[Federal Register Volume 88, Number 2 (Wednesday, January 4, 2023)]
[Notices]
[Pages 357-358]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-28559]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Request for Information: Healthy Start Initiative: Eliminating 
Disparities in Perinatal Health (Healthy Start)

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

ACTION: Notice of request for information.

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SUMMARY: HRSA's Maternal and Child Health Bureau, Division of Healthy 
Start and Perinatal Services seeks the perspectives of Healthy Start 
grantees, community members, people with lived experience, health care 
providers, community health workers, birthing people, parents, and 
other members of the public to inform future Healthy Start program 
development.

DATES: Submit comments no later than February 3, 2023.

ADDRESSES: Submit comments by email to [email protected] 
(subject line Healthy Start Request for Information [RFI]). Submit 
comments by mail to Mia Morrison, MPH, Maternal and Child Health 
Bureau, Health Resources and Services Administration, 5600 Fishers 
Lane, Room 18N-15, Rockville, MD 20857.

FOR FURTHER INFORMATION CONTACT: Mia Morrison, MPH, Supervisory Public 
Health Analyst, Maternal and Child Health Bureau, Division of Healthy 
Start and Perinatal Services, HRSA, 5600 Fisher Lane, 18N15, Rockville, 
MD 20852. Phone: 301-443-2521. Email: [email protected].

SUPPLEMENTARY INFORMATION: HRSA's Healthy Start Initiative: Eliminating 
Disparities in Perinatal Health (Healthy Start) program is authorized 
by 42 U.S.C. 254c-8 (section 330H of the Public Health Service Act). 
Healthy Start is a community-based program dedicated to reducing 
disparities in maternal and infant health. HRSA provides Healthy Start 
grants to communities with infant mortality rates at least 1.5 times 
the U.S. national average and with high rates of adverse perinatal 
outcomes (e.g., low birthweight, preterm birth, maternal morbidity, and 
mortality). Healthy Start programs serve individuals of reproductive 
age, pregnant and post-partum people, fathers/partners, and infants 
from birth through 18 months.
    HRSA currently funds 101 Healthy Start grantees in 35 states, the 
District of Columbia and Puerto Rico, to improve health outcomes 
before, during, and after pregnancy and reduce racial/ethnic 
differences in rates of infant death and adverse perinatal outcomes by: 
(1) improving access to quality health care and services for parents, 
birthing people, infants, children, and families through outreach, care 
coordination, health education, and linkage to health insurance; (2) 
strengthening the health workforce, specifically those individuals 
responsible for providing direct services; and (3) building healthy 
communities and ensuring ongoing, coordinated comprehensive services 
are provided in the most efficient manner through effective service 
delivery.
    In addition, HRSA funds the Supporting Healthy Start Performance 
Project to provide grantees with technical assistance and training in 
order to achieve the goals of the Healthy Start program. Through 
Healthy Start investments, HRSA has also expanded access to doula care 
and invested in communities to improve infant health equity by 
developing data-driven systems level strategies addressing social and 
structural determinants of health. More information about the portfolio 
of Healthy Start programs is available online at: https://
mchb.hrsa.gov/about-us/divisions/division-healthy-start-perinatal-
services-
dhsps#:~:text=Our%20division%3A,between%20racial%20and%20ethnic%20groups
.
    Unacceptably high rates of infant and maternal mortality persist in 
communities across the country, with notable inequities by race and 
ethnicity. HRSA seeks to accelerate the elimination of inequities in 
birth outcomes in communities served by Healthy Start.
    Responses: HRSA is seeking input from the public on the following 
topics related to the design, implementation, and evaluation of the 
Healthy Start program. A response to each question is not required. All 
partners and interested parties are welcome and encouraged to respond 
(e.g., Healthy Start grantees, community members, people with lived 
experience, health care professionals, etc.)

Program Design and Implementation

    (1) Provide input on the types and mix of services (direct \1\, 
enabling \2\ or public health services and systems \3\) and program 
activities (including strategies that address social and structural 
determinants of health) that could accelerate Healthy Start's impact on 
decreasing racial/ethnic disparities in maternal and infant mortality 
and morbidity. In your response, include examples of innovative 
services or strategies that a Healthy Start grantee could elect to 
implement and how the effectiveness of these interventions could be 
measured.
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    \1\ Direct Services--Direct services are preventive, primary, or 
specialty clinical services to pregnant women, infants, and children 
where funds are used to reimburse or fund providers for these 
services through a formal process similar to paying a medical 
billing claim or managed care contracts.
    \2\ Enabling Services--Enabling services are non-clinical 
services (i.e., not included as direct or public health services) 
that enable individuals to access health care and improve health 
outcomes. Enabling services include, but are not limited to case 
management, care coordination, referrals, translation/
interpretation, transportation, eligibility assistance, health 
education for individuals or families, environmental health risk 
reduction, health literacy, and outreach.
    \3\ Public Health Services and Systems--Public health services 
and systems are activities and infrastructure to carry out the core 
public health functions of assessment, assurance, and policy 
development, and the 10 essential public health services. Examples 
include the development of standards and guidelines, needs 
assessment, program planning, implementation, and evaluation, policy 
development, quality assurance and improvement, workforce 
development, and population-based disease prevention and health 
promotion campaigns for services such as newborn screening, 
immunization, injury prevention, safe-sleep education and anti-
smoking.
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    (2) Propose criteria and/or methods for defining applicant project 
area and target population \4\ in order to ensure that Healthy Start 
programs are serving populations and communities with the highest rates 
of infant and maternal mortality and morbidity, including communities 
with the highest racial/ethnic disparities. If applicable to your

[[Page 358]]

response, propose criteria for reviewing Healthy Start grant 
applications with overlapping geographic areas.
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    \4\ Definition of project area and target population from the 
fiscal year (FY) 2019 Healthy Start Initiative Notice of Funding 
Opportunity (HRSA-19-049): A project area must represent a 
reasonable and logical catchment area, but the defined areas do not 
have to be contiguous. The target population is the population that 
you will serve within your geographic project area.
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    (3) Provide recommendations on implementing Healthy Start programs 
with rural populations and underserved populations experiencing 
disproportionate adverse maternal and infant health outcomes (e.g., 
American Indian/Alaskan Native). In your response, describe whether 
potential Healthy Start applicants would benefit from the ability to 
apply for tiered funding (i.e., flexibility to serve fewer participants 
for programs with small numbers of residents within their catchment 
area).
    (4) Provide recommendations on the most effective period to enroll 
Healthy Start participants (i.e., pre-conception, prenatal, postpartum) 
and how long services should be offered to have the greatest impact on 
improving maternal and infant health outcomes.
    (5) Provide input on the engagement of fathers in Healthy Start 
programs and recommendations for types of activities and programming. 
When possible, provide examples of successful community-based 
fatherhood initiatives (non-Healthy Start examples are welcome).
    (6) Provide recommendations for increasing retention of community 
health workers in Healthy Start programs.
    (7) Provide recommendations on culturally responsive approaches for 
providing Black, American Indian, Alaskan Native, and border 
populations with maternal and child health education, support 
navigating resources, and linkages to clinical services including 
doula, prenatal, well-woman, and pediatric care.
    (8) Provide recommendations for strengthening engagement of 
birthing people, fathers, families, and people with lived experience in 
Healthy Start program design, implementation, and evaluation.

Data and Evaluation of Healthy Start Programs

    (9) Provide recommendations on the relevance of the current Healthy 
Start measures pertaining to the key challenges and inequities 
experienced in your community and priority population: (a) Which 
current measures are useful for evaluating program impact and why? (b) 
Which current measures are not useful for evaluating program impact and 
why? (c) Are there additional/new measures that would support Healthy 
Start program evaluation (if applicable provide examples and a 
rationale)? (For a list of current Healthy Start measures, see page 20 
of the Healthy Start Initiative: Eliminating Disparities in Perinatal 
Health Notice of Funding Opportunity at https://grants.hrsa.gov/2010/Web2External/Interface/Common/EHBDisplayAttachment.aspx?dm_rtc=16&dm_attid=d3c378a4-b07d-48e5-ab36-38f05a7eeb48).
    (10) HRSA currently provides an optional Healthy Start database to 
grantees (i.e., CAREWare) https://healthystartepic.org/healthy-start-implementation/careware-for-healthy-start/) free of charge. Provide 
input on the essential and preferred components of an ideal Healthy 
Start data system. Would there be an advantage to having one system 
that all grantees are required to use? Would there be any 
disadvantages?
    Respondents may also provide additional comments or recommendations 
that are not specifically linked to the questions above. All responses 
may, but are not required to, identify the individual's name, address, 
email, telephone number, professional or organizational affiliation, 
background, or area of expertise (e.g., program participant, family 
member, clinician, community health worker, researcher, Healthy Start 
Director, etc.), and topic/subject matter. Information obtained as a 
result of this RFI may be used by HRSA on a non-attribution basis for 
program planning. Comments in response to this RFI may be made publicly 
available, so respondents should bear this in mind when making 
comments. HRSA will not respond to any individual comments.

Special Note to Commenters

    Whenever possible, respondents are asked to draw their responses 
from lived experience and/or objective, empirical, and actionable 
evidence and to cite this evidence within their responses. This RFI is 
issued solely for information and planning purposes; it does not 
constitute a Request for Proposal, applications, proposal abstracts, or 
quotations. This RFI does not commit the government to contract for any 
supplies or services or make a grant or cooperative agreement award. 
Further, HRSA is not seeking proposals through this RFI and will not 
accept unsolicited proposals. HRSA will not respond to questions about 
the policy issues raised in this RFI. Responders are advised that the 
U.S. government will not pay for any information or administrative 
costs incurred in response to this RFI; all costs associated with 
responding to this RFI will be solely at the interested party's 
expense. Not responding to this RFI does not preclude participation in 
any future procurement or program, if conducted.

Diana Espinosa,
Deputy Administrator.
[FR Doc. 2022-28559 Filed 1-3-23; 8:45 am]
BILLING CODE 4165-15-P