[Federal Register Volume 84, Number 240 (Friday, December 13, 2019)]
[Notices]
[Pages 68175-68178]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-26876]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Agency Information Collection Activities: Submission to OMB for 
Review and Approval; Public Comment Request; Bureau of Primary Health 
Care Uniform Data System, OMB No. 0915-0193--Revision

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

[[Page 68176]]


ACTION: Notice.

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SUMMARY: In compliance with of the Paperwork Reduction Act of 1995, 
HRSA has submitted an Information Collection Request (ICR) to the 
Office of Management and Budget (OMB) for review and approval. Comments 
submitted during the first public review of this ICR will be provided 
to OMB. OMB will accept further comments from the public during the 
review and approval period. OMB may act on HRSA's ICR only after the 30 
day comment period for this Notice has closed.

DATES: Comments on this ICR should be received no later than January 
13, 2020.

ADDRESSES: Submit your comments, including the ICR title, to the desk 
officer for HRSA, either by email to [email protected] or by 
fax to (202) 395-5806.

FOR FURTHER INFORMATION CONTACT: To request a copy of the clearance 
requests submitted to OMB for review, email the HRSA Information 
Collection Clearance Officer at [email protected] or call (301) 443-
1984.

SUPPLEMENTARY INFORMATION: 
    Information Collection Request Title: Bureau of Primary Health Care 
(BPHC) Uniform Data System (UDS), 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 
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. HRSA aligns several clinical measures 
reported in UDS with the Centers for Medicare & Medicaid Services' 
(CMS) electronic specified clinical quality measures (eCQM). 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 received comments on the BPHC UDS Federal Register notice 
published on July 26, 2019, vol. 84, No. 144; pp. 36108. We have taken 
the commenter's suggestions into consideration and have made 
appropriate adjustments to the draft instruments. The 2020 UDS data 
collection will be updated in the following ways:
     Retiring CMS126 Use of Appropriate Medications for Asthma: 
The CMS eCQM is no longer being 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 
NQF, and there is currently no comparable eCQM for asthma. Thus, no 
replacement measure is planned at this time.
     Retaining CMS277v0--Dental Sealants for Children Between 
6-9 years: Based upon public feedback, HRSA has decided to retain the 
dental sealant measure for 2020 UDS reporting. HRSA has also decided to 
not add the fluoride varnish measure for 2020 UDS.
     Adding CMS159v8 Depression Remission at Twelve 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 are 
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 ever 
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-ever diagnosis. 
This measure will be modified to change the follow-up treatment from 90 
days to 30 days aligning with Centers for Disease Control and 
Prevention's guidance.\1\
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    \1\ https://www.cdc.gov/hiv/pdf/library/factsheets/cdc-hiv-care-continuum.pdf.
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     Adding CMS349v2 HIV Screening: The addition of the CMS HIV 
screening measure will enable HRSA to better identify priority 
geographic locations, 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 
International Classification of Diseases (ICD) 10 Codes and Current 
Procedural Terminology codes: The addition of the Prescription for Pre-
Exposure Prophylaxis ICD-10 and Current Procedural Terminology codes 
will allow for the collection of this HIV prescription prevention data 
in health centers and further supports the ``Ending the HIV Epidemic'' 
Initiative's goal of reducing new HIV infections.
     Refraining from including additional diabetes measures: 
Based upon public feedback, HRSA will not be adding CMS131v8 Diabetes 
Eye Exam, CMS123v7 Diabetes Foot Exam, or CMS134v8 Diabetes Medial 
Attention to Nephropathy to the 2020 UDS.
     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.\2\ Preventive screening through timely 
access to mammograms can lead to early detection, better treatment 
prognosis, and potential to reduce health disparities.\3\
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    \2\ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4540479/.
    \3\ 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 
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

[[Page 68177]]

reducing over-prescribing of medication.\4\
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    \4\ 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 D: Health Center Health Information Technology Capabilities: 
There is strong evidence that social and economic factors influence an 
individual's health.\5\ Several health care systems are exploring how 
to collect information on the social determinants of health (SDOH). The 
inclusion of these questions into Appendix D 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. For health centers that are using a 
standardized screener, there is one additional question asking for the 
total number of patients that screen positive for food insecurity, 
housing insecurity, financial strain, and lack of transportation/access 
to public transportation.
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    \5\ 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 \6\ and 
intimate partner violence \7\ are part of the 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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    \6\ https://www.acf.hhs.gov/otip/about/what-is-human-trafficking.
    \7\ https://www.hrsa.gov/sites/default/files/hrsa/HRSA-strategy-intimate-partner-violence.pdf.
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     Utilizing the Uniform Data System Test Cooperative (UTC): 
As part of HRSA's efforts to modernize the UDS HRSA is establishing the 
UTC as an enduring testing and piloting capability. The UTC consists of 
three main components: (1) A steering committee, (2) a coordinating 
entity, and (3) 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.
    The total number of estimated respondents changed from 2,075 to 
2,134. The reason for the increase in the number of respondents for the 
UDS Report from 1,471 to 1,503 is because this number was previously 
based on 2018 UDS data that HRSA had available in July 2019. Since 
then, HRSA has been able to update the respondents that we anticipate 
for 2019 UDS reporting due to the incremental increase of awardees in 
the Health Center Program. The increase in the number of Grant Reports 
for Vulnerable Populations from 504 to 531 is due to an increase in a 
subset of awardees who receive Migrant Health Center, Health Care for 
the Homeless, and Health Centers for Residents of Public Housing 
funding.
    The average burden hours per response changed from 223 to 238 as a 
result of comments received on the 60-day Federal Register Notice and 
additional consultation with external stakeholders. These stakeholders 
stated that the inclusion of additional clinical quality measures in 
the UDS would slightly increase the reporting burden. While these 
measures are already included in most electronic health records, there 
is some additional work that health centers will need to do in order to 
incorporate the measures into their workflows and their annual 
reporting. In addition to these changes, the names of the forms 
Universal Report and Grant Report were updated to provide greater 
specificity.
    Likely Respondents: Likely respondents will include Health Center 
Program award recipients, Health Center Program look-alikes, and Nurse 
Education, Practice, Quality and Retention 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 one hundred health centers would 
participate in one test. Participation is voluntary and will not affect 
health centers' funding status. This sample size is sufficient to 
conduct a pilot test and determine if proposed innovations should be 
scaled across the Health Center Program.
    The total annual burden hours estimated for this Information 
Collection Request 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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Uniform Data System (UDS) Report           1,503               1           1,503             238         357,714
Grant Report for Vulnerable                  531               1             531              30          15,930
 Populations....................
UTC Tests.......................             100               3             300              80          24,000
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    Total.......................           2,134  ..............           2,334  ..............         397,644
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Maria G. Button,
Director, Executive Secretariat.
[FR Doc. 2019-26876 Filed 12-12-19; 8:45 am]
BILLING CODE 4165-15-P