[Federal Register Volume 86, Number 184 (Monday, September 27, 2021)]
[Notices]
[Pages 53329-53331]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-20853]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Statutory Requirements and Process Standardization: Maternal, 
Infant, and Early Childhood Home Visiting (MIECHV) Program Model 
Eligibility Review

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

ACTION: Request for public comment.

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SUMMARY: HRSA, in partnership with the Administration for Children and 
Families (ACF) within HHS, oversees the MIECHV Program, which supports 
voluntary, evidence-based home visiting services during pregnancy and 
to families with young children up to kindergarten entry. HRSA proposes 
to standardize a process for also assessing Home Visiting Evidence of 
Effectiveness (HomVEE)-approved home visiting models against the MIECHV 
statutory requirements for a model to determine which of the HomVEE-
approved models can be used to implement the MIECHV Program.

DATES: Comments on this request for public comment should be received 
no later than November 26, 2021.

ADDRESSES: Submit your comments to [email protected] with ``MIECHV 
Model Eligibility'' in the subject line.

SUPPLEMENTARY INFORMATION: 
    Invitation to comment: HRSA invites comments regarding this notice. 
To ensure that your comments are clearly stated, please identify the 
section of this notice that your comments address.

1.0 Background

    The MIECHV Program provides voluntary, evidence-based home visiting 
services to pregnant people and families with young children up to 
kindergarten entry living in at-risk communities.\1\ States, 
jurisdictions, certain non-profit organizations, and Tribal entities 
are eligible to receive funding from the MIECHV Program to implement 
service delivery model(s) that meet statutory requirements, including 
HHS criteria for evidence of effectiveness.2 3
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    \1\ The MIECHV Program is authorized by Social Security Act, 
Title V, Sec.  511; Section 50601 of the Bipartisan Budget Act of 
2018 (Pub. L. 115-123) (BBA) extended appropriated funding for the 
MIECHV Program through FY 2022.
    \2\ In current practice, HHS uses the HomVEE review to conduct a 
thorough and transparent review of the home visiting research 
literature and provide an assessment of the evidence of 
effectiveness for home visiting program models that target families 
with pregnant people and children from birth to kindergarten. 
Information about the HomVEE review is at https://homvee.acf.hhs.gov/.
    \3\ By law, state and jurisdictional awardees must spend the 
majority of their MIECHV Program grants to implement evidence-based 
home visiting models, with up to 25 percent of funding available to 
implement a model that conforms to a promising and new approach to 
achieving the benchmark areas specified in Social Security Act, 
Title V, Sec.  511 (d)(1)(A) and the participant outcomes described 
in Social Security Act, Title V, Sec.  511 (d)(2)(B), has been 
developed or identified by a national organization or institution of 
higher education, and will be evaluated through well-designed and 
rigorous process.
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    The MIECHV authorizing statute specifies that a model selected by 
an eligible entity must include certain key components, including that 
it ``conform to a clear consistent home visitation model that has been 
in existence for at least 3 years and is research-based, grounded in 
relevant empirically-based knowledge, linked to program determined 
outcomes, associated with a national organization or institution of 
higher education that has comprehensive home visitation program 
standards that ensure high-quality service delivery and continuous 
program quality improvement.'' \4\ In addition, the MIECHV-funded 
program must adhere to statutory standards applicable to model use, 
including adherence ``to a clear, consistent model that satisfies the 
requirements of being grounded in empirically-based knowledge related 
to home visiting and linked to the benchmark areas specified in 
[statute] and the participant outcomes described in [statute] related 
to the purposes of the program.'' \5\ Home visiting programs could not 
achieve the standards described in the program's authorizing statute 
without the support of home visiting models.
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    \4\ Social Security Act, Title V, Sec.  511(d)(3)(A)(i)
    \5\ Social Security Act, Title V, Sec.  511(d)(3)(B)
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    HRSA, in collaboration with ACF, has developed a proposed 
transparent and standardized process for assessing home visiting 
service delivery model(s) against statutory requirements to determine 
model eligibility for implementation through the MIECHV Program. 
Through this notice, HRSA seeks to provide public notice of the 
proposed process and gather public comment, including from 
stakeholders. Since the establishment of this process may affect 
critical decision-making, and to better understand the implications of 
these changes for various stakeholders, HRSA seeks public comment on 
the proposed process for assessing home visiting models against the 
MIECHV statutory requirements. HRSA will consider these comments in 
finalizing this process.

2.0 Process for Assessing Eligibility Against Statutory Requirements 
for a Home Visiting Model

    This notice presents statutory requirements for a MIECHV service 
delivery model and the proposed process to assess home visiting models 
against each MIECHV statutory requirement. Then, the notice will 
present the proposed process, with timeline, for collecting information 
to assess whether the model(s) meet these requirements and therefore 
can be used to implement the MIECHV Program.

2.1 Model Eligibility Requirements

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                                                      Statutory citation
           Requirement               Standard used      of requirement
------------------------------------------------------------------------
REQUIREMENT (1): Model is         There is evidence   Social Security
 appropriate for voluntary         of model            Act, Title V,
 service provision.                effectiveness in    Sec.
                                   a voluntary         511(e)(7)(A).
                                   setting.
REQUIREMENT (2): The model        The model conforms  Social Security
 conforms to a clear consistent    to HomVEE's         Act, Title V,
 home visitation model.            definition of an    Sec.
                                   early childhood     511(d)(3)(A)(i)(I
                                   home visiting       ).
                                   model.
REQUIREMENT (3): The model . . .  The model is        Social Security
 has been in existence for at      currently active    Act, Title V,
 least 3 years.                    and was first       Sec.
                                   developed at        511(d)(3)(A)(i)(I
                                   least 3 years       ).
                                   ago;.
                                  OR
                                  The model is
                                   inactive and was
                                   first developed
                                   at least 3 years
                                   before a model
                                   developer stopped
                                   providing
                                   implementation
                                   support;
                                  OR
                                  The model was
                                   implemented as a
                                   demonstration
                                   project that
                                   lasted at least 3
                                   years.

[[Page 53330]]

 
REQUIREMENT (4): The model . . .  The model is        Social Security
 is research-based [and]           evidence-based      Act, Title V,
 grounded in relevant              and grounded in     Sec.   511
 empirically-based knowledge.      relevant            (d)(3)(A)(i)(I).
                                   empirically-based
                                   knowledge, per
                                   the HHS HomVEE
                                   criteria for
                                   evidence of
                                   effectiveness.
REQUIREMENT (5): The model . . .  The model has       Social Security
 has demonstrated significant .    demonstrated        Act, Title V,
 . . positive outcomes . . .       significant         Sec.   511
 when evaluated using well-        positive outcomes   (d)(3)(A)(i)(I).
 designed and rigorous . . .       when evaluated,
 research designs.                 per the HHS
                                   HomVEE criteria
                                   for evidence of
                                   effectiveness.
REQUIREMENT (6): The model [is]   The model was       Social Security
 associated with a national        developed by, is    Act, Title V,
 organization or institution of    currently           Sec.   511
 higher education (IHE) . . ..     supported by, OR    (d)(3)(A)(i)(I).
                                   is currently
                                   being evaluated
                                   by, a national
                                   organization \6\
                                   or IHE\7\.
REQUIREMENT (7): The national     This requirement    Social Security
 organization or IHE with which    is met if           Act, Title V,
 the model is associated has       Requirement 6 is    Sec.   511
 comprehensive home visitation     met.                (d)(3)(A)(i)(I).
 program standards that ensure    AND...............
 high quality service delivery    (A) The
 and continuous program quality    organization or
 improvement.                      IHE can provide
                                   implementing
                                   agencies with
                                   documentation of
                                   its home
                                   visitation
                                   program standards
                                   associated with
                                   the model that
                                   ensure high
                                   quality service
                                   delivery (such as
                                   fidelity
                                   standards or
                                   implementation
                                   guidance);.
                                  AND
                                  (B) The model
                                   supports
                                   continuous
                                   program quality
                                   improvement (such
                                   as through the
                                   use of specific
                                   processes,
                                   systems, or
                                   tools).
REQUIREMENT (8): Employ well-     (A) The model       Social Security
 trained and competent staff.      requires that       Act, Title V,
                                   home visiting       Sec.
                                   staff, including    511(d)(3)(B)(ii).
                                   home visitors and
                                   home visiting
                                   supervisors,
                                   receive pre- AND
                                   in-service
                                   training. Staff
                                   must include, at
                                   a minimum, home
                                   visitors and home
                                   visiting
                                   supervisors.
                                  AND
                                  (B) The model
                                   establishes
                                   educational
                                   requirements and/
                                   or competencies
                                   around knowledge,
                                   skills,
                                   abilities, and
                                   experience to
                                   ensure that
                                   program staff are
                                   able to deliver
                                   the model.
REQUIREMENT (9): Maintain high    (A) The model has   Title V, Sec.
 quality supervision to            quality             511(d)(3)(B)(iii)
 establish home visitor            supervisory         .
 competencies.                     requirements to
                                   establish and
                                   maintain home
                                   visitor
                                   competencies,
                                   including the
                                   mode and
                                   frequency of
                                   supervision;
                                  AND
                                  (B) The model has
                                   a documented plan
                                   for supporting
                                   and assessing the
                                   quality of
                                   supervision.
REQUIREMENT (10): Demonstrate     The model has       Title V, Sec.
 strong organizational capacity    ongoing support     511(d)(3)(B)(iv).
 to implement the activities       to implement the
 involved.                         model, including
                                   implementation
                                   tailored to the
                                   communities
                                   served.
REQUIREMENT (11): Establish       The model has       Title V, Sec.
 appropriate linkages and          guidance OR a       511(d)(3)(B)(v).
 referral networks to other        process to
 community resources and           support local
 supports for eligible families.   implementing
                                   agencies' ability
                                   to establish and
                                   document
                                   appropriate
                                   linkages and
                                   referrals to
                                   community
                                   resources and
                                   supports for
                                   eligible MIECHV
                                   program
                                   participants.
REQUIREMENT (12): Monitor the     (A) The model has   Title V, Sec.
 fidelity of program               standards OR a      511(d)(3)(B)(vi).
 implementation to ensure that     system for
 services are delivered pursuant   monitoring
 to the specified model.           fidelity of
                                   program
                                   implementation on
                                   an ongoing basis;
                                  AND...............
                                  (B) The model
                                   provides training
                                   OR training
                                   materials for
                                   supervisors and
                                   home visitors on
                                   fidelity
                                   standards.
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2.2 Information Collection and Timeline
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    \6\ A national organization may be in the United States 
(including tribal nations or within any of the U.S. territories) or 
non-U.S. based; an organization is ``national'' if it has an office 
that is able to support implementation in two or more states, 
tribes, territories, or regions, or similarly defined geographic 
areas outside of the United States.
    \7\ An IHE may be an accredited community college, college, or 
university in the United States or another country.
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    HRSA, in collaboration with ACF, proposes to conduct model 
developer queries to gather information necessary for assessing models 
against the MIECHV Program statutory requirements. Requirements related 
to HHS evidence of effectiveness (see Section 2.1; requirements 1, 2, 
4, and 5; above) are currently collected and assessed through the 
HomVEE annual review process; HRSA has concluded that this process is 
sufficient to assess these requirements and is not proposing

[[Page 53331]]

any changes to the HomVEE evidence review through this notice.
    Following the publication of this notice, the associated comment 
period, and publication of a final model eligibility review process, 
HRSA anticipates assessing all models that have been determined to meet 
the HHS criteria for evidence of effectiveness, as determined by HomVEE 
review, against the statutory requirements for model implementation 
through the MIECHV Program. HRSA intends to contact model developers 
and request they provide information about model characteristics, 
resources, and processes using a standard set of survey questions. HRSA 
will assess information and resources provided by models against the 
standards for each requirement, described above, to determine 
eligibility for implementation through the MIECHV Program. Following 
this initial review, all models determined to be eligible for 
implementation through the MIECHV Program will be reassessed against 
the statutory requirements for a model every 3 years.
    As the HomVEE review determines that new models meet HHS criteria 
for evidence of effectiveness, HRSA intends to assess these models 
against the MIECHV statutory requirements. Any such model that does not 
meet statutory requirements for implementation through the MIECHV 
Program will be reassessed annually until the model either meets 
remaining statutory requirements or a model developer indicates that 
they no longer want the model to be assessed for implementation through 
the MIECHV program.
    HRSA anticipates applying the updated process for assessing model 
eligibility against MIECHV statutory requirements beginning in Fiscal 
Year (FY) 2024. Specifically, the updated process will apply to all 
HomVEE-approved models to determine eligibility for implementation 
through the MIECHV Program beginning in the FY 2024 MIECHV Notice of 
Funding Opportunity.

3.0 Request for Information

    Through this notice, HRSA is soliciting information from a broad 
array of stakeholders on the proposed process for assessing home 
visiting models against the MIECHV statutory requirements for a model 
to determine eligibility for implementation through the MIECHV Program.
    Responses to this notice will inform HRSA's ongoing discussion with 
the aim of publishing a final process for assessing home visiting 
models against statutory requirements. This notice is for information 
and planning purposes only and should not be construed as a 
solicitation or as an obligation on the part of HRSA or HHS.

Diana Espinosa,
Acting Administrator.
[FR Doc. 2021-20853 Filed 9-24-21; 8:45 am]
BILLING CODE 4165-15-P