[Federal Register Volume 84, Number 144 (Friday, July 26, 2019)]
[Notices]
[Pages 36108-36110]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-15902]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Agency Information Collection Activities: Proposed Collection: 
Public Comment Request Information Collection Request Title: Health 
Resources and Service Administration Uniform Data System, OMB No. 0915-
0193--Revision

AGENCY: Health Resources and Services Administration (HRSA), Department 
of Health and Human Services (HHS).

ACTION: Notice.

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SUMMARY: In compliance with the requirement for opportunity for public 
comment on proposed data collection projects of the Paperwork Reduction 
Act of 1995, HRSA announces plans to submit an Information Collection 
Request (ICR), described below, to the Office of Management and Budget 
(OMB). Prior to submitting the ICR to OMB, HRSA seeks comments from the 
public regarding the burden estimate, below, or any other aspect of the 
ICR.

DATES: Comments on this ICR must be received no later than September 
24, 2019.

ADDRESSES: Submit your comments to [email protected] or mail the HRSA 
Information Collection Clearance Officer, Room 14N136B, 5600 Fishers 
Lane, Rockville, Maryland 20857.

FOR FURTHER INFORMATION CONTACT: To request more information on the 
proposed project or to obtain a copy of the data collection plans and 
draft instruments, email [email protected] or call Lisa Wright-
Solomon, HRSA Information Collection Clearance Officer at (301) 443-
1984.

SUPPLEMENTARY INFORMATION: When submitting comments or requesting 
information, please include the ICR title for reference.
    Information Collection Request Title: Health Resources and Services 
Administration Uniform Data System, OMB No. 0915-0193--Revision.
    Abstract: The Health Center Program, administered by HRSA, is 
authorized under section 330 of the Public Health Service (PHS) Act, 
most recently amended by section 50901(b) of the Bipartisan Budget Act 
of 2018, Public Law 115-123. Health centers are community-based and 
patient-directed organizations that deliver affordable, accessible, 
quality, and cost-effective primary health care services to patients 
regardless of their ability to pay. Nearly 1,400 health centers operate 
approximately 12,000 service delivery sites that provide primary health 
care to more than 27 million people in every U.S. state, the District 
of Columbia, Puerto Rico, the U.S. Virgin Islands, and the Pacific 
Basin. HRSA uses the Uniform Data System (UDS) for annual reporting by 
certain HRSA award recipients, including Health Center Program awardees 
(those funded under section 330 of the PHS Act), Health Center Program 
look-alikes, and Nurse Education, Practice, Quality and Retention 
(NEPQR) Program awardees (specifically those funded under the practice 
priority areas of section 831(b) of the PHS Act).
    Need and Proposed Use of the Information: HRSA collects UDS data 
annually to ensure compliance with legislative and regulatory 
requirements, improve clinical and operational performance, and report 
overall program accomplishments. These data help to identify trends 
over time, enabling HRSA to establish or expand targeted programs and 
to identify effective services and interventions that will improve the 
health of medically underserved communities. HRSA analyzes UDS data 
with other national health-related data sets to compare the Health 
Center Program patient populations and the overall U.S. population.
    HRSA plans to continue aligning several clinical measures reported 
in the UDS with the Centers for Medicare & Medicaid Services' (CMS) 
electronic specified clinical quality measures (eCQM) and is 
considering the following changes for 2020 UDS data collection:
     Retiring CMS126 Use of Appropriate Medications for Asthma: 
The CMS eCQM is no longer being

[[Page 36109]]

updated when new asthma medications are approved for use. This measure 
was also retired from the Healthcare Effectiveness Data and Information 
Set, is no longer endorsed by the National Quality Forum, and there is 
currently no comparable eCQM for asthma. Thus, no replacement measure 
is planned at this time.
     Replacing Dental Sealants for Children Between 6-9 years 
with CMS74v9 Primary Caries Prevention Intervention as Offered by 
Primary Care Providers, Including Dentists: The replacement measure, 
which is the percentage of children age 0-20 years who received a 
fluoride varnish application, is applicable to a broader patient 
population than the use of dental sealants, more applicable to primary 
care settings by measuring oral health activities that health centers 
without dentists can employ, and is part of the CMS Merit-based 
Incentive Payment System quality payment program measure set.
     Adding CMS159v8 Depression Remission at 12 Months: The 
addition of the CMS depression remission measure at 12 months provides 
complementary mental health outcome data on how well health centers 
help patients reach remission. Improvement in the symptoms of 
depression and an ongoing assessment of the current treatment plan is 
crucial to the reduction of symptoms and psychosocial well-being of 
patients. The addition of CMS159v8 further supports HRSA's commitment 
to HHS strategic objective to ``Reduce the impact of mental and 
substance use disorders through prevention, early intervention, 
treatment, and recovery support.''
     Revising the HIV linkage to care measure: The HIV linkage 
to care measure captures the percentage of patients whose first HIV 
diagnosis was made by health center staff between October 1 of the 
prior year and September 30 of the measurement year and who were seen 
for follow-up treatment within 90 days of that first diagnosis. This 
measure will be modified to change the follow-up treatment from 90 days 
to 30 days.
     Adding CMS349v2 HIV Screening: The addition of the CMS HIV 
screening measure will contribute to concerted efforts to better 
identify priority geographies, assist high risk groups among health 
center patients, and more effectively deploy interventions and 
resources in support of the ``Ending the HIV Epidemic'' Initiative.
     Adding Prescription for Pre-Exposure Prophylaxis (PrEP) 
International Classification of Diseases (ICD) 10 Codes and Current 
Procedural Terminology (CPT) codes: The addition of the PrEP ICD-10 and 
CPT codes will allow for the collection of this HIV prescription 
prevention data in health centers and further supports the ``Ending the 
HIV Epidemic'' Initiative.
     Adding Diabetes Measures: CMS131v8 Diabetes Eye Exam; 
CMS123v7 Diabetes Foot Exam; and CMS134v8 Diabetes Medical Attention to 
Nephropathy: Improving the treatment and management of patients with 
diabetes is a HRSA priority. Addition of these CMS eCQMs informs HRSA 
of the breadth of preventive care that patients with diabetes may 
receive in the health center setting that have profound impact on 
diabetes-related outcomes and quality of life.
     Adding CMS125v8 Breast Cancer Screening: There is 
substantial geographic and demographic variation in breast cancer death 
rates, suggesting that there are social and non-economic obstacles that 
affect breast cancer screening. \i\ Preventive screening through timely 
access to mammograms can lead to early detection, better treatment 
prognosis, and has the potential to reduce health disparities. \ii\
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    \i\ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4540479/.
    \ii\ https://www.thecommunityguide.org/findings/cancer-screening-reducing-structural-barriers-clients-breast-cancer.
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     Adding a Prescription Drug Monitoring Programs (PDMPs) 
Question to Appendix D: Health Center Health Information Technology 
(HIT) Capabilities: PDMPs are effective tools for reducing prescription 
drug abuse and diversion. Improving provider utilization and access to 
real-time data has demonstrated meaningful results in reducing over-
prescribing of medication. \iii\
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    \iii\ https://www.pdmpassist.org/content/prescription-drug-monitoring-frequently-asked-questions-faq.
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     Revising the Social Determinants of Health Question in 
Appendix E: Other Data Elements: There is strong evidence that social 
and economic factors influence an individual's health. \iv\Several 
health care systems are exploring how to collect information on the 
social determinants of health. The inclusion of these questions into 
Appendix E allows HRSA to see how health centers are approaching this 
challenge and how many of their vulnerable patients are experiencing 
social and economic risks associated with poor health.
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    \iv\ https://www.countyhealthrankings.org/explore-health-rankings/measures-data-sources/county-health-rankings-model/health-factors/social-and-economic-factors.
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     Adding ICD-10 Codes to Capture Human Trafficking and 
Intimate Partner Violence: HRSA is aware that human trafficking \v\ and 
intimate partner violence \vi\ are part of the social determinants of 
health (SDOH) that can affect a wide range of health and quality of 
life outcomes. Addressing SDOH is a HRSA objective to improve the 
health and well-being of health center patients and the broader 
community in which they reside.
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    \v\ https://www.acf.hhs.gov/otip/about/what-is-human-trafficking.
    \vi\ https://www.hrsa.gov/sites/default/files/hrsa/HRSA-strategy-intimate-partner-violence.pdf.
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     Uniform Data System Test Cooperative (UTC): As part of 
HRSA's efforts to modernize the UDS we are creating the UTC as an 
enduring testing and piloting capability. The UTC consists of three 
main components: A steering committee, a coordinator, and health center 
test participants. Through this cooperative, HRSA will be able to pilot 
test innovative information technology and software, streamlining of 
clinical quality measures, and alternative data collection 
methodologies to reduce reporting burden and improve data quality and 
integrity.
    Likely Respondents: Likely respondents will include Health Center 
Program award recipients, Health Center Program look-alikes, and NEPQR 
Program awardees funded under the practice priority areas of section 
831(b) of the PHS Act.
    Burden Statement: Burden includes the time expended by persons to 
generate, maintain, retain, disclose or provide the information 
requested. This includes the time needed to review instructions; to 
develop, acquire, install and use technology and systems for the 
purpose of: Collecting, validating and verifying information, 
processing and maintaining information, disclosing and providing 
information. It also accounts for time to train personnel, respond to a 
collection of information, search data sources, complete and review the 
collection of information, and transmit or otherwise disclose the 
information. It will also include testing information necessary to 
support the UTC. No more than three tests would be conducted each 
calendar year and no more than 100 health centers would participate in 
1 test. Participation is voluntary and will not affect their funding 
status. This sample size is sufficient to conduct a pilot test and 
determine if the

[[Page 36110]]

innovation should be scaled across the Health Center Program. The total 
annual burden hours estimated for this ICR are summarized in the table 
below.

                                     Total Estimated Annualized Burden Hours
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                                                                                      Average
                                     Number of       Number of         Total        burden per     Total burden
            Form name               respondents    responses per     responses     response  (in       hours
                                                    respondent                        hours)
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Universal Report................           1,471               1           1,471             223         328,033
Grant Report....................             504               1             504              30          15,120
UTC Tests.......................             100               3             300              80          24,000
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    Total.......................           2,075  ..............           2,275  ..............         367,153
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    HRSA specifically requests comments on: (1) The necessity and 
feasibility of the proposed information collection for the proper 
performance of the agency's functions; (2) the accuracy of the 
estimated burden; (3) ways to enhance the quality, utility, and clarity 
of the information to be collected; and (4) the use of automated 
collection techniques or other forms of information technology to 
minimize the information collection burden.

Maria G. Button,
Director, Division of the Executive Secretariat.
[FR Doc. 2019-15902 Filed 7-25-19; 8:45 a.m.]
 BILLING CODE 4165-15-P