[Federal Register Volume 78, Number 233 (Wednesday, December 4, 2013)]
[Notices]
[Pages 72891-72892]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-28991]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the Secretary

[Document Identifier: HHS-OS-20584-30D]


Agency Information Collection Activities; Submission to OMB for 
Review and Approval; Public Comment Request

AGENCY: Office of the Secretary, HHS.

ACTION: Notice.

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SUMMARY: In compliance with section 3507(a)(1)(D) of the Paperwork 
Reduction Act of 1995, the Office of the Secretary (OS), Department of 
Health and Human Services, has submitted an Information Collection 
Request (ICR), described below, to the Office of Management and Budget 
(OMB) for review and approval. The ICR is for a new collection. 
Comments submitted during the first public review of this ICR will be 
provided to OMB. OMB will accept further comments from the public on 
this ICR during the review and approval period.

DATES: Comments on the ICR must be received on or before January 3, 
2014.

ADDRESSES: Submit your comments to [email protected] or via 
facsimile to (202) 395-5806.

FOR FURTHER INFORMATION CONTACT: Information Collection Clearance 
staff, [email protected] or (202) 690-6162.

SUPPLEMENTARY INFORMATION: When submitting comments or requesting 
information, please include the Information Collection Request Title 
and document identifier HHS-OS-20584-30D for reference.
    Information Collection Request Title: Survey on Long-Term Care 
Awareness and Planning.
    Abstract: With the aging of the population, the demand and need for 
long-term care is certain to grow, and with it public and private 
expenditures. Unlike for medical care, few people have private long-
term care insurance and Medicare does not cover long-term care. Many 
older adults pay for long-term care out of their income and personal 
savings until they are poor enough to qualify for Medicaid, a means-
tested welfare program (Wiener et al., 2013). Others, in an effort to 
avoid exhausting their resources and relying on Medicaid, depend on 
unpaid family support or go without needed services. To help inform 
federal policy on long-term care financing and service delivery, this 
study, sponsored by HHS/ASPE, will collect new data on long-term care 
awareness and how people plan for retirement through a web-based 
survey. The main goals of the survey are (1) to understand consumer 
attitudes, knowledge, and experiences with long-term care, how people 
plan for the risk of needing long-term care, and people's preferences 
among public policies on long-term care financing; and (2) to examine 
consumer preferences for specific features of individual long-term care 
insurance policies (e.g., benefit levels, length of coverage, and 
sponsorship). The findings from the survey will be used to inform 
federal policy regarding public and private long-term care financing. 
The first part of the survey addresses the first set of goals, while a 
stated preference survey method, known as a discrete choice experiment 
(DCE) or conjoint analysis, in the second part of the survey addresses 
the second set of goals. RTI has designed and cognitively tested the 
survey instrument and will conduct the analysis; GfK will administer 
the survey.
    The survey instrument was developed by RTI in close cooperation 
with ASPE and in consultation with a TEP and other experts on long-term 
care and long-term care insurance, and underwent two distinct rounds of 
cognitive testing of nine participants each. The survey has two 
components. The first asks questions on (1) the risk of needing long-
term care; (2) psychological characteristics, knowledge, skills, and 
experience; (3) beliefs and concerns about long-term care; (4) 
retirement and long-term care planning; (5) information gathering and 
decision making about insurance; and (6) core demographic and 
socioeconomic information. The second component of the survey is a DCE, 
which seeks to understand respondents' preferences about specific long-
term care insurance features. In the DCE, respondents will complete a 
series of comparison questions in which they select their most 
preferred choice between two alternative insurance products. Some 
scenarios will also offer respondents a third option to not buy either 
of the insurance policies; other scenarios will ``require'' respondents 
to choose between two policies. Both types of hypothetical comparisons 
provide quantitative data on the relative preferences and importance of 
different insurance features, including price. Potentially sensitive 
questions concerning disability status, medical conditions, and income 
and assets have been extensively vetted with ASPE, the TEP, other 
experts, and the participants in the cognitive testing.
    Need and Proposed Use of the Information: Several issues make this 
data collection effort necessary. In 2011, the United States spent $211 
billion on long-term care, approximately 8 percent of total national 
health expenditures, of which two-thirds was public spending, primarily 
Medicaid (Centers for Medicare & Medicaid Services [CMS], 2012; 
O'Shaughnessy, 2013). Total long-term care spending is about 1.4 
percent of the gross domestic product; public spending is about 1 
percent of the gross domestic product (Author's calculation based on 
CMS, 2012). The number of aging and disabled individuals in the 
population is expected to continue to grow and, with it, the need for 
additional public financing. The Organization for Economic Co-operation 
and Development (2006) estimates that public long-term care 
expenditures for older people in the United States will double to 
triple as a percentage of the gross domestic product between 2005 and 
2050. As a result, the government has an increased need for information 
on the general public's knowledge about long-term care and how people 
plan to organize and pay for their possible long-term care needs. HHS/
ASPE is particularly interested in the views of the public on different 
potential public policies on long-term care financing and in what 
design features of long-term care insurance are most important.
    Once the data are received, RTI will analyze them. The first set of 
analyses will address domains in the first part of the survey and will 
include descriptive and multivariate analyses of the extent to which 
respondents plan for long-term care and their preferences among public 
policies for long-term care financing. In addition to sociodemographic 
variables such as financial literacy, the extent to which respondents 
are ``planners'' or ``nonplanners,'' the experience of respondents with 
long-term care, and risk tolerance will be important indicator 
variables. Descriptive analyses will be conducted to describe the

[[Page 72892]]

overall sample along a number of relevant dimensions (e.g., assessment 
of risk of needing long-term care). The analysis will also characterize 
the sample by key indicator variables, to analyze the role of long-term 
care planning within the context of overall retirement planning, and to 
understand long-term care use and payment and policy preferences. 
Multivariate analyses will also be conducted, primarily of planning 
activity for long-term care and preferences for public policies for 
long-term care financing.
    The second set of analyses will address the DCEs that respondents 
conducted to evaluate various features of long-term care insurance 
policies. DCEs are a form of conjoint analysis, an econometric method 
used to estimate the relative importance that respondents place on the 
different features of an individual product (e.g., for long-term care 
insurance, such features as length of coverage, benefit period, benefit 
amount, whether there is medical underwriting, and sponsorship). These 
data will be analyzed using standard discrete choice econometric 
techniques in which the parameter estimates in the choice models 
indicate the relative importance to respondents of different features 
of long-term care insurance. Thus, the ratio of two parameters 
indicates the marginal rate of substitution between them (i.e., the 
rate at which respondents changed their selections when attribute 
levels were varied).
    Likely Respondents: Survey invitations will be sent by the data 
collection partner, GfK, to a random sample of U.S. adults aged 40-70 
participating in its standing Internet panel, KnowledgePanel. Adults 
who read the survey invitation and desire to participate will be 
redirected to a secure, password-protected Web site hosted by GfK which 
contains the next two forms. GfK will send 23,077 invitations to 
participate to members of the sample, yielding an estimated 15,000 
completed questionnaires based on an estimated overall response rate of 
65 percent.
    Burden Statement: The response burden estimates for this data 
collection are shown in Exhibit A.12-1. An IRB-approved consent form 
must be acknowledged by respondents before they are allowed to begin 
the survey. Respondents will be asked to read basic information about 
the research study, the study purpose, procedures, duration of the 
survey, possible risks or discomforts from the survey, benefits of 
participating, incentive for participation, privacy protections, 
individuals' rights, and whom to contact with questions. Respondents 
will then be required to click a box indicating that they have read the 
information, confirm that they are between the ages of 40 and 70, and 
that they voluntarily consent to participate in the study or decline to 
participate. Only those who consent and certify that they meet the age 
qualifications will continue to the full survey instrument. Estimates 
for the time needed to complete the survey are based on cognitive 
testing of the questionnaire conducted during Fall 2012 in Durham, 
North Carolina, and Washington, DC. As part of the cognitive testing, 
the length of time to complete the questionnaire was measured. The 
cognitive testing suggests that the questionnaire requires 
approximately 45 minutes to complete. The initial series of questions 
take approximately 25 minutes to complete and the DCE section takes 
approximately 15-20 minutes to complete. Each respondent will answer 
the questionnaire only once and there are no planned follow-up surveys. 
Respondents will have the ability to pause the survey and restart it at 
a later time at their convenience.

                                    Total Estimated Annualized Burden--Hours
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                                                             Number of          Burden per      Estimated total
                          Task                              respondents      response (hours)   hours of burden
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Self-administered, Web-based questionnaire.............            15,000               0.75             11,250
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Source: RTI International estimates.


Darius Taylor,
Deputy, Information Collection Clearance Officer.
[FR Doc. 2013-28991 Filed 12-3-13; 8:45 am]
BILLING CODE 4151-05-P