[Federal Register Volume 84, Number 90 (Thursday, May 9, 2019)]
[Notices]
[Pages 20360-20367]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-09444]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration for Community Living


Statement of Organization, Functions, and Delegations of 
Authority

    Part B of the Statement of Organization, Functions, and Delegations 
of Authority of the Department of Health and Human Services (HHS), as 
last amended at 79 FR 80 FR 31389-31402, dated June 2, 2015, is amended 
to reflect the reorganization of the Administration on Community Living 
(ACL). This reorganization is being undertaken to improve efficiency 
and effectiveness of the organization; strengthen infrastructure; and 
improve the connections between the organization and its stakeholder, 
grantees and consumers at the national, state and local levels. It 
changes the Office of Elder Justice and Adult Protective Services 
functions to include carrying out the Long-Term Care Ombudsman 
functions established in Section 201(d)(1) of the Older Americans Act 
(OAA) and the Deputy Assistant Secretary for Aging will meet the 
responsibilities for the Director of the Office of Long-Term Care 
Ombudsman Programs. It renames the Independent Living Administration to 
the Office of Independent Living Programs, which will continue to serve 
as the Independent Living Administration as specified in Section 701A 
of the Rehabilitation Act, and renames the Administration on 
Intellectual and Developmental Disabilities to the Office of 
Intellectual and Developmental Disabilities Programs. The Commissioner 
for the Administration on Disabilities (AoD) will also serve as the 
Director of the Independent Living Admininstration. It retitles the 
Center for Integrated Programs to the Center for Innovation and 
Partnership, the Office of Consumer Access and Self-Determination to 
the Office of Network Advancement, and the Office of Integrated Care 
Innovations to the Office of Interagency Innovation. It retitles the 
National Institute of Disability, Independent Living and Rebabilitation 
Research's Office of Research Evaluation and Administration to the 
Office of Research Administration. It retitles the Office of Regional 
Operations to the Center for Regional Operations. The changes are as 
follows:
    I. Under Section B10, Organization, delete Center for Integrated 
Programs (BD) and replace with Center for Innovation and Partnership 
(BD).
    II. Delete Section B20, Functions, in its entirety and replace with 
the following:

    B.20 Functions. ACL is the principal agency in the department 
designated to lead aging and disability programs. More specifically, 
the provisions of the Older Americans Act (OAA) of 1965 are carried 
out by its subcomponent, the Administration on Aging (AoA); the 
provisions of the Developmental Disabilities Assistance and Bill of 
Rights Act (DD Act) of 2000 and Title VII of the Rehabilitation Act 
of 1973 are carried out by its subcomponent, the Administration on 
Disabilities (AoD); and the provisions of Title II of the 
Rehabilitation Act of 1973 are carried out by its subcomponent, the 
National Institute on Disability, Independent Living, and 
Rehabilitation Research. ACL also administers programs authorized 
under Title III and Title XXIX of the Public Health Service Act 
(PHSA), section 262 and 292 of the Help America Vote Act (HAVA), 
section 119 of the Medicare Improvements for Patients and Providers 
Act (MIPPA) of 2008, section 6021(d) of the Deficit Reduction Act 
(DRA) of 2005, section 4360 of the Omnibus Budget Reconciliation Act 
(OBRA) of 1990, the Elder Justice Act (EJA) of 2010 (Subtitle B of 
Title XX of the Social Security Act), the Assistive Technology Act 
of 1998, and the Traumatic Brain Injury Program Reauthorization Act 
of 2018. In addition, ACL provides continuing support for the 
administration of the President's Committee for People with 
Intellectual Disabilities pursuant to E.O. 13652.
    Specifically, ACL: Develops, recommends and issues regulations, 
policies, procedures, standards and guidelines to provide direction 
for the programs it administers. Approves or disapproves plans and 
funding applications for national programs providing community-based 
long-term services and supports. Administers programs for training, 
research, demonstration, evaluation and information dissemination. 
Administers programs related to advocacy, systems change and 
capacity building. Administers national centers for service 
development and provides technical assistance to states, tribal 
organizations, local communities and service providers. Serves as 
the lead federal agency for adult protective services.
    Assists the Secretary in all matters pertaining to opportunities 
and challenges of persons with disabilities, older Americans, and 
Americans of all ages about their current and potential future need 
for information and access to long-term services and supports. 
Advocates for the needs of these constituencies in program planning 
and policy development within the department and in other federal 
agencies. Advises the Secretary, departmental components and other 
federal organizations on the characteristics, circumstances and 
needs of these populations and develops policies, plans and programs 
designed to promote their welfare.
    The functions of the organizational units of ACL are described 
in detail in the succeeding chapters.

    III. Under Section BA.20, Functions, delete Subsection 3. Office of 
Regional Operations (BAC) in its entirety.
    IV. Delete Section B, Administration on Aging (BB), in its entirety 
and replace with the following:

B. Administration on Aging (BB)
BB.00 Mission
BB.10 Organization
BB.20 Functions
    BB.00 Mission. The Administration on Aging (AoA) carries out 
programs operated under the OAA, Sections III, XXIX and 398 of the 
PHSA, and the EJA (Subtitle B of Title XX of the Social Security), 
including, but not limited to, those concerning the Elder Justice 
Coordinating Council and Adult Protective Services. The AoA helps 
elderly individuals maintain their dignity and independence in their 
homes and communities through comprehensive, coordinated, and cost

[[Page 20361]]

effective systems of long-term care, and livable communities across 
the United States.
    BB.10 Organization. The AoA is headed by the Assistant Secretary 
for Aging, who is also the ACL Administrator. The Deputy Assistant 
Secretary for Aging supports the Assistant Secretary in overseeing 
the AoA. The Deputy Assistant Secretary for Aging also serves as the 
Director of the Office of Long-Term Care Ombudsman Programs 
consistent with Section 201 of the OAA. The AoA includes the 
following components:

Office of the Assistant Secretary for Aging (BBA)
Office of Supportive and Caregiver Services (BBB)
Office of Nutrition and Health Promotion Programs (BBC)
Office of Elder Justice and Adult Protective Services (BBD)
Office of American Indian, Alaskan Native, and Native Hawaiian 
Programs (BBE)

    BB.20 Functions.
    1. Office of the Assistant Secretary for Aging (BBA). The Office 
of the Assistant Secretary for Aging advises and supports the 
Administrator, the Secretary, and other elements of the department 
in serving as the visible and effective advocate for older people 
within the federal government. Provides leadership and expertise on 
program development, advocacy and initiatives affecting seniors and 
their caregivers. Plans and directs grant programs designed to 
provide planning, coordination and services to older Americans as 
authorized under the OAA and other legislation. Actively partners 
with other ACL subcomponents to develop coordinated programs and 
policies that jointly address the common needs of older adults and 
people with disabilities.
    Performs functions under Title II of the OAA related to 
consultation with other federal agencies and the provision of 
information about aging services, programs and policies in order to 
enhance coordination and delivery. Supports the Administrator in 
implementing Section 203(1) of the OAA by advising and coordinating 
with the head of each department and agency and instrumentality of 
the federal government proposing or administering programs or 
services substantially related to the objectives of the OAA. 
Oversees the consultation process by which agency heads must consult 
with AoA before establishing programs or services related to the 
OAA. Plans and implements the process for the collaboration with AoA 
and all federal agencies executing programs and services related to 
the OAA.
    Consults with and provides technical assistance to and education 
for State and Area Agencies on Aging, tribal grantees and local 
community service providers in the development of plans, goals, and 
system development activities. Ensures that statutory requirements, 
regulations, policies, and instructions are implemented for 
mandatory grant programs under Titles III, VI and VII of the OAA, 
and for the discretionary grant programs under Title II and Title IV 
of the OAA, as well as Sections XXIX and 398 of the PHSA and Title 
III of the EJA.
    Provides oversight and leadership, technical assistance, and 
guidance to State and Area Agencies on Aging and community service 
providers. Implements the national programs of the OAA in 
coordination with the Regional Support Centers and ensures that 
clear and consistent guidance is given on program and policy 
directives. Issues substantive operating procedures to guide central 
office and regional staff in the conduct of their programmatic 
responsibilities.
    Monitors, assists and evaluates state agencies and tribal 
organizations administering programs supported under the OAA and 
other authorizing legislation as directed. Participates in the 
review of state plans and recommend approval or disapproval. 
Participates in the review of applications for tribal programs and 
recommend approval or disapproval. Reviews grantee financial and 
program reports and provide technical assistance on fiscal 
operations. Oversees disaster assistance and reimbursement 
activities pursuant to Section 310 of the OAA.
    At all levels, from national to the local service delivery 
level, develops methods and collaborations to articulate the 
problems and concerns of the elderly to organizations beyond the 
traditional network of agencies and works with these organizations 
to be more sensitive and responsive to age-related needs and issues. 
In coordination with the Office of External Affairs (OEA), develops 
strategies for increasing public awareness of the needs of older 
Americans and their families, and programs designed to address them.
    2. Office of Supportive and Caregiver Services (BBB). The Office 
of Supportive and Caregiver Services serves as the focal point for 
the operation, administration, and assessment of the programs 
authorized under Titles III-B and III-E of the OAA and Sections XXIX 
and 398 of the PHSA, as well as activities under Titles II and IV of 
the OAA that are designed to provide information and referral 
services to seniors and caregivers, and to support technical 
assistance, outreach, and information dissemination that are 
culturally and linguistically appropriate in order to meet the needs 
of diverse populations of older individuals. In addition, the Office 
performs the functions under Title II of the OAA related to 
consultation with other federal agencies and the provision of 
information about supportive and caregiver services in order to 
enhance service coordination and delivery.
    Implements Titles III-B and III-E of the OAA through the 
development of regulations, policies and guidance governing the 
development and enhancement by State and Area Agencies on Aging of 
comprehensive and coordinated systems of home- and community-based 
supportive and caregiver services. This includes implementing and 
enhancing systems for home- and community-based supportive services, 
the operation of multi-purpose senior centers, and caregiver support 
and assistance services.
    In coordination with the Office of Nutrition and Health 
Promotion Programs, provides guidance regarding state plan 
processing and approval, the process and criteria for approval of 
states' Intrastate Funding Formulas for the allocation and targeting 
of resources within states, and implementation of the Interstate 
Funding Formula for distribution of Title III-B and III-E funds 
among states. Through the analysis of state plans, evaluation 
findings and other relevant material, identifies potential program 
and management issues and develops recommendations on possible 
solutions.
    Fosters, oversees, and ensures accountability for the 
implementation of programs by states and Area Agencies on Aging 
through guidance and direction to regional staff regarding program 
reviews and system development and enhancements. Designs and 
provides training and technical assistance for program compliance, 
effectiveness, and enhancement. Provides technical and subject 
matter expertise targeted at enhancing the capabilities of State and 
Area Agencies on Aging and local communities to improve service 
delivery to older people.
    Directs and assesses the development of state-administered home- 
and community-based long-term care systems providing supportive 
services for the elderly and caregivers. Initiates and encourages 
expansion of the capacities of home- and community-based supportive 
and caregiver services.
    Implements programs under Sections XXIX and 398 of the PHSA, as 
well as activities under Titles II and IV of the OAA, through the 
development of demonstrations designed to test the efficacy of new 
and innovative models in improving the delivery and effectiveness of 
community-based supportive services for seniors and caregivers. 
Plans and develops discretionary grant program announcements. 
Evaluates demonstration grant and contract proposals and recommends 
approval/disapproval. Monitors progress, gives technical guidance, 
and evaluates program performance.
    Promotes the coordination of innovation and demonstration 
activities with other national, field and local programs related to 
aging. Develops standards and identifies successful service and 
systems development strategies and best practice models for use by 
the aging network. Provides technical assistance to aging network 
partners in utilizing the findings from program demonstrations to 
inform policy and program development and enhance service delivery 
and coordination at the federal, state and local level.
    3. Office of Nutrition and Health Promotion Programs (BBC). The 
Office of Nutrition and Health Promotion Programs serves as the 
focal point for the operation, administration, and assessment of the 
programs authorized under Titles III-C and III-D of the OAA and 
Title III of the PHSA, as well as activities under Titles II and IV 
of the OAA designed to promote healthy behaviors and improved health 
status for older people. In addition, the office performs the 
functions under Title II of the OAA related to consultation with 
other federal agencies and the provision of information about 
nutrition and preventive health services in order to enhance service 
coordination and delivery.

[[Page 20362]]

    Implements Titles III-C and III-D of the OAA through the 
development of regulations, policies and guidance governing the 
development and enhancement by State and Area Agencies on Aging of 
comprehensive and coordinated systems of home- and community-based 
nutrition and preventive health services. Carries out the functions 
of the designated Nutrition Officer, who coordinates nutritional 
services under the OAA, develops the regulations and guidelines, and 
provides technical assistance regarding nutrition to State and Area 
Agencies on Aging, nutrition service providers, and other 
organizations. Serves as the liaison to the Department of 
Agriculture and other federal agencies and organizations related to 
nutrition policy and program issues.
    In coordination with ACL's Office of Supportive and Caregiver 
Services, provides guidance regarding state plan processing and 
approval, the process and criteria for approval of states' 
Intrastate Funding Formulas for the allocation and targeting of 
resources within states, and implementation of the Interstate 
Funding Formula for distribution of Title III-C and III-D funds 
among states. Through the analysis of state plans, evaluation 
findings and other relevant material, identifies potential program 
and management issues and develops recommendations on possible 
solutions.
    Fosters, oversees, and ensures accountability for the 
implementation of programs by states and Area Agencies on Aging 
through guidance and direction to regional staff regarding program 
reviews and system development and enhancements. Designs and 
provides training and technical assistance for program compliance, 
effectiveness, and enhancement. Provides technical and subject 
matter expertise targeted at enhancing the capabilities of State and 
Area Agencies on Aging and local communities to improve service 
delivery to older people.
    Directs and assesses the development of State-administered home- 
and community-based long-term care systems providing nutrition and 
preventive health services for the elderly and caregivers. Initiates 
and encourages expansion of the capacities of home- and community-
based nutrition and preventive health services to deliver 
comprehensive services to the elderly.
    Implements programs under Title III of the PHSA, as well as 
other activities under Titles II and IV of the OAA, through the 
development of demonstrations designed to test the efficacy of new 
and innovative models in improving the delivery and effectiveness of 
community-based nutrition, health promotion, and evidenced-based 
disease prevention. Prepares the planning documents for and develops 
discretionary grant program announcements. Evaluates demonstration 
grant and contract proposals; and recommends approval/disapproval. 
Monitors progress, gives technical guidance to, and evaluates the 
performance of grantees and contractors.
    Promotes the coordination of innovation and demonstration 
activities with other national, field and local programs related to 
aging. Develops standards and identifies successful service and 
systems development strategies and best practice models for use by 
the aging network. Provides technical assistance to aging network 
partners in utilizing the findings from program demonstrations to 
inform policy and program development and enhance service delivery 
and coordination at the federal, state and local level.
    4. Office of Elder Justice and Adult Protective Services (BBD). 
The Office of Elder Justice and Adult Protective Services serves as 
the focal point for the operation, administration, and assessment of 
the elder abuse prevention, legal assistance development, and 
pension counseling programs under Titles II and VII of the OAA, and 
for Adult Protective Services and related activities carried out 
under the Elder Justice Act. The office also carries out the Long-
Term Care Ombudsman functions established in Section 201(d)(1) of 
the OAA, serving as the advocate for older Americans in the 
development and implementation of federal policies and laws that may 
affect the health, safety, welfare, or rights of residents of long-
term care facilities.
    Reviews state plans to determine eligibility for funding under 
the OAA and recommends approval or disapproval. Implements Title VII 
in the field, through the provision of guidance and information, and 
the development and interpretation of Title VII program regulations 
and policy. Ensures the implementation of guidance and instructions 
concerning prevention of elder abuse, elder justice and legal 
assistance development programs. Provides guidance and leadership in 
the development of the pension counseling program and effective 
models for nationwide replication.
    Fosters, coordinates, and ensures accountability for the 
implementation of Title VII by states through guidance and direction 
to regional staff regarding program reviews, and program and system 
development and enhancements. Designs and provides training and 
technical assistance for program compliance, effectiveness, and 
enhancement. Develops program plans and instructions for State and 
Area Agencies on Aging to improve the Title VII protection and 
representational programs funded under the OAA.
    Implements demonstration activities under Titles II and IV of 
the OAA and the EJA designed to test the efficacy of new and 
innovative models in improving the delivery and effectiveness of 
elder rights activities. Prepares the planning documents for and 
develops discretionary grant program announcements. Evaluates 
demonstration grant and contract proposals and recommends approval/
disapproval. Monitors progress, gives technical guidance, and 
evaluates program performance.
    Promotes the coordination of innovation and demonstration 
activities with other national, field and local programs related to 
aging. Develops standards and identifies successful service and 
systems development strategies and best practice models for use by 
the aging network. Provides technical assistance to aging network 
partners in utilizing the findings from program demonstrations to 
inform policy and program development and enhance service delivery 
and coordination at the federal, state and local level.
    Provides federal leadership for the development and 
implementation of comprehensive Adult Protective Services systems in 
order to provide a coordinated and seamless response for helping 
adult victims of abuse and to prevent abuse before it happens. 
Develops national Adult Protective Services data systems and 
standards, and provides technical assistance to states on using and 
interfacing with the system. Develops model Adult Protective 
Services program standards that help states improve the quality and 
consistency of programs. Advances a coordinated federal research 
strategy to fill the gaps in knowledge and develop evidence-based 
interventions to prevent, identify and report, and respond to elder 
abuse, neglect and exploitation. Provides support for the Elder 
Justice Coordinating Council.
    Reviews federal legislation, regulations, and policies regarding 
long-term care ombudsman programs and makes recommendations to the 
Assistant Secretary for Aging. Coordinates the activities of ACL 
with other federal, state and local entities relating to long-term 
care ombudsman programs; prepares an annual report to Congress on 
the effectiveness of services provided by state long-term care 
ombudsman programs; and establishes standards for the training of 
state long-term care ombudsman staff. Coordinates the administration 
of the Long-Term Care Ombudsman Program and the National Ombudsman 
Resource Center to ensure alignment with agency initiatives related 
to elder justice and adult protective services. Makes 
recommendations to the Administrator regarding the operation of the 
National Ombudsman Resource Center, and the review and approval of 
the provisions in state plans submitted under section 307(a) of the 
OAA that relate to state long-term care ombudsman programs.
    5. Office for American Indian, Alaskan Native, and Native 
Hawaiian Programs (BBE). The Office for American Indian, Alaskan 
Native, and Native Hawaiian Programs serves as advocate within the 
Department of Health and Human Services and with other departments 
and agencies of the federal government regarding all federal 
policies affecting older individuals who are Native Americans. Works 
with state, local and tribal governments providing leadership and 
coordination of activities, services and policies affecting American 
Indians, Alaskan Natives and Native Hawaiian elders. Promotes 
linkages among national Indian organizations, national aging 
organizations, and national provider organizations with the goal of 
enhancing the interests of and services to Native American elders. 
Recommends policies and priorities with respect to the development 
and operation of programs and activities relating to individuals who 
are older Native Americans. Coordinates activities among other 
federal departments and agencies to ensure a continuum of improved 
services through memoranda of agreements or through other 
appropriate means of coordination.
    Evaluates outreach under Title III and Title VI of the OAA and 
recommends necessary

[[Page 20363]]

action to improve service delivery, outreach, and coordination 
between Title III and Title VI services. Encourages and assists with 
the provision of information to older Native Americans to ensure a 
continuum of services. Develops research plans, conducts and 
arranges for research in the field of Native American aging; 
collects, analyzes, and disseminates information related to problems 
experienced by older Native Americans, including information on 
health status of older individuals who are Native Americans, elder 
abuse, in-home care, and problems unique to Native Americans. 
Develops, implements, and oversees the uniform data collection 
procedures for tribal and Native Hawaiian Organizations and 
implements and oversees the consultation requirements of Title II as 
they apply to Native American issues.
    Serves as the AoA focal point for the administration of the 
programs authorized under Title VI and the Native American 
Organization provisions of Title VII-B of the OAA, including 
administering grants, cooperative agreements and contracts. Provides 
program guidance, policy direction, training, technical assistance, 
and monitoring of Title VI grantees. Oversees the development and 
operation of Resource Centers on Native American Elders under Title 
IV of the OAA, which gather information, perform research, provide 
for dissemination of results, and provide technical assistance and 
training to those who provide services to Native American elders. 
Arranges for and manages ongoing training and technical assistance 
for Title VI grantees. Coordinates additional training and technical 
assistance related to diversity and national minority aging 
organizations and coalitions with other projects managed by other 
components of the agency.

    V. Delete Section C, Administration on Disabilities (BC), in its 
entirety and replace with the following:

C. Administration on Disabilities (BC)

BC.00 Mission
BC.10 Organization
BC.20 Functions

    BC.00 Mission. The Administration on Disabilities (AoD) advises 
the Secretary, through the Administrator and Principal Deputy 
Administrator for Community Living, on matters relating to services 
and supports for individuals with disabilities and their families, 
and serves as a focal point in the department to support and 
encourage the provision of quality services and supports, and 
implementation of program and policy that benefit people with 
disabilities and their families. AoD supports states and communities 
in increasing the independence, productivity and community inclusion 
of individuals with disabilities; empowers individuals with 
disabilities to maximize opportunities for competitive integrated 
employment, economic self-sufficiency, independence and integration 
into society; promotes consumer control and self-advocacy; and 
ensures that the rights of individuals with disabilities are 
protected. Carries out programs operated under the DD Act, Title VII 
of the Rehabilitation Act, Section 262 and 292 of the HAVA, Section 
5 of the Assistive Technology Act of 1998, Title III of the PHSA, 
and the Traumatic Brain Injury Program Reauthorization Act of 2018.
    BC.10 Organization. AoD is headed by a Commissioner on 
Disabilities who also serves as the Director of the Independent 
Living Administration. This dual role reports directly to the 
Administrator and is appointed by the Secretary consistent with DD 
Act and Section 701A of the Rehabilitation Act. This role serves as 
a member of the Administrator's senior leadership team. AoD includes 
the following components:

Office of the Commissioner on Disabilities (BCA)
Office of Intellectual and Developmental Disability Programs (BCB)
President's Committee for People with Intellectual Disabilities 
(BCB1A)
Office of Independent Living Programs (BCC)
Office of Disability Services Innovation (BCD)

    BC.20 Functions.
    1. Office of the Commissioner on Disabilities (BCA). The Office 
of the Commissioner on Disabilities provides executive leadership 
and management strategies for all components of AoD. Advises the ACL 
Administrator on issues related to services and supports, civil 
rights and other matters affecting individuals with disabilities and 
their families. Plans, coordinates and controls AoD policy, planning 
and management activities which include the development of 
legislative proposals, regulations and policy issuances for AoD.
    Provides executive direction to AoD's components and establishes 
goals and objectives for AoD programs. Assists states, through the 
design and implementation of state plans for independent living, 
developmental disabilities, and protection and advocacy programs, in 
making optimal use of federal, state, and local resources that 
maximize the independence, productivity, economic self-sufficiency 
and community inclusion and integration of individuals with 
disabilities and their families.
    In concert with other components of ACL as well as other public, 
private, and volunteer sector partners, develops and implements 
research, demonstration and evaluation strategies for discretionary 
funding of activities designed to improve and enrich the lives of 
individuals with disabilities. Serves as a resource in the 
development of policies and programs to reduce or eliminate barriers 
experienced by individuals with disabilities through the 
identification of promising practices and dissemination of 
information. Supports and encourages programs or services and 
manages initiatives, involving the private and voluntary sectors 
that benefit individuals with disabilities and their families.
    Initiates, executes and supports the development of interagency, 
intergovernmental and public-private sector agreements, committees, 
task forces, commissions or joint-funding efforts as appropriate. 
Actively partners with other ACL subcomponents to develop 
coordinated programs and policies that jointly address the common 
needs of older adults and people with disabilities. In coordination 
with OEA, develops strategies for increasing public awareness of the 
needs of individuals with disabilities, their families, and programs 
designed to address them.
    2. Office of Intellectual and Developmental Disability Programs 
(BCB). The Office of Intellectual and Developmental Disability 
Programs is responsible for the coordination, oversight, management 
and evaluation of programs authorized by the DD Act. The office is 
responsible for the coordination, oversight, management and 
evaluation of the State Councils on Developmental Disabilities, and 
the University Centers for Excellence in Developmental Disabilities 
grant programs as authorized by the DD Act. Develops procedures and 
performance standards that ensure compliance with the DD Act and 
that improve the outcomes of the programs in increasing the 
independence, productivity and community inclusion of persons with 
developmental disabilities. Conducts routine and special analyses of 
state plans of State Councils on Developmental Disabilities, and 
five-year plans of the University Centers for Excellence in 
Developmental Disabilities, to ensure consistent application of 
program goals and objectives. Provides program development services, 
develops and initiates guidelines, policy issuances and actions with 
team participation by other components of AoD, ACL, HHS and other 
government agencies to fulfill the mission and goals of the DD Act, 
as amended.
    Oversees activities that support state efforts to improve 
accessibility for individuals with the full range of disabilities to 
polling places and voting facilities. The office also provides 
general staff support for the President's Committee for People with 
Intellectual Disabilities (BCB1A) as established by Executive Order. 
Coordinates all meetings, provides advice and assistance in the 
areas of intellectual disabilities as requested by the President or 
the Secretary, and prepares and issues an annual report concerning 
intellectual disabilities and additional reports or recommendations 
as appropriate.
    3. Office of Independent Living Programs (BCC). The Office of 
Independent Living Programs, which serves as the Independent Living 
Administration as specified in Section 701A of the Rehabilitation 
Act, aims to maximize the leadership, empowerment, independence, and 
productivity of individuals with disabilities while promoting the 
independent living philosophy of consumer control, self-help and 
self-advocacy, development of peer relationships and peer role 
models, and equal access for individuals with significant 
disabilities to all aspects of society. The office administers 
grants to support independent living programs that offer financial 
assistance to provide expanded and improved independent living 
services. Develops and supports statewide networks of centers for 
independent living and improves working relationships among state 
independent living rehabilitation programs, centers for independent 
living, statewide Independent Living Councils, Rehabilitation Act 
programs outside of Title VII, and other relevant federal and non-
federal programs. Funds grants for consumer-controlled, community-

[[Page 20364]]

based, cross-disability, nonresidential, private nonprofit agencies 
that are designed and operated within a local community by 
individuals with disabilities and provide an array of independent 
living services, such as community planning and decision making; 
school-based peer counseling, transition services, role modeling, 
and skills training. Manages other grants, contracts or cooperative 
agreements to provide training and technical assistance with respect 
to planning, developing, conducting, administering, and evaluating 
centers for independent living. Ensures compliance with the 
Rehabilitation Act, which establishes a set of standards and 
assurances that centers for independent living must meet and 
requires development and publication of indicators of minimum 
compliance with the standards.
    In addition, participates in the development and dissemination 
of policy guidance, regulations, and program guidance related to 
Independent Living Programs. In collaboration with the Center for 
Policy and Evaluation (CPE), develops program performance measures, 
which are used to evaluate and monitor grantees. Provides program 
development services, develops and initiates guidelines, policy 
issuances and actions with team participation by other components of 
ACL, HHS and other government agencies to fulfill the purpose and 
goals of Title VII of the Rehabilitation Act, as amended.
    4. Office of Disability Services Innovation (BCD). The Office of 
Disability Services Innovation works across disability populations, 
programs and resources to advance education and technical assistance 
while addressing the most prevailing issues and opportunities for 
Americans with disabilities. The office administers the Protection 
and Advocacy programs as authorized by the DD Act, Section 292 of 
the HAVA, Section 5 of the Assistive Technology Act, and the 
Traumatic Brain Injury Program Reauthorization Act of 2018, that 
together work to protect individuals with disabilities in every 
state and territory by empowering them to fight for personal and 
civil rights, providing legal support to traditionally unserved or 
underserved populations to help them navigate the legal system to 
achieve resolution and encourage systems change, and advocating on 
their behalf to help ensure they are able to exercise their rights 
to make choices, contribute to society, and live independently. This 
includes administering a training and technical assistance grant 
program under the HAVA that provides technical assistance to 
Protection and Advocacy systems in their mission to promote the full 
participation in the electoral process for individuals with the full 
range of disabilities, including registering to vote, casting vote, 
and accessing polling places.
    The office is also responsible for the coordination, oversight, 
management and evaluation of the Projects of National Significance 
program authorized by the DD Act. Ensures the dissemination of 
grantee results, including project results and information produced 
by grantees, in coordination with the Office of Intellectual and 
Developmental Disability Programs, the Office of Independent Living 
Programs, and the Office of the Commissioner on Disabilities. 
Manages cross-cutting research, demonstration and evaluation 
initiatives consistent with the purposes of the DD Act and 
Rehabilitation Act, with other components of ACL, HHS and other 
government agencies to promote and integrate the grant programs into 
cross-agency and cross-disability efforts. Coordinates information 
sharing and other activities related to national program trends and 
studies, reviews and analyzes other federal programs providing 
services applicable to persons with disabilities for the purpose of 
integrating and coordinating program efforts.
    The office also administers grants to states to expand and 
improve capability for individuals with traumatic brain injury and 
their families have better access to comprehensive and coordinated 
services, to encourage systems change, and to address barriers to 
needed services as authorized by the Traumatic Brain Injury Program 
Reauthorization Act of 2018. The office also carries out activities 
under Title III of the PHSA that promote the health and well-being 
of people living with paralysis and limb loss. Supports their 
families and caregivers by providing comprehensive information and 
referral services that assist individuals to remain at home and in 
the community.

    VI. Delete Section D, Center for Integrated Programs (BD), in its 
entirety and replace with the following:

D. Center for Innovation and Partnership (BD):

BD.00 Mission
BD.10 Organization
BD.20 Functions

    BD.00 Mission. The Center for Innovation and Partnership (CIP) 
serves as the locus within ACL for the administration of programs 
and initiatives that serve both older adults and persons with 
disabilities, including consumer access and protection programs. 
Manages programs and initiatives that promote the use of self-
directed and person-centered service models and advance the 
development of health and long-term care services and support 
systems that are responsive to the needs and preferences of older 
adults, persons with disabilities, caregivers, and families. Carries 
out programs authorized under Titles II and IV of the OAA, Section 
119 of the MIPPA, Section 4360 of the OBRA of 1990, and Section 4 of 
the Assistive Technology Act that focus on helping states make their 
health care and long-term service and support systems more person-
centered, improve access to health care and assistive technology 
services, and promote the values of self-determination, full 
participation in community, integration and independence. Also 
implements initiatives at the national, state and local level to 
strengthen the capacity of ACL's network of state and community-
based organizations to play a meaningful role in the transformation 
of our nation's health and long-term service and support systems.
    BD.10 Organization. CIP is headed by a Deputy Administrator, who 
reports directly to the ACL Administrator. The Center includes the 
following components:

Office of the Deputy Administrator for Innovation and Partnership 
(BDA)
Office of Healthcare Information and Counseling (BDB)
Office of Network Advancement (BDC)
Office of Interagency Innovation (BDD)

    BD.20 Functions.
    1. Office of the Deputy Administrator for Innovation and 
Partnership (BDA). The Office of the Deputy Administrator for 
Innovation and Partnership supports the ACL Administrator and the 
Principal Deputy Administrator in advancing programmatic and 
systemic changes to make state health and long-term services and 
supports systems more person-centered and responsive to the needs 
and preferences of older Americans, people with disabilities, their 
families, and caregivers. Works with other ACL components, federal 
partners and key external stakeholder groups to engage the multiple 
state agencies involved in long-term services and supports in 
developing high performing, consumer-oriented, and responsive 
systems of care for all populations.
    Provides leadership and strategic direction to guide the 
administration of ACL programs that assist consumers in 
understanding their health care and long-term services and supports 
options, improve access to services including assistive 
technologies, and prevent fraud and abuse. Consults with, provides 
technical assistance to, and supports the education of states and 
local community service providers in the development of plans, 
goals, and system development activities. Supports the coordination 
of programs within HHS and with federal, state, community and 
private-sector partners.
    Works closely with AoA, AoD, NIDILRR and other ACL components to 
facilitate the coordination across ACL of multiple consumer 
protection and family support programs and various systems change 
and network capacity initiatives to fully optimize the potential 
synergies of these investments across ACL. Uses data and learnings 
from the programs administered to inform the work of other ACL 
components and ACL's policy priorities and provides guidance to the 
Regional Support Centers to ensure clear and consistent direction to 
the states on relevant program implementation issues.
    2. Office of Healthcare Information and Counseling (BDB). The 
Office of Healthcare Information and Counseling oversees the 
operation and administration of the State Health Insurance 
Assistance Program, authorized under the section 4360 of the OBRA of 
1990, and the Senior Medicare Patrol Program, authorized under Title 
IV of the OAA, that help Medicare and Medicaid beneficiaries as well 
as coming-of-agers navigate the complexities of health and long-term 
care systems and educate them on how to prevent fraud, waste, and 
abuse. The office also manages related activities funded under 
section 119 of the MIPPA that focus on outreach to help 
beneficiaries understand and apply for their Medicare benefits 
including the Low Income Subsidy program (LIS), Medicare Savings 
Program (MSP), and Medicare Prescription Drug Coverage (Part D).

[[Page 20365]]

    Coordinates, implements, monitors, and promotes efforts to 
provide consumer information and education designed to increase 
access to, and detect, prevent and report error, fraud and abuse in, 
the Medicare and Medicaid programs. Provides in-depth expertise, 
information, leadership and technical assistance to assist the State 
Health Insurance Assistance Program and Senior Medicare Patrol 
networks, and serves as a reliable clearinghouse of information for 
older persons, people with disabilities, and their families and 
caregivers.
    Develops funding opportunities and monitors grants to ensure all 
necessary activities are completed. Manages the full spectrum of 
contract requirements including identifying contractual needs, 
developing statements of work and necessary planning documents, and 
ensuring that contractors are completing assigned tasks. Ensures 
that grantees and their volunteers have the necessary information 
and training to carry out program functions. Develops and refines 
the performance management systems and provides specialized guidance 
and technical assistance to help grantees improve their performance. 
Coordinates with the Centers for Medicare & Medicaid Services (CMS) 
and other national partnerships to advance program objectives.
    Administers, in partnership with the CMS, the Duals 
Demonstration Ombudsman Technical Assistance Program which supports 
grantees serving beneficiaries of state demonstrations to integrate 
care for Medicare-Medicaid enrollees associated with the CMS 
Financial Alignment Initiative. Ensures that grantees and their 
volunteers have the necessary information and training to carry out 
program functions. Coordinates with CMS and the state grantees in 
developing and refining performance management systems and provides 
specialized guidance and technical assistance to help grantees 
improve their performance. Analyzes program reports, including 
consumer feedback and complaints, and makes recommendations to CMS 
for improving the Ombudsman Program and the Financial Alignment 
Initiative.
    3. Office of Network Advancement (BDC). The Office of Network 
Advancement oversees a variety of initiatives to ensure that the 
interests and needs of older adults and people with disabilities, as 
well as the state and local organizations that serve these 
populations, are adequately reflected in the transformations 
occurring in our nation's health and long-term services and support 
systems as those systems shift toward the use of managed care, 
Health Information Technology (IT), and other models and approaches 
to better integrate the delivery of health and long-term services 
and supports as well as to make those systems more person-centered. 
These initiatives involve partnerships with other federal agencies 
and external stakeholders at the national, state, and local level 
and the management and execution of technical assistance activities, 
including the identification and dissemination of best practices and 
program models.
    Serves as the focal point for the administration the Aging and 
Disability Resource Center program authorized under Title II of the 
OAA, providing leadership and a central strategic focus for ACL's 
efforts to work with states and communities to develop single entry 
point/no wrong door systems of access to long-term services and 
supports for seniors, persons with disabilities, and their families 
and caregivers, in coordination with CMS and other Federal agencies. 
Leads ACL's Business Acumen work to help community-based 
organizations that serve older adults and persons with disabilities 
to build their business capacity and align their service 
capabilities in order to work effectively with integrated healthcare 
entities (e.g., accountable care organizations, health plans, 
managed care organizations, hospitals, health systems, etc.) to 
provide community-based long-term services and supports and/or 
evidence-based preventive health programs and services. Works with 
other ACL components to coordinate the various business acumen and 
related activities across ACL, and oversees the provision of the 
business acumen technical assistance that is delivered through a 
variety of methods and techniques to state level and community-based 
aging and disability agencies and organizations. Develops 
partnerships with external stakeholders at the national, state and 
local level in both the public and private sectors, including 
private foundations, to enhance and complement ACL's work in this 
area.
    Works with the HHS Office of the National Coordinator for Health 
Information Technology, CMS, and other internal and external 
stakeholders on Health IT initiatives that have a potential impact 
on older adults and persons with disabilities and the state and 
local agencies and organizations that serve these populations to 
ensure that the needs and interests of these populations and 
organizations are reflected in the Health IT initiatives that are 
shaping the future of our nation's health and long-term services and 
support systems. Works with CPE and other ACL components to track 
policy and program trends and emerging issues related to integrated 
care to inform ACL's ongoing program and policy development work as 
the transformations in health and long-terms services and supports 
continue to evolve.
    4. Office of Interagency Innovation (BDD). The Office of 
Interagency Innovation plans and directs the implementation of 
programs designed to enhance consumer access to long-term services 
and supports, including integrated systems of services and person-
centered programs and systems at the state and local level that 
support community living. Supports state and community efforts to 
improve the provision of assistive technology for individuals with 
disabilities of all ages through comprehensive, statewide programs 
that are consumer responsive. Serves as the focal point for the 
administration of the Assistive Technology state programs authorized 
under Section 4 of the Assistive Technology Act, the Veteran-
Directed Home and Community-Based Services program, and other 
activities as deemed appropriate.
    Promotes initiatives to expand access to services and the 
development of more responsive service systems, including person-
centered planning and self-directed service models. Implements 
partnerships with external stakeholder organizations to enhance 
access to integrated systems of services that support both older 
Americans and persons of all ages with disabilities. Coordinates 
with the Department of Veterans Affairs on the development and 
implementation of their long term services and support programs, 
including the Veteran-Directed Home and Community-Based Services 
program and caregiver support programs. Provides technical 
assistance and support services to programs funded under the 
Assistive Technology Act to make assistive technology devices and 
services more available and accessible to individuals with 
disabilities and their families. Works with NIDILRR and other ACL 
components to facilitate and accelerate the translation of relevant 
research findings into practice nationwide. Supports the development 
and maintenance of a database of technical assistance resources, 
best practices and model programs for use by federal, state and 
local agencies and organizations involved in advancing system 
changes that make long-term services and support systems more 
person-centered and more responsive to the needs and preferences of 
older adults and persons with disabilities. Partners with other 
federal departments on innovative activities, policies and technical 
assistance, including the Department of Transportation, Department 
of Housing and Urban Development, Department of Agriculture, among 
others.
    Develops funding opportunities and monitors grants to ensure all 
necessary activities are completed. Manages the full spectrum of 
contract requirements including identifying contractual needs, 
developing statements of work and necessary planning documents, and 
ensuring that contractors are completing assigned tasks. Ensures 
that grantees have the necessary information and training to carry 
out program functions. Develops and refines performance management 
systems and provides specialized guidance and technical assistance 
to help grantees improve their performance.

    VII. Delete Section G, National Institute on Disability, 
Independent Living, and Rehabilitation Research (BG), in its entirety 
and replace with the following:

G. National Institute on Disability, Independent Living, and 
Rehabilitation Research (BG):

BG.00 Mission
BG.10 Organization
BG.20 Functions

    BG.00 Mission. The National Institute on Disability, Independent 
Living and Rehabilitation Research (NIDILRR) administers research 
programs authorized under Sections 202 and 204 of the Rehabilitation 
Act of 1973, NIDILRR supports the generation of new knowledge and 
promotes the effective use of this knowledge to: improve the 
abilities of individuals with disabilities to participate in 
community activities of their choice; and, enhance society's 
capacity to provide opportunities

[[Page 20366]]

and accommodations for these individuals. NIDILRR fulfills its 
mission through research, development, and dissemination and related 
activities designed to contribute to community living and 
participation, employment, and health and function of individuals of 
all ages with all types and degrees of disability, including low-
incidence disability.
    BG.10 Organization. NIDILRR is headed by a Deputy Administrator, 
who serves as the Director as defined in Section 202 of the 
Rehabilitation Act, and as a member of the Administrator's senior 
leadership team. NIDILRR includes the following components:

Office of the Director of Disability, Independent Living, and 
Rehabilitation Research (BGA)
Disability, Independent Living, and Rehabilitation Research Advisory 
Council (BGA1)
Office of Research Administration (BGB)
Office of Research Sciences (BGC)

    BG.20 Functions.
    1. Office of the Deputy Administrator of Disability, Independent 
Living, and Rehabilitation Research (BGA). The Office of the Deputy 
Administrator for Disability, Independent Living and Rehabilitation 
Research provides executive leadership and management strategies for 
all components of NIDILRR. The office, which includes a Deputy 
Director, manages all internal and external activities of the 
NIDILRR, including the research, dissemination, and public 
information programs, research evaluation, and provides direction 
and guidance to NIDILLR's scientific peer review. Prepares and 
issues an annual report and coordinates with OEA and other agency 
components to ensure that the results of research are disseminated 
to, and utilized by service providers, people with disabilities and 
their families, and the general public.
    Responsible for the coordination and management of research and 
research capacity building programs. Promotes the widespread 
dissemination of research results and other new knowledge both 
nationally and internationally to individuals with disabilities, 
families, service providers, researchers, and others through 
appropriate and accessible media, training, and technical 
assistance. Sponsors research that can be used to promote the use of 
appropriate assistive technology and the development of coordinated 
systems of technology services. Provides general staff support for 
the Disability, Independent Living, and Rehabilitation Research 
Advisory Council. Coordinates all meetings, provides advice and 
assistance, and prepares and issues reports or recommendations as 
appropriate. Chairs and supports the Interagency Committee on 
Disability Research (ICDR), authorized by Section 203 of the 
Rehabilitation Act, and promotes the coordination of disability 
independent living, and research throughout the federal Government. 
The ICDR is responsible for identifying, assessing, and seeking to 
coordinate and promote cooperation among all federal program 
activities, projects, and plans with respect to the conduct of 
research related to rehabilitation of individuals with disabilities; 
facilitating the compilation of information about the status of 
disability, independent living and rehabilitation research sponsored 
by federal agencies. Coordinates its activities with other federal 
agencies and participates in joint-funding of rehabilitation 
research and related activities, in collaboration with the ICDR. 
Prepares and submits to Congress a long-range plan for 
rehabilitation research and provides necessary data and information 
required by the National Council on Disability. The ICDR is also 
responsible for preparing a comprehensive government-wide strategic 
plan for disability, independent living and rehabilitation research 
and ensuring accountability for achievement of measurable goals, 
objectives and timetables.
    2. Office of Research Administration (BGB). The Office of 
Research Administration supports the administration of NIDILRR's 
grants and contracts portfolio. The office also coordinates 
NIDILRR's program evaluation activities and collaborates with the 
Office of Research Sciences in program planning and priority 
setting. Coordinates with the Office of Research Sciences staff in 
the preparation of all contract packages, development of 
requirements and performance work statements. Conducts routine 
contract management activities to include completion of 
administrative and fiscal tasks required throughout the contract 
lifecycle. Maintains and monitors annual grant forecasts and 
schedules, and provides grants administration support for NIDILRR 
including packaging grant announcements and application kits.
    Makes recommendations to the Deputy Administrator of NIDILRR 
regarding allocation of NIDILRR program funds for current and future 
budget years. Coordinates and collaborates with Office of Research 
Sciences program staff in the preparation of the annual spending 
plan and facilitate the implementation of the plan to ensure 
compliance with established departmental guidance. Provides 
administrative support in the monitoring of grants and cooperative 
agreements, and facilitates the administrative execution of 
interagency agreements.
    Administers NIDILRR evaluation activities to improve the 
effectiveness of NIDILRR's research activities. This includes 
collaborating with NIDILRR's senior management to define and 
facilitate the conduct of analyses of program and budget data as 
well as focused, special program evaluation activities. In its 
evaluation function, it coordinates with CPE to prepare planning and 
evaluation documents required by ACL, HHS, OMB and Congress.
    3. Office of Research Sciences (BGC). The Office of Research 
Sciences is responsible for national and international programs of 
research, training, and knowledge translation. Develops and manages 
a comprehensive program of grants, cooperative agreements, and 
contracts that address all of NIDILRR's research, capacity building, 
and knowledge translation activities. Sponsors research on, and 
development of programs and interventions involving technological 
systems, techniques and devices to overcome environmental barriers, 
and enable persons with disabilities to maximize community living 
and participation, employment, and their health and functional 
abilities. Responsible for providing research-based knowledge to 
industry to facilitate development, marketing, and distribution of 
aids and devices that can be used by people with disabilities. 
Determines criteria and standards and sets priorities for all 
NIDILRR research, training, and evaluation activities in the areas 
of community living and participation, employment, and health and 
function.
    Plans, develops, implements, and manages a comprehensive 
national and international program of research, training, and 
knowledge translation in specific program areas. Identifies trends 
and needs and recommends research and development priorities to the 
leadership of NIDILRR. Manages a comprehensive scientific peer 
review of all grant applications and conducts pre-award site visits, 
as required by statute. Recommends new and continuation awards, as 
well as award terminations. Performs program oversight and 
monitoring of the progress of grants and contracts. Collaborates 
with ACL senior leaders, the CPE, and the Center for Management and 
Budget in developing and publishing regulatory documents, including 
annual announcements of priorities and grant application packages.
    Enhances the public understanding of the barriers to and 
facilitators of optimal outcomes for individuals with disabilities 
through the dissemination of research findings and other data, to 
include statistical data on disability status and outcomes, as 
evidenced by the annual publication of the Annual Compendium of 
Disability Statistics, distributed widely each year. Coordinates 
with OEA as well as ACL subcomponents to plan, develop, and 
administer knowledge translation, research utilization, public 
information, public education, and publications which address 
NIDILRR research activities and findings; and manages a 
comprehensive program to disseminate NIDILRR research findings 
through accessible media to a range of target audiences. Provides 
research-based information from grantees to the ICDR, the National 
Council on Disability, and other agencies and private organizations 
serving individuals with disabilities. Sponsors studies to determine 
innovative techniques and systems for the dissemination and 
utilization of rehabilitation research findings.

    VIII. Insert Section H, Center for Regional Operations (BH), as 
follows:

H. Center for Regional Operations (BH):

BH.00 Mission
BH.10 Organization
BH.20 Functions

    BH.00 Mission. The Center for Regional Operations (CRO) serves 
as the liaison, advocate and representative for the agency 
regionally across the United States for all of ACLs programs areas. 
This includes working with and connecting stakeholders to other HHS 
divisions and federal agencies to help advance the development of 
programs and activities serving older adults, persons with 
disabilities and their caregivers, and developing new partnerships 
with and

[[Page 20367]]

coordinating with public and private organizations in the planning 
and development of comprehensive and coordinated services and 
supports.
    BG.10 Organization. CRO is directed by a Deputy Administrator 
and includes a coordinating central office and Regional Support 
Centers around the country. The Center for Regional Operations 
includes the following components: Office of the Deputy 
Administrator for Regional Operations (BHA) Regional Support Centers 
(BHB1-BHB10)
    BG.20 Functions.
    1. Office of the Deputy Administrator of Regional Operations 
(BHA). The Office of the Deputy Administrator of Regional Operations 
directs and coordinates the work of all ACL regional operations and 
activities and supervises the ten Regional Administrators who each 
serve as a liaison to their assigned region.
    The Regional Support Centers (BHB1-BHB10) serve as the focal 
point for the coordination of ACL programs within their designated 
HHS region, and support state and local efforts to improve community 
living for older adults and persons with disabilities. Represent the 
agency within the region, providing information for, and helping to 
advance the development of, national programs serving older adults 
and persons with disabilities. Serve as advocates for ACL 
stakeholders to other federal agencies in their geographic 
jurisdictions; advise, consult and cooperate with each federal 
agency proposing or administering programs or services that affect 
ACL stakeholders; coordinate and assist public (including federal, 
state, tribal and local agencies) and private organizations in the 
planning and development of comprehensive and coordinated services; 
and conduct education of officials and the broader community to 
ensure understanding of the need for community-based services and 
supports for older adults and people with disabilities.
    Advise the Deputy Administrator on problems and progress of 
programs; evaluate the effectiveness of programs and services in the 
regions and recommend changes that would improve program operations 
and enhance effectiveness; and provide guidance to agencies and 
grantees in applications of policy to specific operational issues 
requiring resolution. Facilitate interagency cooperation at the 
federal, regional, state and tribal levels to enhance resources and 
assistance available to older adults and persons with disabilities. 
Disseminate and provide technical assistance regarding program 
guidelines and developments to state agencies, tribal organizations, 
and local community service providers.

    IX. Delegations of Authority: All delegations and re-delegations of 
authority made to officials and employees of affected organizational 
components will continue in them or their successors pending further 
redelegation, provided they are consistent with this reorganization.
    X. Funds, Personnel and Equipment: Transfer of functions affected 
by this reorganization shall be accompanied in each instance by direct 
and support funds, positions, personnel, records, equipment, supplies 
and other resources.
    This reorganization will be effective upon date of signature.

    Dated: May 2, 2019.
Alex M. Azar II,
Secretary.
[FR Doc. 2019-09444 Filed 5-8-19; 8:45 am]
 BILLING CODE 4154-01-P