[Federal Register Volume 86, Number 89 (Tuesday, May 11, 2021)]
[Notices]
[Pages 25873-25875]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-09910]


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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; The Maternal, Infant, and 
Early Childhood Home Visiting Program Pay for Outcomes Supplemental 
Information Request, OMB NO. 0906-XXXX NEW

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

ACTION: Notice.

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SUMMARY: In compliance with of the Paperwork Reduction Act of 1995, 
HRSA has submitted a Supplemental Information Request (SIR) to the 
Office of Management and Budget (OMB) for review and approval. Comments 
submitted during the first public review of this SIR will be provided 
to OMB. OMB will accept further comments from the public during the 
review and approval period.

DATES: Comments on this SIR should be received no later than June 10, 
2021.

ADDRESSES: Submit your comments, including the SIR 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 Lisa Wright-Solomon, the 
HRSA Information Collection Clearance Officer at [email protected] or 
call (301) 443-1984.

SUPPLEMENTARY INFORMATION: When submitting comments or requesting 
information, please include the Information Collection Request title 
for reference.

[[Page 25874]]

    Information Collection Request Title: Maternal, Infant, and Early 
Childhood Home Visiting Program Pay for Outcomes Supplemental 
Information Request, OMB NO. 0906-XXXX, NEW
    Abstract: HRSA is requesting approval to collect information in 
response to a SIR which will include eligible entities' plans for 
implementation and evaluation of Pay for Outcomes (PFO) initiatives to 
be applied for through the Maternal, Infant, and Early Childhood Home 
Visiting (MIECHV) Program. The Bipartisan Budget Act of 2018 (Pub. L. 
115-123) added subsection (c)(3) to Section 511 of the Social Security 
Act, 42 U.S.C. 711. The new provision authorizes MIECHV Program funding 
recipients to use up to 25 percent of the funds awarded under 
subsection 511(c)(1) ``to enable eligible entities to deliver services 
under early childhood home visitation programs'' for ``outcomes or 
success payments related to a pay for outcomes initiative that will not 
result in a reduction of funding for services delivered by the entity 
under a childhood home visitation program under this section while the 
eligible entity develops or operates such an initiative.'' Subsection 
511(j)(3)(B) further requires that ``funds made available to an 
eligible entity under this section for a fiscal year (or portion of a 
fiscal year) for a pay for outcomes initiative shall remain available 
for expenditure by the eligible entity for not more than 10 years after 
the funds are so made available.''
    Eligible entities may propose to use MIECHV funds for outcomes or 
success payments related to a PFO initiative in response to the fiscal 
year 2021 MIECHV Notice of Funding Opportunity and in succeeding fiscal 
years pending availability of future funds, the recipient must submit a 
detailed application that responds to the forthcoming SIR (henceforth 
this application is referred to as a PFO SIR Response).
    A 60-day notice was published in the Federal Register on July 8, 
2020. HRSA received four comments. Comments sought clarification on 
guidance related to third-party evaluation, selection of outcome 
measures, partnership agreements, budgeting PFO funds, annual reports, 
and maintenance of service delivery. Other comments highlighted topics 
that would benefit from specific technical assistance, indicated 
support for various aspects of the guidance, or offered suggestions 
that were outside the intended scope of the guidance. After taking the 
public comments into consideration, HRSA is proposing final revisions 
to the PFO SIR Guidance by making the following changes:
     Revising the SIR to further describe expectations and best 
practices associated with conducting feasibility studies and ensuring 
independence and accountability in the process. HRSA will not specify 
credentials or level of experience of evaluators or researchers, 
allowing recipients to have flexibility to determine what will work 
best for their context.
     Revising the SIR to further clarify that applicants are to 
select outcome measure(s) that will have meaningful impacts for the 
children and families served.
     Editing the SIR to broaden the requirements around 
obtaining signed partnership agreements so that a draft agreement or 
letter of intent, as well as a signed partnership agreement, would be 
acceptable.
     Revising the SIR to clarify that recipients can set aside 
funds awarded in multiple years as part of its PFO initiative. 
Recipients must propose a PFO project extending over the project period 
of the entire initiative, and must work closely with HRSA to ensure 
appropriate monitoring of use of funds for this purpose over the 10-
year period of availability.
     Revising the SIR to clarify that the required annual 
reports must be made available to the public and removing language that 
may suggest that the annual reports will include outcomes that have 
been achieved and/or payments made.
     Revising the SIR to clarify the expectation that 
recipients must continue to meet program and model fidelity 
requirements with no reduction of funding for services. HRSA will 
further develop and apply criteria as part of the review and approval 
process of any proposed PFO initiatives to ensure PFO initiatives have 
no negative impact on high-quality service delivery.
    Need and Proposed Use of the Information: Congress, through 
enactment of the Social Security Act, Title V, Section 511 (42 U.S.C. 
711), as amended, established the MIECHV Program. The MIECHV Program is 
designed to (1) strengthen and improve the programs and activities 
carried out under Title V of the Social Security Act, (2) improve 
coordination of services for at risk communities, and (3) identify and 
provide comprehensive services to improve outcomes for families who 
reside in at risk communities. The MIECHV Program, authorized by 
section 511 of the Social Security Act, 42 U.S.C. 711, and administered 
by HRSA, in partnership with the Administration for Children and 
Families, supports voluntary, evidence-based home visiting services 
during pregnancy and to parents with young children up to kindergarten 
entry. States, territories, tribal entities, and in certain 
circumstances, nonprofit organizations are eligible to receive funding 
through MIECHV and have the flexibility, within the parameters of the 
authorizing statute, to tailor the program to serve the specific needs 
of their communities.
    Section 50605 of the Bipartisan Budget Act (BBA) of 2018 (Pub. L. 
115-123) added new Section 511(c)(3), which authorizes MIECHV 
recipients the option to use up to 25 percent of MIECHV funding for 
``outcomes or success payments related to a PFO initiative that will 
not result in reduction of funding for home visiting services. The new 
authority establishes new requirements, including that the PFO 
initiative ``will not result in a reduction of funding for services 
delivered by the entity under a childhood home visitation program under 
this section while the eligible entity develops or operates such an 
initiative.'' Under Section 511(j)(3)(A), funds used by recipients for 
a PFO initiative remain available for expenditure by the eligible 
entity for not more than 10 years after the funds are made available.
    In response to the forthcoming SIR, MIECHV recipients planning to 
use MIECHV grant funds for outcomes or success payments related to a 
PFO initiative will be required to submit a PFO SIR Response outlining 
how their plans will meet all of the applicable statutory requirements 
and identifying what specific MIECHV funds (e.g., fiscal year 2021 
formula funding) they propose to use to (1) develop and implement their 
PFO initiative and (2) make PFO outcomes or success payments based on 
the planned PFO initiative.
    Regarding a PFO initiative, the MIECHV authorizing statute requires 
the following:

    (1) A PFO initiative may not result in a reduction of funding 
for services delivered by the entity under a childhood home 
visitation program under this section while the eligible entity 
develops or operates such an initiative (section 711(c)(3)); and
    (2) The PFO initiative for which outcome or success payments may 
be made must include:
    (a) A feasibility study that describes how the proposed 
intervention is based on evidence of effectiveness;
    (b) A rigorous, third-party evaluation that uses experimental or 
quasi-experimental design or other research methodologies that allow 
for the strongest possible causal inferences to determine whether 
the initiative has met its proposed outcomes as a result of 
implementation;
    (c) An annual, publicly available report on the progress of the 
initiative; and

[[Page 25875]]

    (d) A requirement that payments are made to the recipient of the 
grant, contract, or cooperative agreement only when agreed upon 
outcomes are achieved, excluding payments made to a third party 
conducting the evaluation.

See 42 U.S.C. 711(k)(4).
    The forthcoming SIR will provide further instructions to recipients 
in proposing a PFO initiative and submitting the required information 
to HRSA. Recipients are not required to propose or implement a PFO 
initiative, but if they wish to do so, they must submit a PFO SIR 
Response describing how their PFO initiative will meet all of the 
applicable statutory requirements. HRSA will use the information 
collected through the PFO SIR Response to ensure that MIECHV 
recipients' proposals to use grant funds for PFO initiatives meet 
statutory requirements and to provide technical assistance to 
recipients. The implementation of a PFO initiative is not intended to 
disrupt current services or negatively impact communities that have 
benefited from home visiting programs and must not result in a 
reduction of funding for home visiting services.
    Likely Respondents: MIECHV Program recipients that are states, 
territories, and, where applicable, nonprofit organizations providing 
home visiting services within states.
    Burden Statement: Burden in this context means the time expended by 
persons to generate, maintain, retain, disclose, or provide the 
information requested. This includes the time needed to review 
instructions and supporting materials; to collect and analyze data and 
information to develop the PFO SIR Response; engage with stakeholders 
and coordinate with state level partners; and to draft and submit the 
PFO SIR Response. The table below summarizes the total annual burden 
hours estimated for this SIR.
    Total Estimated Annualized Burden Hours:

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                                                     Number of                        Average
           Instrument                Number of     responses per       Total       burden hours    Total burden
                                    respondents     respondent       responses     per response        hours
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MIECHV PAY FOR OUTCOMES SIR.....              15               1              15              92           1,380
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    Total.......................              15  ..............              15  ..............           1,380
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    HRSA specifically requests comments on (1) the necessity and 
utility 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, Executive Secretariat.
[FR Doc. 2021-09910 Filed 5-10-21; 8:45 am]
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