[Federal Register Volume 83, Number 37 (Friday, February 23, 2018)]
[Notices]
[Pages 8086-8088]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-03767]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration for Community Living

Administration on Aging


Agency Information Collection Activities; Submission for OMB 
Review; Public Comment Request; State Annual Long-Term Care Ombudsman 
Report Known as the National Ombudsman Reporting System (NORS) and 
Instructions (OMB No: 0985-0005)

AGENCY: Administration for Community Living/Administration on Aging, 
HHS.

ACTION: Notice.

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SUMMARY: The Administration for Community Living/Administration on 
Aging (ACL/AoA) is announcing that the proposed collection of 
information listed above has been submitted to the Office of Management 
and Budget (OMB) for review and clearance as required under the 
Paperwork Reduction Act of 1995. This 30-day notice collects comments 
on the information collection requirements related to the Long-Term 
Care Ombudsman Program (Proposed Extension with Changes of a Currently 
Approved Collection (ICR Rev)).

DATES: Submit written comments on the collection of information by 
March 26, 2018.

ADDRESSES: Submit written comments on the collection of information by 
fax to 202.395.5806, Attn: OMB Desk Officer for ACL; by email to 
[email protected], Attn: OMB Desk Officer for ACL; or by mail 
to the Office of Information and Regulatory Affairs, OMB, New Executive 
Office Bldg., 725 17th St. NW, Rm. 10235, Washington, DC 20503, Attn: 
OMB Desk Officer for ACL.

FOR FURTHER INFORMATION CONTACT: Louise Ryan, telephone: (206) 615-
2514; email: [email protected].

SUPPLEMENTARY INFORMATION: In compliance with 44 U.S.C. 3507, ACL/AoA 
has submitted the following proposed collection of information to OMB 
for review and clearance.
    States provide the following data and narrative information in the 
report:
    1. Numbers and descriptions of cases filed and complaints made on 
behalf of long-term care facility residents to the statewide ombudsman 
program;
    2. Major issues identified that impact the quality of care and life 
of long-term care facility residents;
    3. Statewide program operations; and
    4. Ombudsman activities in addition to complaint investigation.

[[Page 8087]]

    The report form and instructions have been in continuous use, with 
minor modifications, since they were first approved by OMB for the FY 
1995 reporting period. This current request is for a Revision of a 
Currently Approved Collection (ICR Rev) to acquire new approval for a 
revised modification of instruction and data collection elements for 
FFY 2019-2021.
    The data collected on complaints filed with ombudsman programs and 
narrative on long-term care issues provide information to the Centers 
for Medicare and Medicaid Services and others on patterns of concerns 
and major long-term care issues affecting residents of long-term care 
facilities. Both the complaint and program data collected assist the 
states and local Ombudsman programs in planning strategies and 
activities, providing training and technical assistance, and developing 
performance measures.

Comments in Response to the 60 Day Federal Register Notice

    A notice was published in the Federal Register, Vol. 81, No. 152, 
Page 52438 on Monday, August 8, 2016 announcing that ACL/AoA was 
requesting comments on: (1) Whether the proposed collection of 
information is necessary for the proper performance of ACL/AoA's 
functions, including whether the information will have practical 
utility; (2) the accuracy of ACL/AoA's estimate of the burden of the 
proposed collection of information, including the validity of the 
methodology and assumptions used; (3) ways to enhance the quality, 
utility, and clarity of the information to be collected; and (4) ways 
to minimize the burden of the collection of information on respondents, 
including through the use of automated collection techniques when 
appropriate, and other forms of information technology. Readers were 
directed to the ACL/AoA website where the documents were posted and 
provided an opportunity to comment. ACL received comments from 18 
individuals and groups. Comments were received by the following groups 
and individuals: National Association of State Ombudsman Programs 
(NASOP); National Association of Local LTC Ombudsman (NALLTCO); one 
software vendor; the California Association of Local LTC Ombudsmen; the 
Consumer Voice for Quality LTC Care. Individuals included one 
researcher with expertise in dementia, abuse and neglect and one local 
representative of the Office of State Ombudsman. The following State 
Ombudsman programs provided comment: California; Florida; Maryland; New 
York; Iowa; Pennsylvania; Arizona; New Hampshire; Texas; Alaska; 
Virginia. Many of the state Ombudsman comments were identical to 
NASOP's comments.
    In general, there were no significant comments on the proposed data 
elements. Instead, comments focused on ways to enhance the quality, 
utility, and clarity of the information to be collected. These comments 
were very helpful and many of the proposed edits and language 
suggestions were adopted.
    Concerns regarding burden included: Disagreement about the burden 
hours because of changes in data collection requirements and additional 
structured requirements of narrative complaint examples, systems issues 
and conflicts of interest reporting. The new reporting system will 
streamline these current reporting activities, allowing for flexibility 
and the ability to import data from the previous year for use in the 
next year, where appropriate, and will reduce overall reporting burden 
for State LTC Ombudsmen. Several commenters expressed concern about 
undue burden of a name change from ``board and care'' to ``residential 
care community'', but did not provide a specific estimate of burden 
hours. In response to their concerns the definition of residential care 
was revised to eliminate any confusion about the jurisdiction of the 
program with regards to the types of settings the program serves. ACL 
does not believe that a change in definition and title will cause 
confusion at the state and local level because there will not be a 
change in state level practice. These concerns are addressed in detail 
in the response to comments tables posted on the ACL website. Some 
responders expressed concern about burden with a data collection item 
to indicate if a complaint was a complaint on behalf of more than one 
complainant, i.e., a ``group complaint'' (Table 1, code C5 on the 60 
day submission). ACL removed this data element. Some commenters 
expressed concerns about the cost to update and revise their reporting 
systems, but the estimates of impact on data collection burden varied. 
One State that has developed their own software utilizing in-house IT 
services, estimates a range from 9-52 days of work for software changes 
and 5-55 days to update training materials, update their in-house 
reference guide, provide training, etc. Another state estimates that 
the changes required will cost around $10,000. One vendor commented 
that they see ``no issue'' with the proposed changes and that they are 
committed to keeping all of their customers using their Ombudsman 
product up to date with any NORS reporting changes. Since the comments 
were not consistent in this area no changes have been made. Additional 
concerns about the wording in proposed definitions and requests to add 
additional data collection elements are addressed in the response to 
comments tables.
    Some commenters expressed concerns about training needs and time 
required to adapt their software. ACL is working with the contractor 
developing the reporting software to develop training modules on how to 
use the new software. ACL anticipates that states will not need to 
develop training materials or host training to meet the federal 
reporting requirements. Training will be offered as webinars and in 
person at national conferences, when possible. User support materials 
and recorded webinars will also be available on the submission website. 
The National Ombudsman Resource Center will develop modules on how to 
interpret the new definitions and codes similar to past training. This 
includes hosting webinars and providing in-person training at their 
annual spring training for state LTC Ombudsmen. In addition, they will 
host all tools and modules on their website. The contractor is holding 
meetings with vendors and state information technology staff on the 
technical requirements of the new system and will provide data 
templates in various formats; and detailed crosswalks of the current 
data collection to the new data collection. Despite the concerns 
addressed, there was an overall positive tone to the comments. State 
Ombudsman programs largely support the changes made by ACL to NORS. 
They indicated they appreciate ACL's efforts to incorporate many of the 
revisions previously recommended. Further, they indicated these changes 
will result in more accurate and consistent reporting as well as more 
precise identification of trends and the systems advocacy needed to 
address common complaints.

Estimated Program Burden

    In consideration of the comments, additional burden time has been 
factored in to accommodate changes in data collection at the case level 
resulting in an average increase of 75.6 hours per state for a total 
223.6 hours annually. Despite the decrease in the number of data 
elements we believe this more adequately reflects the overall burden. 
This increase in burden hours also recognizes that this revision is the 
most significant change to NORS data collection since its 
implementation in 1995.

[[Page 8088]]

    The reporting form tables and a crosswalk from the old data 
collection to the new may be viewed at the ACL website: https://www.acl.gov/about-acl/public-input.
    AoA estimates the burden of this collection and entering the 
additional report information as follows:

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                                                                    Number       Average burden
                 Instrument                      Number of      responses per     per response     Total burden
                                                respondents       respondent       (in hours)         hours
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Annual State Ombudsman Report...............              52                1            223.6         11,628.6
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    Dated: February 16, 2018.
Mary Lazare,
Administrator and Assistant Secretary for Aging.
[FR Doc. 2018-03767 Filed 2-22-18; 8:45 am]
 BILLING CODE 4154-01-P