[Federal Register Volume 88, Number 3 (Thursday, January 5, 2023)]
[Notices]
[Pages 874-876]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-28621]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Agency Information Collection Activities: Proposed Collection: 
Public Comment Request; Information Collection Request Title: Health 
Resources and Services Administration Uniform Data System, OMB No. 
0915-0193--Revision

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

ACTION: Notice.

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SUMMARY: In compliance with the requirement for opportunity for public 
comment on proposed data collection projects of the Paperwork Reduction 
Act of 1995, HRSA announces plans to submit an Information Collection 
Request (ICR), described below, to the Office of Management and Budget 
(OMB). Prior to submitting the ICR to OMB, HRSA seeks comments from the 
public regarding the burden estimate, below, or any other aspect of the 
ICR.

DATES: Comments on this ICR must be received no later than February 6, 
2023.

ADDRESSES: Submit your comments to [email protected] or mail the HRSA 
Information Collection Clearance Officer, Room 14N39, 5600 Fishers 
Lane, Rockville, MD 20857.

FOR FURTHER INFORMATION CONTACT: To request more information on the 
proposed project or to obtain a copy of the data collection plans and 
draft instruments, email [email protected] or call the HRSA OMB PRA 
Officer, Samantha Miller, at (301) 443-1984.

SUPPLEMENTARY INFORMATION: When submitting comments or requesting 
information, please include the information request collection title 
for reference.
    Information Collection Request Title: HRSA 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 (42 
U.S.C. 254b). 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 30 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 UDS \1\ for annual reporting by 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 \2\ 
(NEPQR) Program awardees (specifically those funded under the practice 
priority areas of section 831(b) of the PHS Act). Look-alikes do not 
routinely receive Federal funding under section 330 of the PHS Act, but 
meet the Health Center Program requirements for designation under the 
program (42 U.S.C. 1395x(aa)(4)(A)(ii) and 42 U.S.C. 
1396d(l)(2)(B)(ii)).
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    \1\ https://www.cms.gov/files/document/sgm-clearinghouse-uds.pdf.
    \2\ https://www.hrsa.gov/grants/find-funding/hrsa-20-012.
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    Need and Proposed Use of the Information: UDS data collection 
updates must be completed in a timely manner in order for health 
centers to fulfill Health Center Program requirements. Approval of 
these

[[Page 875]]

changes is needed by February 1, 2023, to implement the changes in the 
data collection system and to provide adequate information on UDS 
reporting guidance to health centers, partners, and key stakeholders. 
HRSA plans to make the following updates for the performance year 2023 
UDS data collection:
     Table 3B (Demographic Characteristics), will be updated to 
include additional subpopulations selection options to better reflect 
the diversity of patients served by health centers. Race/ethnicity 
categories will be updated to align with U.S. Department of Health and 
Human Services (HHS) data standards.\3\ In accordance with section 4302 
within the Office of the Assistant Secretary for Planning and 
Evaluation (ASPE) \4\ Implementation Guidance on Data Standards for 
Race, Ethnicity, Sex, Primary Language, and Disability Status, the UDS 
will be updated to include subpopulations categories for: Asian, Native 
Hawaiian, Other Pacific Islanders as well as a broader selection for 
Hispanic ethnicity.
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    \3\ https://aspe.hhs.gov/reports/hhs-implementation-guidance-data-collection-standards-race-ethnicity-sex-primary-language-disability-0.
    \4\ https://aspe.hhs.gov/reports/hhs-implementation-guidance-
data-collection-standards-race-ethnicity-sex-primary-language-
disability-
0#:~:text=Section%204302%20requires%20the%20Secretary,all%20national%
20population%20health%20surveys.
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    The 2011 HHS race and ethnicity categories maintains alignment with 
the 1997 OMB \5\ minimum categories for race and ethnicity allow for a 
better understanding of the cultural diversity of patients served by 
health centers.
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    \5\ https://obamawhitehouse.archives.gov/omb/fedreg_1997standards.
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     Table 5 (Staffing and Utilization), will be updated to 
include four distinct lines for reporting Pharmacy Personnel 
categorized by Pharmacists, Clinical Pharmacist, Pharmacy Technicians, 
and Other Pharmacy Personnel. Health center personnel are critical to 
the functioning of health centers, collecting inclusive information 
about the health center workforce, will allow HRSA's Bureau of Primary 
Health Care to better understand workforce composition as well as 
improve the ability to articulate the role that pharmacy personnel play 
in an integrated primary care.
     Table 6A (Selected Diagnoses and Services Rendered), will 
be updated to include a diagnostic measure representing long COVID. 
This measure is labeled Post COVID-19 condition, unspecified, within 
the Selected Infectious and Parasitic Diseases grouping of measures. 
With this measure, health centers are able to report both number of 
patients with this diagnosis as well as the number of patient visits 
related to the diagnosis.\6\ The Centers for Disease Control and 
Prevention classifies long COVID, also known as post-COVID, conditions 
as a wide range of new, returning, or ongoing health problems people 
can experience four or more weeks after first being infected with the 
virus that causes COVID-19.\7\ Data on this measure will lead to better 
understanding the impact of COVID-19 post-acute infection on health 
center patients.
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    \6\ https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html.
    \7\ https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html.
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     Table 6A (Selected Diagnoses and Services Rendered), will 
be updated to include a measure that tracks the number of patients who 
receive pediatric developmental screening and evaluation services. The 
2023 UDS will include developmental screening, behavioral screening/
testing, and administrative assessment International Classification of 
Diseases diagnostic and Current Procedural Terminology billing codes 
for use to track the changes in the number of children who receive 
developmental screening and evaluation services. Early childhood is a 
critical period for physical, cognitive, and social development, laying 
the foundation for life-long health and well-being.\8\ Children who 
experience poverty, particularly during early life are at risk of 
adverse health and developmental outcomes.
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    \8\ https://www.hrsa.gov/grants/find-funding/hrsa-22-091.
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     Table 6B (Quality of Care Measures), and Table 7 (Health 
Outcomes and Disparities), collected UDS clinical quality measures \9\ 
(CQMs) where applicable. Collected UDS CQMs will be updated in 
alignment with specifications of the issued performance year 2023 
electronic-specified clinical quality measures, released by the Centers 
for Medicare and Medicaid Services for use by eligible providers. 
Clinical performance measure alignment across national programs 
promotes data standardization, quality, and transparency, and decreases 
reporting burden for providers and organizations participating in 
multiple Federal programs.
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    \9\ https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/downloads/guidetocqms_remediated_2011.pdf.
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     Appendix D: (Health Center Health Information Technology 
{HIT{time}  Capabilities Form), will be updated with a question asking 
health centers to provide the total number of patients that were 
screened for social risk factors, using a standardized screener, during 
the calendar year. This question provides a more accurate view of the 
impact of social risk on the health center patient population and 
continues to reinforce Social Determinates of Health as a priority area 
intrinsically linked with health equity.
     Beginning with the 2023 UDS, health centers will be able 
to submit patient-level data in fulfillment of data elements on Tables:

[cir] Table PBZC (Patients by Zip Code)
[cir] Table 3A (Patients by Age and Sex Assigned at Birth)
[cir] Table 3B (Demographic Characteristics)
[cir] Table 4 (Selected Characteristics)
[cir] Table 6A (Selected Diagnoses and Services Rendered)
[cir] Table 6B (Quality of Care Measures)
[cir] Table 7 (Health Outcomes and Disparities

    UDS+ Patent Level Reporting leverages a methodological shift in the 
process by which health centers submit their annual UDS report, while 
maintaining historic UDS measures. High-quality accessible data are 
critical to strategically meeting the needs of patients and identifying 
opportunities for clinical process improvement. The growth in health 
information technology coupled with the increased adoption of 
electronic health records has transformed patient care delivery and 
underscored the need for secure and rapid exchange of health data 
between disparate systems. Health Level Seven International \10\ 
developed Fast Healthcare Interoperability Resources \11\ (FHIR) to 
standardize the electronic exchange of patient data across systems. 
FHIR, which is the current gold standard, has the flexibility to 
support a variety of user needs and enhances interoperability by 
transmitting health data rapidly and more securely than ever before. It 
is important for the collection of UDS data to align with 
interoperability standards and reporting requirements across HHS and 
the healthcare industry. Leveraging FHIR to collect UDS patient-level 
data will improve data granularity, allow for the development of robust 
patient management programs, and improve equitable access to high-
quality, cost-effective primary care services.
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    \10\ https://www.hl7.org/.
    \11\ https://ecqi.healthit.gov/fhir.
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    This electronic reporting mechanism will reduce reliance on manual 
data entry to populate the annual UDS report, in turn yielding a 
reduction in reporting effort burden, and will greatly

[[Page 876]]

increase the analytical value of UDS data for informing policy and 
Program decision-making.
    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. FHIR standards align with the Centers for Medicare and 
Medicaid Services electronic clinical quality measures, allow for 
standardization of data, and reduce the potential for misinterpretation 
of measures or calculation errors. FHIR 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. FHIR will also include testing 
information necessary to support the UDS Test Cooperative. No more than 
three tests will be conducted each calendar year and no more than one 
hundred health centers will participate in one test. Participation is 
voluntary and will not affect their funding status. The total annual 
burden hours estimated for this Information Collection Request are 
summarized in the forthcoming table.

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                                                                     Estimated
                                           Estimated number of       number of    Average burden     Estimated
               Form name                       respondents         responses per   per response    total burden
                                                                    respondent      (in hours)         hours
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Universal Report......................  Total: 1,505............            1.00             238         358,190
                                        H80s: 1,370.............
                                        LALs: 117...............
                                        BHW: 18.................
Grant Report..........................  Total: 438..............            1.24              30          16,294
                                        438 Health Centers
                                         submitted 1 or more
                                         Grant Reports..
                                        1: 346..................
                                        2: 80...................
                                        3: 12...................
UTC Tests.............................  35......................            3.00               8             840
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    Total.............................  1,978...................            5.24  ..............         375,324
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    HRSA specifically requests comments on: (1) the necessity and 
feasibility 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. 2022-28621 Filed 1-4-23; 8:45 am]
BILLING CODE 4165-15-P