80 FR 29323 - Final 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 98 (May 21, 2015)

The Administrator of the Administration for Community Living announces a priority for the Rehabilitation Research and Training Center (RRTC) Program administered by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). Specifically, we announce a priority for an RRTC on Outcomes Measurement for Home and Community Based Services. The Administrator of the Administration for Community Living may use this priority for competitions in fiscal year (FY) 2015 and later years. We take this action to focus research attention on an area of national need. We intend for this priority to contribute to improved home and community based services for individuals with disabilities.

[Federal Register Volume 80, Number 98 (Thursday, May 21, 2015)]
[Notices]
[Pages 29323-29325]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2015-12308]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration for Community Living

[CFDA Number: 84.133B-6]


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

AGENCY: Administration for Community Living, Department of Health and 
Human Services.

ACTION: Final priority.

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SUMMARY: The Administrator of the Administration for Community Living 
announces a priority for the Rehabilitation Research and Training 
Center (RRTC) Program administered by the National Institute on 
Disability, Independent Living, and Rehabilitation Research (NIDILRR). 
Specifically, we announce a priority for an RRTC on Outcomes 
Measurement for Home and Community Based Services. The Administrator of 
the Administration for Community Living may use this priority for 
competitions in fiscal year (FY) 2015 and later years. We take this 
action to focus research attention on an area of national need. We 
intend for this priority to contribute to improved home and community 
based services for individuals with disabilities.

DATES: Effective Date: This priority is effective June 22, 2015.

FOR FURTHER INFORMATION CONTACT: Marlene Spencer, U.S. Department of 
Health and Human Services, 400 Maryland Avenue SW., Room 5133, Potomac 
Center Plaza (PCP), Washington, DC 20202-2700. Telephone: (202) 245-
7532 or by email: [email protected].
    If you use a telecommunications device for the deaf (TDD) or a text 
telephone (TTY), call the Federal Relay Service (FRS), toll free, at 1-
800-877-8339.

SUPPLEMENTARY INFORMATION:
    Purpose of Program: The purpose of the Disability and 
Rehabilitation Research Projects and Centers Program is to plan and 
conduct research, demonstration projects, training, and related 
activities, including international activities, to develop methods, 
procedures, and rehabilitation technology that maximize the full 
inclusion and integration into society, employment, independent living, 
family support, and economic and social self-sufficiency of individuals 
with disabilities, especially individuals with the most severe 
disabilities, and to improve the effectiveness of services authorized 
under the Rehabilitation Act of 1973, as amended (Rehabilitation Act).

Rehabilitation Research and Training Centers

    The purpose of the RRTCs, which are funded through the Disability 
and Rehabilitation Research Projects and Centers Program, is to achieve 
the goals of, and improve the effectiveness of, services authorized 
under the Rehabilitation Act through well-designed research, training, 
technical assistance, and dissemination activities in important topical 
areas as specified by NIDILRR. These activities are designed to benefit 
rehabilitation service providers, individuals with disabilities, family 
members, policymakers and other research stakeholders. Additional 
information on the RRTC program can be found at: http://www2.ed.gov/programs/rrtc/index.html#types.
    Program Authority: 29 U.S.C. 762(g) and 764(b)(2)(A).
    Applicable Program Regulations: 34 CFR part 350.
    We published a notice of proposed priority (NPP) for this program 
in the Federal Register on February 25, 2015 (80 FR 10099). That notice 
contained background information and our reasons for proposing the 
particular priority.
    There are differences between the proposed priority and this final 
priority.
    Public Comment: In response to our invitation in the notice of 
proposed priority, one party submitted comments on the proposed 
priority.
    Generally, we do not address technical and other minor changes. In 
addition, we do not address general comments that raised concerns not 
directly related to the proposed priority.
    Analysis of the Comments and Changes: An analysis of the comments 
and of any changes in the priority since publication of the NPP 
follows.
    Comment: One commenter asked whether the RRTC's work should apply 
to elderly users of home and community based services (HCBS), as well 
as people with disabilities who use HCBS.
    Discussion: NIDILRR's priority does not specify the age range of 
people with disabilities who are to be the focus of the RRTC's work. 
Throughout the priority we refer to people with disabilities, or people 
with disabilities who use or receive HCBS. NIDILRR's ultimate intent is 
to build HCBS outcomes measurement capacity that is relevant to HCBS 
recipients of all ages. Given the early stage of outcomes development 
work in this area, the limited resources of this RRTC, and the broad 
populations served by HCBS, it is up to applicants to describe their 
target population(s) of HCBS users. The peer review process will 
determine the merits of each application.
    Changes: None.
    Comment: One commenter agreed with the priority's requirement that 
measures to be developed by the RRTC should minimize data collection 
burden on HCBS recipients. At the same time, the commenter noted the 
critical importance of gathering information directly from HCBS users 
to determine the impact of those services on the quality of their 
lives. The commenter cautioned NIDILRR and the eventual RRTC against 
minimizing data collection burden to such an extent that data on HCBS 
users' experiences and outcomes aren't available for such quality 
improvement purposes.
    Discussion: NIDILRR agrees with the commenter that gathering 
outcomes information directly from HCBS recipients is critically 
important. The priority consistently emphasizes the importance of 
creating outcome measurement tools that focus on HCBS users' 
experiences and outcomes. By requiring the RRTC to minimize data 
collection burden on HCBS end users, NIDILRR is simply recognizing the 
potential for lengthy, duplicative, and overly burdensome data 
collection methods. With this requirement we are also highlighting the 
existence of advanced item-scaling and person-centered measurement 
techniques such as computerized adaptive tests, as well as the 
existence of administrative data that can be relevant to the 
measurement of person-centered outcomes.
    Changes: None.
    Comment: One commenter noted that different groups of HCBS users 
have different needs, and that the importance placed on different 
outcome domains may vary across subgroups of HCBS users. The commenter 
questioned whether the measures developed by the RRTC should be 
tailored to the needs of subgroups of HCBS users.
    Discussion: NIDILRR agrees with the commenter that different 
subgroups of HCBS users may have outcome domains

[[Page 29324]]

that are particularly important to them. Given the early stage of 
outcomes development work in this area, the limited resources of this 
RRTC, and the broad populations served by HCBS, it is up to applicants 
to describe their target population(s) of HCBS users. It is also up to 
applicants to describe the extent to which their proposed outcomes 
development work will address potential variation in how subgroups 
prioritize different HCBS outcome domains. The peer review process will 
determine the merits of each application.
    Changes: None.
    Comment: One commenter asked whether NIDILRR intends the RRTC to 
evaluate interventions to determine whether they are associated with 
positive HCBS outcomes.
    Discussion: NIDILRR does not intend the RRTC to evaluate 
interventions to determine whether they are associated with positive 
HCBS outcomes. The primary intent of the research requirements under 
paragraph (a) is the development and testing of HCBS outcome measures--
which will serve as infrastructure for future testing of interventions.
    Changes: NIDILRR has made minor modifications to paragraph (a) to 
clarify that our intent for this RRTC is the development and testing of 
HCBS outcome measures--and not the testing of HCBS interventions.
    Comment: One commenter recommended that the RRTC be required to 
provide technical assistance to a range of stakeholders, with the aim 
of promoting the use of new HCBS outcomes measures and resulting data 
for HCBS system improvement.
    Discussion: NIDILRR agrees that technical assistance toward 
promoting the use of new HCBS outcomes measures is an important task 
for the RRTC. In the opening paragraph of the priority we state that 
``Ultimately, the RRTC's development of non-medical, person-centered 
outcome measures is intended to inform the design, implementation, and 
continuous improvement of Federal and state policies and programs 
related to the delivery of HCBS to people with disabilities.'' 
Paragraph (b)(3) requires direct collaboration with a wide range of 
stakeholder groups to develop, evaluate, or implement strategies to 
increase the use of new HCBS outcomes measures. Similarly, paragraph 
(c)(1) requires the provision of technical assistance related to HCBS 
outcome and measurement.
    Changes: None.
    Comment: One commenter recommended that the RRTC develop data 
formats that are accessible to a range of stakeholders.
    Discussion: The primary aim of this priority is the development and 
testing of person-centered HCBS outcome measures that generate data 
that is reliable, valid, and usable. This foundational work of creating 
reliable and valid HCBS outcomes measures precedes the development of 
databases and multiple data formats. While some applicants may choose 
to specify the formats of data that new outcomes measures can generate, 
the RRTC has no basis for requiring all applicants to take this step.
    Changes: None.

Final Priority

    The Administrator of the Administration for Community Living 
establishes a priority for the RRTC on Outcomes Measurement for Home 
and Community Based Services. The RRTC will engage in research, 
development, and testing of measures to assess the quality of HCBS in 
terms of the person-centered outcomes achieved by people with 
disabilities who use the services in home and community settings. The 
RRTC will also engage in knowledge translation, development of 
informational products, and dissemination to enhance the field's 
capacity to measure the extent to which HCBS leads to improved outcomes 
in community living and independent living areas that are important to 
people with disabilities and other stakeholders.
    Ultimately, the RRTC's development of non-medical, person-centered 
outcome measures is intended to inform the design, implementation, and 
continuous improvement of Federal and state policies and programs 
related to the delivery of HCBS to people with disabilities. The RRTC 
must contribute to these outcomes by:
    (a) Identifying or developing measures, and then testing the 
reliability, validity, and usability of those proposed measures to 
assess the person-centered outcomes of individuals with disabilities 
who are receiving home and community-based services. HCBS measures 
developed under this priority must be non-medical and must focus on the 
end-users' experience of community living, independent living, social 
integration, community participation, and other similar outcomes. The 
measures developed under this priority must also be designed to 
minimize data collection burden on HCBS recipients. Possible methods 
for minimizing this burden include, but are not limited to, use of 
relevant administrative data, modifying administrative data to include 
person-centered goals as well as fields to assess progress toward those 
goals, and use of advanced item-scaling and person-centered measurement 
techniques that can be implemented as computerized adaptive tests 
(CAT).
    (b) Increasing incorporation of the RRTC's HCBS outcome measures 
into practice and policy. The RRTC must contribute to this outcome by--
    (1) Working closely with NIDILRR and the Administration for 
Community Living (ACL) at each stage of the measure development and 
testing processes to ensure that its activities are informing and 
informed by other HCBS quality initiatives taking place within ACL and 
other relevant Federal and state agencies. This specifically includes 
the work taking place under the National Quality Forum's work with the 
Department of Health and Human Services (http://www.qualityforum.org/ProjectDescription.aspx?projectID=77692).
    (2) Developing procedures and mechanisms for applying HCBS outcome 
measures in policy and service delivery settings to maximize quality 
and appropriateness of HCBS from the end-user perspective.
    (3) Collaborating with stakeholder groups to develop, evaluate, or 
implement strategies to increase utilization of new HCBS outcome 
measures. Stakeholder groups include but, are not limited to, people 
with disabilities, Federal- and state-level policymakers; home and 
community based service providers; advocacy organizations; and Centers 
for Independent Living.
    (4) Collaborating with relevant NIDILRR-sponsored knowledge 
translation grantees to help promote the uptake of RRTC products by 
relevant stakeholders and embed the outcome measures into the overall 
health care measurement system.
    (c) Serving as a national resource center related to person-
centered measurement of HCBS outcomes:
    (1) Disseminating information and providing technical assistance 
related to HCBS outcome and quality measurement to policymakers, 
service providers, people with disabilities and their representatives, 
and other key stakeholders; and
    (2) Providing relevant and appropriate training, including 
graduate, pre-service, and in-service training, to HCBS providers, 
researchers and quality-measurement personnel, and other disability 
service providers, to facilitate more effective delivery of HCBS to 
people with disabilities. This training may be provided through 
conferences, workshops, public education programs,

[[Page 29325]]

in-service training programs, and similar activities.

Types of Priorities

    When inviting applications for a competition using one or more 
priorities, we designate the type of each priority as absolute, 
competitive preference, or invitational through a notice in the Federal 
Register. The effect of each type of priority follows:
    Absolute priority: Under an absolute priority, we consider only 
applications that meet the priority (34 CFR 75.105(c)(3)).
    Competitive preference priority: Under a competitive preference 
priority, we give competitive preference to an application by (1) 
awarding additional points, depending on the extent to which the 
application meets the priority (45 CFR part 75); or (2) selecting an 
application that meets the priority over an application of comparable 
merit that does not meet the priority (45 CFR part 75).
    Invitational priority: Under an invitational priority, we are 
particularly interested in applications that meet the priority. 
However, we do not give an application that meets the priority a 
preference over other applications (45 CFR part 75).
    This notice does not preclude us from proposing additional 
priorities, requirements, definitions, or selection criteria, subject 
to meeting applicable rulemaking requirements.

    Note:  This notice does not solicit applications. In any year in 
which we choose to use this priority, we invite applications through 
a notice in the Federal Register.

Executive Orders 12866 and 13563

    Electronic Access to This Document: The official version of this 
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by the Department.

    Dated: May 18, 2015.
John Tschida,
Director, National Institute on Disability, Independent Living, and 
Rehabilitation Research.
[FR Doc. 2015-12308 Filed 5-20-15; 8:45 am]
BILLING CODE 4154-01-P