[Federal Register Volume 84, Number 84 (Wednesday, May 1, 2019)]
[Notices]
[Pages 18544-18548]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-08765]



[[Page 18544]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Agency for Healthcare Research and Quality, HHS.

ACTION: Notice.

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SUMMARY: This notice announces the intention of the Agency for 
Healthcare Research and Quality (AHRQ) to request that the Office of 
Management and Budget (OMB) approve the proposed updates to the 
currently approved information collection project: ``Medical 
Expenditure Panel Survey (MEPS) Household Component.''

DATES: Comments on this notice must be received by July 1, 2019.

ADDRESSES: Written comments should be submitted to: Doris Lefkowitz, 
Reports Clearance Officer, AHRQ, by email at 
[email protected].
    Copies of the proposed collection plans, data collection 
instruments, and specific details on the estimated burden can be 
obtained from the AHRQ Reports Clearance Officer.

FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports 
Clearance Officer, (301) 427-1477, or by emails at 
[email protected].

SUPPLEMENTARY INFORMATION: 

Proposed Project

    In accordance with the Paperwork Reduction Act, 44 U.S.C. 3501-
3521, AHRQ invites the public to comment on this proposed information 
collection. This request is for an update to the previously submitted 
and OMB-approved clearance for the data collections of the Household 
and Medical Provider Components of the Medical Expenditure Panel Survey 
(MEPS). The previous OMB clearance request for the MEPS was approved 
November, 2018, with an expiration date of November 30, 2021. We 
propose updating the MEPS -HC by (1) adding a self-administered 
questionnaire focusing on mental health, (2) collecting a health 
insurance cost-sharing document and (3) implementing a pilot study to 
evaluate the potential effectiveness of including a sample of NHIS 
nonrespondents in future MEPS panels as a strategy to improve the 
overall MEPS response rate.

Medical Expenditure Panel Survey (MEPS) Household Component and the 
MEPS Medical Provider Component

     Household Component: A sample of households participating 
in the National Health Interview Survey (NHIS) in the prior calendar 
year are interviewed 5 times over a 2 and one half (2.5) year period. 
These 5 interviews yield two years of information on use of, and 
expenditures for, health care, sources of payment for that health care, 
insurance status, employment, health status and health care quality.
     Medical Provider Component: The MEPS-MPC collects 
information from medical and financial records maintained by hospitals, 
physicians, pharmacies and home health agencies named as sources of 
care by household respondents.
     Insurance Component (MEPS-IC): The MEPS-IC collects 
information on establishment characteristics, insurance offerings and 
premiums from employers. The MEPS-IC is conducted by the Census Bureau 
for AHRQ and is cleared separately.
    The MEPS is a multi-purpose survey. In addition to collecting data 
to yield annual estimates for a variety of measures related to health 
care use and expenditures, MEPS also provides estimates of measures 
related to health status, consumer assessment of health care, health 
insurance coverage, demographic characteristics, employment and access 
to health care indicators. Estimates can be provided for individuals, 
families and population subgroups of interest. Data obtained in this 
study are used to provide, among others, the following national 
estimates:

 Annual estimates of health care use and expenditures for 
persons and families
 annual estimates of sources of payment for health care 
utilizations, including public programs such as Medicare and Medicaid, 
private insurance, and out of pocket payments
 annual estimates of health care use, expenditures and sources 
of payment of persons and families by type of utilization including 
inpatient stay, ambulatory care, home health, dental care and 
prescribed medications
 the number and characteristics of the population eligible for 
public programs including the use of services and expenditures of the 
population(s) eligible for benefits under Medicare and Medicaid
 the number, characteristics, and use of services and 
expenditures of persons and families with various forms of insurance
 annual estimates of consumer satisfaction with health care, 
and indicators of health care quality for key conditions
 annual estimates to track disparities in health care use and 
access

    In addition to national estimates, data collected in this ongoing 
longitudinal study are used to study the determinants of the use of 
services and expenditures, and changes in the access to and the 
provision of health care in relation to:

 Socio-economic and demographic factors such as employment or 
income
 the health status and satisfaction with health care of 
individuals and families
 the health needs and circumstances of specific subpopulation 
groups such as the elderly and children

    To meet the need for national data on health care use, access, cost 
and quality, MEPS-HC collects information on:

 Access to care and barriers to receiving needed care
 satisfaction with usual providers
 health status and limitations in activities
 medical conditions for which health care was used
 use, expense and payment (as well as insurance status of 
person receiving care) for health services

    Given the twin problems of nonresponse and response error of some 
household reported data, information is collected directly from medical 
providers in the MEPS-MPC to improve the accuracy of expenditure 
estimates derived from the MEPS-HC. Because of their greater level of 
precision and detail, we also use MEPS-MPC data as the main source of 
imputations of missing expenditure data. Thus, the MEPS-MPC is designed 
to satisfy the following analytical objectives:

 Serve as source data for household reported events with 
missing expenditure information
 Serve as an imputation source to reduce the level of bias in 
survey estimates of medical expenditures due to item nonresponse and 
less complete and less accurate household data
 Serve as the primary data source for expenditure estimates of 
medical care provided by separately billing doctors in hospitals, 
emergency rooms, and outpatient departments, Medicaid recipients and 
expenditure estimates for pharmacies
 Allow for an examination of the level of agreement in reported 
expenditures from household respondents and medical providers


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    Data from the MEPS, both the HC and MPC components, are intended 
for a number of annual reports produced by AHRQ, including the National 
Healthcare Quality and Disparities Report.
    This study is being conducted by AHRQ through its contractors, 
Westat and RTI International, pursuant to AHRQ's statutory authority to 
conduct and support research on health care and on systems for the 
delivery of such care, including activities with respect to the cost 
and use of health care services and with respect to health statistics 
and surveys. 42 U.S.C. 299a(a)(3) and (8); 42 U.S.C. 299b-2.

Method of Collection

    To achieve the goals of the MEPS-HC the following data collections 
are implemented:
    1. Household Component Core Instrument. The core instrument 
collects data about persons in sample households. Topical areas asked 
in each round of interviewing include priority condition enumeration, 
health status, health care utilization including prescribed medicines, 
expenses and payments, employment, and health insurance. Other topical 
areas that are asked only once a year include access to care, income, 
assets, satisfaction with providers, and children's health. While many 
of the questions are asked about the entire reporting unit (RU), which 
is typically a family, only one person normally provides this 
information. All sections of the current core instrument are available 
on the AHRQ website at http://meps.ahrq.gov/mepsweb/survey_comp/survey_questionnaires.jsp .
    2. Adult Self-Administered Questionnaire. A brief self-administered 
questionnaire (SAQ) is used to collect self-reported (rather than 
through household proxy) health opinions and satisfaction with health 
care, and information on health status, preventive care and health care 
quality measures for adults 18 and older.
    3. Diabetes Care SAQ. A brief self-administered paper-and-pencil 
questionnaire on the quality of diabetes care is administered once a 
year (during rounds 3 and 5) to persons identified as having diabetes. 
Included are questions about the number of times the respondent 
reported having a hemoglobin A1c blood test, whether the respondent 
reported having his or her feet checked for sores or irritations, 
whether the respondent reported having an eye exam in which the pupils 
were dilated, the last time the respondent had his or her blood 
cholesterol checked and whether the diabetes has caused kidney or eye 
problems. Respondents are also asked if their diabetes is being treated 
with diet, oral medications or insulin.
    4. Authorization forms for the MEPS-MPC Provider and Pharmacy 
Survey. We ask respondents for authorization to obtain supplemental 
information from their medical providers (hospitals, physicians, home 
health agencies and institutions) and pharmacies.
    5. MEPS Validation Interview. Each interviewer is required to have 
at least 15 percent of his/her caseload validated to insure that the 
computer assisted personal interview (CAPI) questionnaire content was 
asked appropriately and procedures followed, for example, the use of 
show cards. Validation flags are set programmatically for cases pre-
selected by data processing staff before each round of interviewing. 
Home office and field management may also request that other cases be 
validated throughout the field period. When an interviewer fails a 
validation their work is subject to 100 percent validation. 
Additionally, any case completed in less than 30 minutes is validated. 
A validation abstract form containing selected data collected in the 
CAPI interview is generated and used by the validator to guide the 
validation interview.

Proposed HC Additions

    6. Mental Health SAQ. MEPS will include a new self-administered 
questionnaire for spring of 2020 data collection targeting the adult 
(age 18 and over) population. The questionnaire includes questions 
addressing issues in regards to an individual's mental health and 
mental health treatment including mental health status, access to care, 
barriers to care, experiences with care, and use of peer support and 
other services. AHRQ worked with several experts in the mental health 
field to develop this self-administered questionnaire and used their 
expertise to take advantage of already tested and widely accepted 
measures in the SAQ.
    7. Health Insurance Cost Sharing Collection. AHRQ is seeking to 
enhance data collection practices in the 2020 fielding of the MEPS-HC 
to collect more detailed health insurance cost-sharing information from 
respondents with current private insurance, Medicare Advantage, or 
Medicare Part D Prescription Drug plans. Specifically, we will ask 
respondents to provide a document for themselves and family members 
that includes information on plan deductibles, out-of-pocket maximums 
and other cost sharing details for specific services. An example of the 
type of document we propose to collect is the Summary of Benefits and 
Coverage (SBC). AHRQ worked with experts on a feasibility study to 
identify the best methods for collecting these types of documents in a 
way that would minimize respondent burden (OMB approval 0935-0124).
    8. Pilot Test on Sampling NHIS Nonrespondents. This test will be 
conducted on a relatively small sample of households in a few selected 
primary sampling units (PSUs) in the 2020 spring data collection cycle. 
The sample households for this test will be drawn from nonrespondents 
to the 2019 NHIS (which are not currently part of the MEPS frame) and 
only the MEPS Round 1 interview will be administered. The purpose of 
the test is to evaluate the potential effectiveness of including a 
sample of NHIS nonrespondents in future MEPS panels to mitigate the 
impact of declining NHIS response rates on the overall MEPS response 
rate. The general trend of declining response rates for household 
surveys is problematic and this evaluation is designed to explore an 
avenue to stop further declines and potentially improve the overall 
MEPS response rate.
    To achieve the goal of the MEPS-MPC the following data collections 
are implemented. No updates to the MEPS-MPC are being requested:
    1. MPC Contact Guide/Screening Call. An initial screening call is 
placed to determine the type of facility, whether the practice or 
facility is in scope for the MEPS-MPC, the appropriate MEPS-MPC 
respondent and some details about the organization and availability of 
medical records and billing at the practice/facility. All hospitals, 
physician offices, home health agencies, institutions and pharmacies 
are screened by telephone. A unique screening instrument is used for 
each of these seven provider types in the MEPS-MPC, except for the two 
home care provider types which use the same screening form.
    2. Home Care Provider Questionnaire for Health Care Providers. This 
questionnaire is used to collect data from home health care agencies 
which provide medical care services to household respondents. 
Information collected includes type of personnel providing care, hours 
or visits provided per month, and the charges and payments for services 
received. Some HMOs may be included in this provider type.
    3. Home Care Provider Questionnaire for Non-Health Care Providers. 
This questionnaire is used to collect information about services 
provided in the home by non-health care workers to household 
respondents because of a medical condition; for example, cleaning or 
yard work, transportation, shopping, or child care.

[[Page 18546]]

    4. Medical Event Questionnaire for Office-Based Providers. This 
questionnaire is for office-based physicians, including doctors of 
medicine (MDs) and osteopathy (DOs), as well as providers practicing 
under the direction or supervision of an MD or DO (e.g., physician 
assistants and nurse practitioners working in clinics). Providers of 
care in private offices as well as staff model HMOs are included.
    5. Medical Event Questionnaire for Separately Billing Doctors. This 
questionnaire collects information from physicians identified by 
hospitals (during the Hospital Event data collection) as providing care 
to sampled persons during the course of inpatient, outpatient 
department or emergency room care, but who bill separately from the 
hospital.
    6. Hospital Event Questionnaire. This questionnaire is used to 
collect information about hospital events, including inpatient stays, 
outpatient department, and emergency room visits. Hospital data are 
collected not only from the billing department, but from medical 
records and administrative records departments as well. Medical records 
departments are contacted to determine the names of all the doctors who 
treated the patient during a stay or visit. In many cases, the hospital 
administrative office also has to be contacted to determine whether the 
doctors identified by medical records billed separately from the 
hospital; doctors that do bill separately from the hospital will be 
contacted as part of the Medical Event Questionnaire for Separately 
Billing Doctors. HMOs are included in this provider type.
    7. Institutions Event Questionnaire. This questionnaire is used to 
collect information about institution events, including nursing homes, 
rehabilitation facilities and skilled nursing facilities. Institution 
data are collected not only from the billing department, but from 
medical records and administrative records departments as well. Medical 
records departments are contacted to determine the names of all the 
doctors who treated the patient during a stay. In many cases, the 
institution's administrative office also has to be contacted to 
determine whether the doctors identified by medical records billed 
separately from the institution itself. Some HMOs may be included in 
this provider type.
    8. Pharmacy Data Collection Questionnaire. This questionnaire 
requests the National Drug Code (NDC) and when that is not available 
the prescription name, strength and form as well as the date 
prescription was filled, payments by source, the quantity, and person 
for whom the prescription was filled. When the NDC is available, we do 
not ask for prescription name, strength or form because that 
information is embedded in the NDC; this reduces burden on the 
respondent. Most pharmacies have the requested information available in 
electronic format and respond by providing a computer generated 
printout of the patient's prescription information. If the computerized 
form is unavailable, the pharmacy can report their data to a telephone 
interviewer. Pharmacies are also able to provide a CD-ROM with the 
requested information if that is preferred. HMOs are included in this 
provider type.
    Dentists, optometrists, psychologists, podiatrists, chiropractors, 
and others not providing care under the supervision of a MD or DO are 
considered out of scope for the MEPS-MPC.

Estimated Annual Respondent Burden

    Exhibit 1 shows the estimated annualized burden hours for the 
respondents' time to participate in the MEPS-HC and the MEPS-MPC.
    The MEPS-HC Core Interview will be completed by 13,338 * (see note 
below Exhibit 1) ``family level'' respondents, also referred to as RU 
respondents. Since the MEPS-HC consists of 5 rounds of interviewing 
covering a full two years of data, the annual average number of 
responses per respondent is 2.5 responses per year. The MEPS-HC core 
requires an average response time of 92 minutes to administer. The 
Adult Female SAQ (PSAQ) and Adult SAQ (SAQ) will be completed once a 
year by each female person in the RU that is 18 years old and older, an 
estimated 12,984 persons. The Adult Male SAQ (PSAQ) and Adult SAQ (SAQ) 
will be completed once a year by each male person in the RU that is 18 
years old and older, an estimated 11,985 persons. The Adult SAQs each 
require an average of 7 minutes to complete. The Mental Health SAQ will 
be completed during Round 1, Panel 25; Round 3, Panel 24; Round 5, 
Panel 23 interviews by each person in the RU that is 18 years old and 
older, an estimated 24,969 persons, and takes about 7 minutes to 
complete. The Diabetes care SAQ will be completed once a year by each 
person in the RU identified as having diabetes, an estimated 2,072 
persons, and takes about 3 minutes to complete. The 12,804 RUs in the 
MEPS-HC will complete an average of 5.4 forms, which require about 3 
minutes each to complete. The authorization form for the MEPS-MPC 
Pharmacy Survey will be completed once for each pharmacy for any RU 
member who has obtained a prescription medication. RUs will complete an 
average of 3.1 forms, which take about 3 minutes to complete. The 
Health Insurance Cost Sharing collection will be completed during Round 
1, Panel 25 and Round 3, Panel 24 by each RU with a current private 
health insurance plan, a Medicare Advantage plan, or a Medicare Part D 
plan. An estimated 5,835 respondents will locate and provide cost-
sharing documentation for an average of 1.3 plans per eligible RU. This 
activity will require 45 minutes to complete for each plan. About one 
third of all interviewed RUs will complete a validation interview as 
part of the MEPS-HC quality control, which takes an average of 5 
minutes to complete. The total annual burden hours for the MEPS-HC are 
estimated to be 68,772 hours.
    All medical providers and pharmacies included in the MEPS-MPC will 
receive a screening call and the MEPS-MPC uses 7 different 
questionnaires; 6 for medical providers and 1 for pharmacies. Each 
questionnaire is relatively short and requires 2 to 13 minutes to 
complete. The total annual burden hours for the MEPS-MPC are estimated 
to be 17,388 hours. The total annual burden for the MEPS-HC and MPC is 
estimated to be 86,160 hours.
    The total estimated annual burden hours for the MEPS has increased 
from 77,666 hours in the previous clearance to 86,160 hours in this 
clearance request, an increase of 2,913 hours due to the addition of 
the Mental Health SAQ, 5,689 hours due to the health insurance cost 
sharing collection, and 230 hours due to the pilot test on sampling 
NHIS nonrespondents.
    Exhibit 2 shows the estimated annual cost burden associated with 
the respondents' time to participate in this information collection. 
The annual cost burden for the MEPS-HC is estimated to be $1,673,909; 
the annual cost burden for the MEPS-MPC is estimated to be $298,580. 
The total annual cost burden for the MEPS-HC and MPC is estimated to be 
$1,972,489.

[[Page 18547]]



                                  Exhibit 1--Estimated Annualized Burden Hours
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                                                                     Number of
                    Form name                        Number of     responses per     Hours per     Total burden
                                                    respondents     respondent       response          hours
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                                                     MEPS-HC
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MEPS-HC Core Interview..........................      \*\ 13,338             2.5           92/60          51,129
Adult Female SAQ (PSAQ)--Years 2019 and 2021;             12,984               1            7/60           1,515
 Adult SAQ (SAQ)--Year 2020.....................
Adult Male SAQ (PSAQ)--Years 2019 and 2021;               11,985               1            7/60           1,398
 Adult SAQ (SAQ)--Year 2020.....................
Diabetes care SAQ...............................           2,072               1            3/60             104
Mental Health SAQ--Year 2020....................          24,969               1            7/60           2,913
Authorization form for the MEPS-MPC Provider              12,804             5.4            3/60           3,457
 Survey.........................................
Authorization form for the MEPS-MPC Pharmacy              12,804             3.1            3/60           1,985
 Survey.........................................
Health Insurance Cost Sharing Collection--2020..           5,835             1.3           45/60           5,689
MEPS-HC Validation Interview....................           4,225               1            5/60             352
Pilot Test on Sampling NHIS Nonrespondents--2020             150               1           92/60             230
Subtotal for the MEPS-HC........................         102,366              na              na          68,772
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                                                    MEPS-MPC
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MPC Contact Guide/Screening Call \**\...........          36,598               1            2/60           1,220
Home care for health care providers                          635            1.53            9/60             146
 questionnaire..................................
Home care for non-health care providers                       11               1           11/60               2
 questionnaire..................................
Office-based providers questionnaire............          11,210            1.65           10/60           3,083
Separately billing doctors questionnaire........          12,397            3.46           13/60           9,294
Hospitals questionnaire.........................           5,310            3.26            9/60           2,597
Institutions (non-hospital) questionnaire.......             116            2.05            9/60              36
Pharmacies questionnaire........................           6,919            2.92            3/60           1,010
Subtotal for the MEPS-MPC.......................          73,196              na              na          17,388
                                                 ---------------------------------------------------------------
    Grand Total.................................        175, 562              na              na          86,160
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* While the expected number of responding units for the annual estimates is 12,804, it is necessary to adjust
  for survey attrition of initial respondents by a factor of 0.96 (13,338=12,804/0.96).
** There are 6 different contact guides; one for office based, separately billing doctor, hospital, institution,
  and pharmacy provider types, and the two home care provider types, which use the same contact guide.


                                   Exhibit 2--Estimated Annualized Cost Burden
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                                                     Number of     Total burden   Average hourly    Total cost
                    Form name                       respondents        hours         wage rate        burden
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                                                     MEPS-HC
----------------------------------------------------------------------------------------------------------------
MEPS-HC Core Interview..........................          13,338          51,129          $24.34      $1,244,480
Adult Female SAQ (PSAQ)--Years 2019 and 2021;             12,984           1,515       \*\ 24.34          36,875
 Adult SAQ (SAQ)--Year 2020.....................
Adult Male SAQ (PSAQ)--Years 2019 and 2021;               11,985           1,398       \*\ 24.34          34,027
 Adult SAQ (SAQ)--Year 2020.....................
Diabetes care SAQ...............................           2,072             104        \*\24.34           2,531
Mental Health SAQ--Year 2020....................          24,969           2,913        \*\24.34          70,902
Authorization forms for the MEPS-MPC Provider             12,804           3,457        \*\24.34          84,143
 Survey.........................................
Authorization form for the MEPS-MPC Pharmacy              12,804           1,985        \*\24.34          48,315
 Survey.........................................
Health Insurance Cost Sharing Collection--2020..           5,835           5,689        \*\24.34         138,470
MEPS-HC Validation Interview....................           4,225             352        \*\24.34           8,568
Pilot Test on Sampling NHIS Nonrespondents--2020             150             230        \*\24.34           5,598
Subtotal for the MEPS-HC........................         102,366          68,800              na       1,673,909
----------------------------------------------------------------------------------------------------------------
                                                    MEPS-MPC
----------------------------------------------------------------------------------------------------------------
MPC Contact Guide/Screening Call................          36,598           1,220       \**\17.25          21,045
Home care for health care providers                          635             146       \**\17.25           2,519
 questionnaire..................................
Home care for non[dash]health care providers                  11               2       \**\17.25              35
 questionnaire..................................
Office[dash]based providers questionnaire.......          11,210           3,083       \**\17.25          53,182
Separately billing doctors questionnaire........          12,397           9,294       \**\17.25         160,322
Hospitals questionnaire.........................           5,310           2,597       \**\17.25          44,798
Institutions (non-hospital) questionnaire.......             116              36       \**\17.25             621
Pharmacies questionnaire........................           6,919           1,010      \***\15.90          16,059
Subtotal for the MEPS-MPC.......................          73,196          17,388              na         298,580
                                                 ---------------------------------------------------------------
    Grand Total.................................        175, 562  ..............              na       1,972,489
----------------------------------------------------------------------------------------------------------------
\*\ Mean hourly wage for All Occupations (00-0000).

[[Page 18548]]

 
\**\ Mean hourly wage for Medical Secretaries (43-6013).
\***\ Mean hourly wage for Pharmacy Technicians (29-2052).

    Occupational Employment Statistics, May 2017 National Occupational 
Employment and Wage Estimates United States, U.S. Department of Labor, 
Bureau of Labor Statistics.

Request for Comments

    In accordance with the Paperwork Reduction Act, comments on AHRQ's 
information collection are requested with regard to any of the 
following: (a) Whether the proposed collection of information is 
necessary for the proper performance of AHRQ's health care research and 
health care information dissemination functions, including whether the 
information will have practical utility; (b) the accuracy of AHRQ's 
estimate of burden (including hours and costs) of the proposed 
collection(s) of information; (c) ways to enhance the quality, utility 
and clarity of the information to be collected; and (d) ways to 
minimize the burden of the collection of information upon the 
respondents, including the use of automated collection techniques or 
other forms of information technology.
    Comments submitted in response to this notice will be summarized 
and included in the Agency's subsequent request for OMB approval of the 
proposed information collection. All comments will become a matter of 
public record.

Gopal Khanna,
Director.
[FR Doc. 2019-08765 Filed 4-30-19; 8:45 am]
 BILLING CODE 4160-90-P