[Federal Register Volume 85, Number 23 (Tuesday, February 4, 2020)]
[Notices]
[Pages 6198-6201]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-02091]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration for Community Living


Agency Information Collection Activities; Submission for OMB 
Review; Public Comment Request; Traumatic Brain Injury (TBI) State 
Partnership Program, OMB approval number 0985-NEW

AGENCY: Administration for Community Living, HHS.

ACTION: Notice.

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SUMMARY: The Administration for Community Living (ACL) is announcing 
that the proposed collection of information listed above has been 
submitted to the Office of Management and Budget (OMB) for review and 
clearance as required under the Paperwork Reduction Act of 1995. This 
30-Day notice collects comments on the information collection 
requirements related to Proposed New information collection 
requirements related to the Traumatic Brain Injury (TBI) State 
Partnership Program.

DATES: Submit written comments on the collection of information by 
March 5, 2020.

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

FOR FURTHER INFORMATION CONTACT: Dana Fink, Administration for 
Community Living, Washington, DC 20201, (202) 795-7604, or 
[email protected].

SUPPLEMENTARY INFORMATION: In compliance with the Paperwork Reduction 
Act, ACL has submitted the following proposed new information 
collection to OMB for review and clearance.

[[Page 6199]]

    The purpose of the federal Traumatic Brain Injury (TBI) State 
Partnership Program is to create and strengthen a system of services 
and supports that maximizes the independence, well-being, and health of 
people with TBIs across the lifespan and all other demographics, their 
family members, and support networks. The TBI State Partnership Program 
funds the development and implementation of statewide systems that 
ensure access to TBI related services, including transitional services, 
rehabilitation, education and employment, and long-term community 
support. To best monitor, guide, and support TBI State Partnership 
Program grantees, ACL needs regular information about the grantees' 
activities and outcomes. The simplest, least burdensome and most useful 
way to accomplish this goal is to require grantees to submit 
information as part of their required semiannual reports via the 
proposed electronic data submission instrument.
    In 1996, the Public Health Service Act was amended ``to provide for 
the conduct of expanded studies and the establishment of innovative 
programs with respect to traumatic brain injury, and for other 
purposes'' (Pub. L. 104-166). This legislation allowed for the 
implementation of ``grants to States for the purpose of carrying out 
demonstration projects to improve access to health and other services 
regarding traumatic brain injury.'' The TBI Reauthorization Act of 2014 
(Pub. L. 113-196) allowed the Department of Health and Human Services 
Secretary to review oversight of the federal TBI programs (TBI State 
Partnership Grant program and the TBI Protection and Advocacy program) 
and reconsider which operating division should lead them. With avid 
support from TBI stakeholders, the Secretary found that the goals of 
the federal TBI programs closely align with ACL's mission to advance 
policy and implement programs that support the rights of older 
Americans and people with disabilities to live in their communities. As 
a result, on Oct. 1, 2015, the federal TBI programs moved from the 
Health Resources and Services Administration to ACL. These programs 
were reauthorized again by the Traumatic Brain Injury Reauthorization 
Act of 2018 (Pub. L. 115-377).
    The proposed performance measures assess progress toward 
surmounting the four commonly recognized barriers to accessing care for 
people with TBI:
    (1) A lack of information about available services and supports 
with little or no assistance in accessing them (information and 
referral services);
    (2) A shortage of health professionals who may encounter 
individuals with TBI but lack relevant training to identify or treat 
the resulting symptoms (professional training);
    (3) The absence of a TBI diagnosis or the assignment of an 
incorrect diagnosis (screening); and (4) Critical TBI services are 
spread across numerous agencies resulting in services being difficult 
for individuals and families to identify and navigate (resource 
facilitation).
    The proposed performance measures are designed to account for the 
varied approaches used across state grantees and are consistent with 
the TBI State Partnership Program's purpose and ACL's mission.

Comments in Response to the 60-Day Federal Register Notice

    ACL published a 60-day Federal Register Notice from 11/13/2017-01/
12/2018 (Vol. 82, No. 217 pp. 52305-52306). ACL received a large volume 
of substantive stakeholder comments, causing revisions to the IC based 
on those public comments. The period in publication between the 60-day 
FRN and 30-day FRN, allowed ACL to thoughtfully review and apply the 
significant number of substantive public comments to the proposed new 
TBI IC.
    In response to the original Federal Register notice in 2018, 
twenty-three (23) individuals provided written comments in response to 
the Federal Register notice containing the original proposed TBI 
Performance Measures, presented in the form of a reporting instrument 
for future TBI grantees. Commenters provided feedback on specific 
reporting instrument questions as well as general suggestions and 
recommendations for ACL about what grantees should report.
     268 separate comments were made about one or more specific 
survey questions.
     102 separate comments asked for a definition, further 
guidance, or clarification with regard to terminology used.
     81 comments made a general recommendation, not specific to 
a particular question.
    ACL also received feedback in 2018 through multiple face-to-face 
interactions with a majority of the current TBI grantees regarding the 
proposed measures.
    ACL revised the instrument in 2019, in order to remain compliant 
with PRA 5 CFR 1320.8(d), ACL published an abbreviated public comment 
period prior to publishing the 30-day FRN and submitting to OMB. ACL 
solicited comments during the abbreviated public comment period 
regarding: (1) The accuracy of ACL's revised estimate of the burden for 
the proposed collection of information performance reporting data 
elements and (2) whether the proposed revisions to the collection of 
information enhance the quality, utility, and clarity of the 
information to be collected.
    During the abbreviated public comment period published in the 83 FR 
53738 received 14 additional comments. These comments have been 
addressed largely through the addition of definitions and guidance. The 
tool has been simplified, some questions have been eliminated or 
simplified because of concern about the burden, and three open-ended 
narrative questions added. The most prevalent comments and themes 
emerging from the public comments are summarized below:
    Intended scope of the questions: The suggestion that occurred most 
across all commenters was for ACL to better define the scope of the 
questions. Many commenters asked whether ACL expected grantees to limit 
their reporting to their own grant activities, the staff they train 
with the grant funds, and the people with TBI they interact with using 
grant funds or if they would be expected to report about activities 
going on in the state beyond their grant activities. Commenters raised 
the issue of intended scope in general and specifically about almost 
all the questions in the instrument. Several commenters noted that the 
grants were awarded to different types of state agencies in different 
states and the reporting instrument did not make clear what ACL meant 
by the term ``TBI System,'' which could be interpreted to mean 
different things such as: The Medicaid system, the criminal justice 
system, the educational system, the vocational rehabilitation system, 
the broader medical system, or all of these together. Many indicated 
that grantees would have limited or no access to data about activities 
or people supported outside the grant activities being conducted by 
their own partnering organizations.
    Response and Changes to Instrument: ACL intends for TBI grantees to 
report only about their own grant activities, the staff they train 
using grant funds, the partners they work with, and the people affected 
by TBI they interact with using grant funds. Additional guidance and 
definitions will be added to the online version of the instrument to 
clarify this intent and provide more guidance for grantees operating in 
different systems. For example:
    (1) If a grantee is using grant funds to serve people with TBI 
within the criminal justice system statewide, the

[[Page 6200]]

scope of their reporting will be limited to the statewide criminal 
justice system.
    (2) If a grantee is using their grant funds to assist people 
interacting with the vocational rehabilitation system in one region of 
the state, the scope of their reporting will be limited to that 
region's vocational rehabilitation system.
    (3) If grant funds are going to several partnering organizations to 
work with people with TBI, the scope of that grantee's reporting will 
include the grant-funded activities of all of those partnering 
organizations (to the extent possible).
    In addition, ACL added some new structured and open-ended questions 
to the instrument to allow grantees to identify their main areas of 
focus and describe report full or partial data from across their 
partners depending on what they can access.
    Purpose of performance measures and accounting for state and 
grantee differences: Several commenters indicated they thought the 
instrument did not adequately account for the differences in how state 
systems are structured and the different focus areas of different 
grantees. Several commenters expressed concern that individual grantees 
would be negatively evaluated. Specific questions were edited to allow 
for grantees that are not able to provide data about activities and 
people outside of the scope of their grants or are otherwise not able 
to respond to every question.
    Response and Changes to Instrument: ACL does not intend to use this 
reporting instrument to score grantees' individual performance or to 
compare grantees' performance with one another. ACL's intent is to 
gather a standard set of information from all grantee states, so that 
it can be aggregated to provide a better picture of the national impact 
of the grant program. However, ACL understands that states are working 
within different systems and focusing on different activities and that 
states' current capacity to collect and report data varies. ACL 
anticipates that some grantees will not be able to respond to every 
question on the instrument and this will not negatively affect those 
grantees. ACL hopes that every question will be applicable and feasible 
to answer for at least a subset of grantees, therefore providing a more 
complete (although not perfect) picture of grant activities than is 
currently available.
    ACL revised the instrument questions to account more for state and 
grantee differences. For example, new structured and open-ended 
questions have been added at the beginning of the instrument to allow 
grantees to identify their main areas of focus and describe where the 
data they report are coming from so that ACL can interpret it 
appropriately. Using skip patterns programmed into the online tool, 
additional questions related to these areas of focus will only appear 
to grantees who indicate they are working in those areas. ACL will 
program the instrument into the online system so that some grantees may 
be directed to answer or not to answer some questions depending on how 
they answer initial questions about their grant activities and scope. 
Finally, an additional field has been added to most questions to allow 
grantees who do not respond or who can only respond partially to 
provide some descriptive notes about the data they submit.
    Estimating prevalence and unmet need: Several commenters noted that 
reporting the prevalence of TBI and estimating the needs of people 
living with a TBI and their families would be very challenging for many 
grantees. Some noted that many states do not have registries or good/
recent epidemiology data. Others indicated grantees would have no way 
of estimating the number of people who might need supports but are not 
accessing them. Several suggested that grantees might be able to 
respond to these questions if additional funding and/or technical 
assistance to carry out further study are provided.
    Response and Changes to Instrument: These questions have been 
eliminated from the proposed instrument.
    Defining services and supports: Several commenters expressed 
concern that the instrument asked questions about ``services and 
supports'' and wondered what ACL means by that term. Noting that 
grantees are currently focusing on system change work and are not 
allowed to use grant funds to provide direct in-home hands-on services 
and supports, some asked whether the funding announcement for new 
grants will include a different set of objectives and scope than they 
have in the past. Finally, several commenters interpreted the term to 
mean Medicaid home and community-based services and noted that not all 
states have a TBI Medicaid waiver. Those that do not are not likely to 
be able to access information about participants in other Medicaid 
waivers who are living with a TBI, so they would not be able to report 
about people with TBI receiving Medicaid services and supports.
    Response and Changes to Instrument: ACL does not intend for 
grantees to use grant funds to provide direct in-home hands-on services 
and supports, such as those provided through Medicaid HCBS programs. 
The instrument's questions were revised to ask more clearly about the 
specific types of ways grantees may be assisting or supporting people 
with TBI and their families, such as with information and referral, 
screening, resource facilitation, service coordination/case management, 
outreach and education, building stronger partnerships, and other 
systems change work.
    The remaining questions about utilization of home and community-
based services and supports are intended to capture information about 
the extent to which people with TBI who are eligible for these types of 
services are accessing them, which may be an indicator of long-term 
systems change that grantees are working towards. These questions will 
only be applicable to grantees specifically working to increase access 
to and utilization of home and community-based services in their 
states.
    Medically oriented questions: Several commenters expressed 
confusion about the instrument including questions they interpreted to 
be medically oriented, such as questions about technological tools, 
diagnosis, and treatment. They noted that grant activities might 
include screening people to identify a history of TBI and/or to better 
support people with TBI to live more fully in the community--but not 
diagnosis or medical treatment. They noted these questions would not be 
applicable to many grantees nor would grantees have access to data 
about diagnoses and treatment.
    Response and Changes to Instrument: The instrument questions have 
been revised to ask more clearly about the specific ways grantees may 
be assisting people with TBI and their families, such as by screening 
for a lifetime history of TBI and facilitating access to community-
based services. Questions about diagnosis and treatment have been 
removed.
    Estimated Program Burden: These revisions based on public comments 
caused a change in the annual reporting burden estimates; there is a 
program change decrease of -1,008 annual burden hours from the 60-day 
FRN. In addition, the 60-day FRN respondent estimate was based on the 
highest number of possible awards anticipated; there is an adjustment 
decrease of -18 respondents.

[[Page 6201]]



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                                                                  Number of      Average burden
                Adjusted number of respondents                  responses (per     hours (per      Total burden
                                                                 respondent)       response)          hours
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27...........................................................               2                8              432
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----------------------------------------------------------------------------------------------------------------
                                                                  Number of      Average burden
               60-day FRN number of respondents                 responses (per     hours (per      Total burden
                                                                 respondent)       response)          hours
----------------------------------------------------------------------------------------------------------------
45...........................................................               2               16            1,440
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    Dated: January 22, 2020.
Mary Lazare,
Principal Deputy Administrator.
[FR Doc. 2020-02091 Filed 2-3-20; 8:45 am]
 BILLING CODE 4154-01-P