring
                                               Wisconsin has developed state-wide                      This RRTC will conduct research and                       Healthcare Quality for the Dual Eligible
                                               quality of life outcomes reports that                                                                             Beneficiary Population, Measure
                                                                                                       development activities in this critical
                                               aggregate findings for all of its HCBS                                                                            Application Partnership, Final Report to
                                                                                                       area and will serve as a national                         HHS,’’ June, 2012.
                                               users, as well as reports that provide                  resource center on HCBS outcomes                      Walker, N., Mellick, D., Brooks, CA,
                                               comparisons of outcomes across                          measurement for Federal and state-level                   Whiteneck, G. (2003). Measuring
                                               different HCBS programs and                             policymakers, people with disabilities                    Participation Across Impairment Groups
                                               subpopulations (Karon & Schlaak,                        and other key stakeholders.                               Using the Craig Handicap Assessment
                                               2012).                                                                                                            Reporting Technique. American Journal
                                                 Recent efforts at the Federal level                   References                                                of Physical Medicine and Rehabilitation.
                                               have begun to address the need for                      Booth, M., Fralich, J. (2006). Performance                82(12): 936–941.
                                               HCBS quality measures. For example,                         Measurement: Managing and Using                   Whiteneck, G., & Dijkers, M. (2009). Difficult
                                               the Administration for Community                            Home and Community-Based Services                     to Measure Constructs. Conceptual and
                                               Living (ACL) is contracting with the                        Data for Quality Improvement.                         Methodological Issues Concerning
                                               National Quality Forum (NQF) to create                      University of Southern Maine: Muskie                  Participation and Environmental Factors.
                                                                                                           School of Public Service. http://                     Archives of Physical Medicine and
                                               a conceptual framework for HCBS
                                                                                                           muskie.usm.maine.edu/Publications/                    Rehabilitation. 90(11) S22–S35.
                                               quality measurement and to make                                                                               Wisconsin Department of Health Services
                                                                                                           DA/Performance-Measurement-
                                               recommendations for HCBS measure                            HCBS.pdf.                                             (2014). Measuring Person-Centered
                                               development efforts. Through this work,                 Commission on Long Term Care. (September                  Quality. November 11, 2014: https://
                                               ACL aims to create a conceptual                             30, 2013). Report to the Congress. http://            www.dhs.wisconsin.gov/familycare/
                                               foundation for the development of                           ltccommission.lmp01.lucidus.net/wp-                   reports/peonies.htm.
                                               measures that can be used to assess and                     content/uploads/2013/12/Commission-
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                                               ultimately support independence and                         on-Long-Term-Care-Final-Report-9-26-              Definitions
                                               community living outcomes of HCBS                           13.pdf.                                             The research that is proposed under
                                                                                                       Disability Rights Education & Defense Fund
                                               recipients (National Quality Forum,                                                                           this priority must be focused on one or
                                                                                                           (2013). Identifying and Selecting Long
                                               2015). Much work remains to                                 Term Services and Supports Outcomes               more stages of research. If the RRTC is
                                               conceptualize and measure HCBS                              Measures. http://dredf.org/2013-                  to conduct research that can be
                                               quality in terms of the outcomes that are                   documents/Guide-LTSS-Outcome-                     categorized under more than one
                                               important to long-term care recipients.                     Measures.pdf.                                     research stage, or research that


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                                               13572                         Federal Register / Vol. 80, No. 50 / Monday, March 16, 2015 / Notices

                                               progresses from one stage to another,                   analyzes whether an intervention is                   collection burden on HCBS recipients.
                                               those research stages must be clearly                   effective in producing improved                       Possible methods for minimizing this
                                               specified. For purposes of this priority,               outcomes for individuals with                         burden include, but are not limited to,
                                               the stages of research are from the notice              disabilities when implemented in a real-              use of relevant administrative data,
                                               of final priorities and definitions                     world setting. During this stage of                   modifying administrative data to
                                               published in the Federal Register on                    research, a project tests the outcomes of             include person-centered goals as well as
                                               June 7, 2013 (78 FR 34261).                             an evidence-based intervention in                     fields to assess progress toward those
                                                  (a) Exploration and Discovery means                  different settings. It examines the                   goals, and use of advanced item-scaling
                                               the stage of research that generates                    challenges to successful replication of               and person-centered measurement
                                               hypotheses or theories by conducting                    the intervention, and the circumstances               techniques that can be implemented as
                                               new and refined analyses of data,                       and activities that contribute to                     computerized adaptive tests (CAT).
                                               producing observational findings, and                   successful adoption of the intervention                  (b) Increasing incorporation of the
                                               creating other sources of research-based                in real-world settings. This stage of                 RRTC’s HCBS outcome measures into
                                               information. This research stage may                    research may also include well-designed               practice and policy. The RRTC must
                                               include identifying or describing the                   studies of an intervention that has been              contribute to this outcome by—
                                               barriers to and facilitators of improved                widely adopted in practice, but that                     (1) Working closely with NIDILRR
                                               outcomes of individuals with                            lacks a sufficient evidence-base to                   and the Administration for Community
                                               disabilities, as well as identifying or                 demonstrate its effectiveness.                        Living (ACL) at each stage of the
                                               describing existing practices, programs,                                                                      measure development and testing
                                               or policies that are associated with                    Proposed Priority                                     processes to ensure that its activities are
                                               important aspects of the lives of                          The Administrator of the                           informing and informed by other HCBS
                                               individuals with disabilities. Results                  Administration for Community Living                   quality initiatives taking place within
                                               achieved under this stage of research                   proposes a priority for the                           ACL and other relevant Federal and
                                               may inform the development of                           Rehabilitation Research and Training                  state agencies. This specifically includes
                                               interventions or lead to evaluations of                 Center (RRTC) program administered by                 the work taking place under the
                                               interventions or policies. The results of               the National Institute on Disability,                 National Quality Forum’s work with the
                                               the exploration and discovery stage of                  Independent Living, and Rehabilitation                Department of Health and Human
                                               research may also be used to inform                     Research (NIDILRR). Specifically, this                Services (http://www.qualityforum.org/
                                               decisions or priorities.                                notice proposes a priority for an RRTC                ProjectDescription.aspx
                                                  (b) Intervention Development means                   on Outcomes Measurement for Home                      ?projectID=77692).
                                               the stage of research that focuses on                   and Community Based Services. The                        (2) Developing procedures and
                                               generating and testing interventions that               RRTC will engage in research,                         mechanisms for applying HCBS
                                               have the potential to improve outcomes                  development, and testing of measures to               outcome measures in policy and service
                                               for individuals with disabilities.                      assess the quality of HCBS in terms of                delivery settings to maximize quality
                                               Intervention development involves                       the person-centered outcomes achieved                 and appropriateness of HCBS from the
                                               determining the active components of                    by people with disabilities who use the               end-user perspective.
                                               possible interventions, developing                      services in home and community                           (3) Collaborating with stakeholder
                                               measures that would be required to                      settings. The RRTC will also engage in                groups to develop, evaluate, or
                                               illustrate outcomes, specifying target                  knowledge translation, development of                 implement strategies to increase
                                               populations, conducting field tests, and                informational products, and                           utilization of new HCBS outcome
                                               assessing the feasibility of conducting a               dissemination to enhance the field’s                  measures. Stakeholder groups include
                                               well-designed interventions study.                      capacity to measure the extent to which               but, are not limited to, people with
                                               Results from this stage of research may                 HCBS leads to improved outcomes in                    disabilities, Federal- and state-level
                                               be used to inform the design of a study                 community living and independent                      policymakers; home and community
                                               to test the efficacy of an intervention.                living areas that are important to people             based service providers; advocacy
                                                  (c) Intervention Efficacy means the                  with disabilities and other stakeholders.             organizations; and Centers for
                                               stage of research during which a project                Ultimately, the RRTC’s development of                 Independent Living.
                                               evaluates and tests whether an                          non-medical, person-centered outcome                     (4) Collaborating with relevant
                                               intervention is feasible, practical, and                measures is intended to inform the                    NIDILRR-sponsored knowledge
                                               has the potential to yield positive                     design, implementation, and continuous                translation grantees to help promote the
                                               outcomes for individuals with                           improvement of Federal and state                      uptake of RRTC products by relevant
                                               disabilities. Efficacy research may assess              policies and programs related to the                  stakeholders and embed the outcome
                                               the strength of the relationships                       delivery of HCBS to people with                       measures into the overall health care
                                               between an intervention and outcomes,                   disabilities. The RRTC must contribute                measurement system.
                                               and may identify factors or individual                  to these outcomes by:                                    (c) Serving as a national resource
                                               characteristics that affect the                            (a) Identifying or developing                      center related to person-centered
                                               relationship between the intervention                   measures, and then testing the proposed               measurement of HCBS outcomes:
                                               and outcomes. Efficacy research can                     measures to assess the person-centered                   (1) Disseminating information and
                                               inform decisions about whether there is                 outcomes of individuals with                          providing technical assistance related to
                                               sufficient evidence to support ‘‘scaling-               disabilities who are receiving home and               HCBS outcome and quality
                                               up’’ an intervention to other sites and                 community-based services. HCBS                        measurement to policymakers, service
                                               contexts. This stage of research can                    measures developed under this priority                providers, people with disabilities and
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                                               include assessing the training needed                   must be non-medical and must focus on                 their representatives, and other key
                                               for wide-scale implementation of the                    the end-users’ experience of community                stakeholders; and
                                               intervention, and approaches to                         living, independent living, social                       (2) Providing relevant and appropriate
                                               evaluation of the intervention in real                  integration, community participation,                 training, including graduate, pre-
                                               world applications.                                     and other similar outcomes. The                       service, and in-service training, to HCBS
                                                  (d) Scale-Up Evaluation means the                    measures developed under this priority                providers, researchers and quality-
                                               stage of research during which a project                must also be designed to minimize data                measurement personnel, and other


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                                                                             Federal Register / Vol. 80, No. 50 / Monday, March 16, 2015 / Notices                                                   13573

                                               disability service providers, to facilitate             by law, E.O. 13563 requires that an                   Centers Program have been well
                                               more effective delivery of HCBS to                      agency—                                               established over the years. Projects
                                               people with disabilities. This training                    (1) Propose or adopt regulations only              similar to one envisioned by the
                                               may be provided through conferences,                    upon a reasoned determination that                    proposed priority have been completed
                                               workshops, public education programs,                   their benefits justify their costs                    successfully, and the proposed priority
                                               in-service training programs, and                       (recognizing that some benefits and                   would generate new knowledge through
                                               similar activities.                                     costs are difficult to quantify);                     research. The new RRTC would
                                                                                                          (2) Tailor its regulations to impose the           generate, disseminate, and promote the
                                               Final Priority                                          least burden on society, consistent with              use of new information that would
                                                 We will announce the final priority in                obtaining regulatory objectives and                   improve outcomes for individuals with
                                               a notice in the Federal Register. We will               taking into account—among other things                disabilities in the area of home and
                                               determine the final priority after                      and to the extent practicable—the costs               community based services.
                                               considering responses to this notice and                of cumulative regulations;                               Intergovernmental Review: This
                                               other information available to the                         (3) In choosing among alternative                  program is not subject to E.O. 12372.
                                               Department. This notice does not                        regulatory approaches, select those                      Electronic Access to This Document:
                                               preclude us from proposing additional                   approaches that maximize net benefits                 The official version of this document is
                                               priorities, requirements, definitions, or               (including potential economic,                        the document published in the Federal
                                               selection criteria, subject to meeting                  environmental, public health and safety,              Register. Free Internet access to the
                                               applicable rulemaking requirements.                     and other advantages; distributive                    official edition of the Federal Register
                                                 Note: This notice does not solicit
                                                                                                       impacts; and equity);                                 and the Code of Federal Regulations is
                                               applications. In any year in which we choose               (4) To the extent feasible, specify                available via the Federal Digital System
                                               to use this priority, we invite applications            performance objectives, rather than the               at: www.gpo.gov/fdsys. At this site you
                                               through a notice in the Federal Register or             behavior or manner of compliance a                    can view this document, as well as all
                                               in a Funding Opportunity Announcement                   regulated entity must adopt; and                      other documents of this Department
                                               posted at www.grants.gov.                                  (5) Identify and assess available                  published in the Federal Register, in
                                                                                                       alternatives to direct regulation,                    text or Adobe Portable Document
                                               Executive Orders 12866 and 13563                        including economic incentives—such as                 Format (PDF). To use PDF you must
                                                                                                       user fees or marketable permits—to                    have Adobe Acrobat Reader, which is
                                               Regulatory Impact Analysis
                                                                                                       encourage the desired behavior, or                    available free at the site.
                                                  Under E.O. 12866, the Secretary must                 provide information that enables the
                                               determine whether this regulatory                                                                                You may also access documents of the
                                                                                                       public to make choices.                               Department published in the Federal
                                               action is ‘‘significant’’ and, therefore,                  E.O. 13563 also requires an agency ‘‘to
                                               subject to the requirements of the                                                                            Register by using the article search
                                                                                                       use the best available techniques to
                                               Executive Order and subject to review                                                                         feature at: www.federalregister.gov.
                                                                                                       quantify anticipated present and future
                                               by the Office of Management and                                                                               Specifically, through the advanced
                                                                                                       benefits and costs as accurately as
                                               Budget (OMB). Section 3(f) of E.O.                                                                            search feature at this site, you can limit
                                                                                                       possible.’’ The Office of Information and
                                               12866 defines a ‘‘significant regulatory                                                                      your search to documents published by
                                                                                                       Regulatory Affairs of OMB has
                                               action’’ as an action likely to result in                                                                     the Department.
                                                                                                       emphasized that these techniques may
                                               a rule that may—                                        include ‘‘identifying changing future                   Dated: March 11, 2015.
                                                  (1) Have an annual effect on the                     compliance costs that might result from               Kathy Greenlee,
                                               economy of $100 million or more, or                     technological innovation or anticipated               Administrator.
                                               adversely affect a sector of the economy,               behavioral changes.’’                                 [FR Doc. 2015–05989 Filed 3–13–15; 8:45 am]
                                               productivity, competition, jobs, the                       We are issuing this proposed priority              BILLING CODE 4154–01–P
                                               environment, public health or safety, or                only upon a reasoned determination
                                               State, local, or tribal governments or                  that its benefits would justify its costs.
                                               communities in a material way (also                     In choosing among alternative                         DEPARTMENT OF HEALTH AND
                                               referred to as an ‘‘economically                        regulatory approaches, we selected                    HUMAN SERVICES
                                               significant’’ rule);                                    those approaches that would maximize
                                                  (2) Create serious inconsistency or                  net benefits. Based on the analysis that              Office of the Secretary
                                               otherwise interfere with an action taken                follows, the Department believes that
                                               or planned by another agency;                                                                                 [Document Identifier: HHS–OS–0990–New–
                                                                                                       this proposed priority is consistent with             60D]
                                                  (3) Materially alter the budgetary                   the principles in E.O. 13563.
                                               impacts of entitlement grants, user fees,                  We also have determined that this                  Agency Information Collection
                                               or loan programs or the rights and                      regulatory action would not unduly                    Activities; Proposed Collection; Public
                                               obligations of recipients thereof; or                   interfere with State, local, and tribal               Comment Request
                                                  (4) Raise novel legal or policy issues               governments in the exercise of their
                                               arising out of legal mandates, the                      governmental functions.                               AGENCY:   Office of the Secretary, HHS.
                                               President’s priorities, or the principles                  In accordance with both Executive                  ACTION:   Notice.
                                               stated in the E.O.                                      Orders, the Department has assessed the
                                                  This proposed regulatory action is not               potential costs and benefits, both                    SUMMARY:   In compliance with section
                                               a significant regulatory action subject to              quantitative and qualitative, of this                 3506(c)(2)(A) of the Paperwork
                                               review by OMB under section 3(f) of                     regulatory action. The potential costs                Reduction Act of 1995, the Office of the
Rmajette on DSK2VPTVN1PROD with NOTICES




                                               E.O. 12866.                                             are those resulting from statutory                    Secretary (OS), Department of Health
                                                  We have also reviewed this regulatory                requirements and those we have                        and Human Services, announces plans
                                               action under E.O. 13563, which                          determined as necessary for                           to submit a new Information Collection
                                               supplements and explicitly reaffirms the                administering the Department’s                        Request (ICR), described below, to the
                                               principles, structures, and definitions                 programs and activities.                              Office of Management and Budget
                                               governing regulatory review established                    The benefits of the Disability and                 (OMB). Prior to submitting that ICR to
                                               in E.O. 12866. To the extent permitted                  Rehabilitation Research Projects and                  OMB, OS seeks comments from the


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Document Created: 2018-02-21 09:38:02
Document Modified: 2018-02-21 09:38:02
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionNotices
ActionNotice of Proposed Priority.
DatesWe must receive your comments on or before April 15, 2015.
ContactCarolyn Baron. Telephone: (202) 245- 7244 or by email: [email protected]
FR Citation80 FR 13569 

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