[Federal Register Volume 88, Number 112 (Monday, June 12, 2023)]
[Notices]
[Pages 38070-38073]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-12460]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration


Agency Information Collection Activities: Proposed Collection; 
Comment Request

    In compliance with section 3506(c)(2)(A) of the Paperwork Reduction 
Act of 1995 concerning opportunity for public comment on proposed 
collections of information, SAMHSA will publish periodic summaries of 
proposed projects. To request more information on the proposed projects 
or to obtain a copy of the information collection plans, call the 
SAMHSA Reports Clearance Officer on (240) 276-0361.
    Comments are invited on: (a) whether the proposed collections of 
information are necessary for the proper performance of the functions 
of the agency, including whether the information shall have practical 
utility; (b) the accuracy of the agency's estimate of the burden of the 
proposed collection of information; (c) ways to enhance the quality, 
utility, and clarity of the information to be collected; and (d) ways 
to minimize the burden of the collection of information on respondents, 
including leveraging automated data collection techniques or other 
forms of information technology.

Proposed Project: Protection and Advocacy for Individuals With Mental 
Illness (PAIMI)--Revised Annual Program Performance Report (PPR)--
Office of Management and Budget (OMB) No. 0930-0169--Revision

    SAMHSA is requesting approval from the OMB for changes to the 
Annual PPR, PPR Instructions, and the ACR for the PAIMI program. The 
OMB clearance for the current 2022-2023 PPR, PPR Instructions, and ACR 
(0930-0169) will expire on June 30, 2023.
    Additionally, SAMHSA is requesting Terms of Clearance from OMB to 
use the current 2022-2023 PPR, PPR Instructions, and ACR (0930-0169) 
for the fiscal year (FY) 2023-2024 reporting period due on January 1, 
2024. The reasons for this special request are the PAIMI grantees (1) 
have been serving and tracking PAIMI client statistics for six months 
of the 2023-2024 reporting period and to require them to adjust the 
counting, tracking, and documenting of the PAIMI work at this time 
would create an administrative and excessive burden; (2) need adequate 
time to update their statistical tracking systems that are used to 
gather the correct information and obtain training and technical 
assistance to ensure proper data collection is occurring; and (3) asked 
SAMHSA to consider not implementing the proposed changes and revisions 
to the current 2022-2023 PPR, PPR Instructions, and ACR (0930-0169) 
until the 2023-2024 reporting period due on January 1, 2025.
    The protection and advocacy (P&A) systems were established under 
the Developmental Disabilities Act of 1975 [42 U.S.C. 15001 et seq., as 
amended in 2000]. The amendments of 2000 require the Secretary of 
Health and Human Services submit a biennial report on disabilities to 
the President, Congress, and the National Council on Disability. The 
Secretary's report is prepared by the Administration on Intellectual 
and Developmental Disabilities (AIDD), within the Administration on 
Community Living. The PPR, which includes an ACR, contains information 
from the PAIMI grantees on the types of activities and services they 
provided on behalf of PAIMI-eligible individuals. SAMHSA aggregates 
this information into a biennial summary report that AIDD includes in 
an appendix to the Secretary's biennial report on disabilities.
    The PAIMI Act at 42 U.S.C. 10805(7) requires that each P&A system 
prepare and transmit a report to the Secretary HHS and to the head of 
its State mental health agency on January 1. This report describes the 
activities, accomplishments, and expenditures of the system during the 
most recently completed fiscal year, including a section prepared by 
the advisory council (the PAIMI Advisory Council or PAC), that 
describes the activities of the council and its independent assessment 
of the operations of the system.
    The Protection and Advocacy for Individuals with Mental Illness 
(PAIMI) Act at 42 U.S.C. 10801 et seq., authorized funds to the same 
protection and advocacy (P&A) systems created under the Developmental 
Disabilities Assistance and Bill of Rights Act of 1975, known as the DD 
Act (as amended in 2000, 42 U.S.C. 15001 et seq.]. The DD Act supports 
the Protection and

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Advocacy for Developmental Disabilities (PADD) Program administered by 
the Administration on Intellectual and Developmental Disabilities 
(AIDD) within the Administration on Community Living. AIDD is the lead 
Federal P&A agency. The PAIMI Program supports the same governor-
designated P&A systems established under the DD Act by providing legal-
based individual and systemic advocacy services to individuals with 
significant (severe) mental illness (adults) and significant (severe) 
emotional impairment (children/youth) who are at risk for abuse, 
neglect and other rights violations while residing in a care or 
treatment facility.
    In 2000, the PAIMI Act amendments created a 57th P&A system--the 
American Indian Consortium (the Navajo and Hopi Tribes in the Four 
Corners region of the Southwest). The Act, at 42 U.S.C. 10804(d), 
states that a P&A system may use its allotment to provide 
representation to individuals with mental illness, as defined by 
section 42 U.S.C. 10802 (4)(B)(iii), residing in the community, 
including their own home, only if the total allotment under this title 
for any fiscal year is $30 million or more, and in such cases, an 
eligible P&A system must give priority to representing PAIMI-eligible 
individuals, as defined by 42 U.S.C. 10802(4)(A) and (B)(i).
    The Children's Health Act of 2000 (CHA) also referenced the Ftate 
P&A system authority to obtain information on incidents of seclusion, 
restraint, and related deaths [see, CHA, part H at 42 U.S.C. 290ii-1]. 
PAIMI Program formula grants awarded by SAMHSA go directly to each of 
the 57 governor-designated P&A systems. These systems are located in 
each of the 50 States, the District of Columbia, the American Indian 
Consortium, American Samoa, Guam, the Commonwealth of the Northern 
Mariana Islands, the Commonwealth of Puerto Rico, and the U.S. Virgin 
Islands.
    The Substance Abuse Mental Health Services Administration (SAMHSA) 
proposes the following revisions to its annual PAIMI Program 
Performance Report (PPR), PPR Instructions, and ACR:
    1. All questions related to Race; added the following choices of 
Some other race and Race unknown;
    2. All questions related to Gender; added the following choices of 
Transgender (Trans Woman and Trans Man), Two-Spirit for American 
Indian/Alaska Native (AIAN), Gender Non-Conforming, Other, and Prefer 
not to say;
    3. All questions related Sexual Orientation; added the following 
choices of Lesbian or gay, Straight (not lesbian or gay), Bisexual, 
Other, and Prefer not to say;
    4. Demographic Composition of PAIMI Governing Board, Advisory 
Council and Program Staff; the following was added for clarification, 
``Transgender is someone whose gender identity is incongruent with 
their sex assigned at birth. A trans woman or a transgender woman is a 
woman who was assigned male at birth. A trans man or a transgender man 
is a man who was assigned female at birth. Two-Spirit is a term by and 
for Indigenous peoples and is culturally anchored with a particular 
meaning and, potentially, social status, it is not appropriate for use 
by non-Indigenous populations. Gender Non-Conforming refers to people 
who do not follow other people's ideas or stereotypes about how they 
should look, or act based on the female or male sex they were assigned 
at birth. Lesbian is a woman who has a romantic and/or sexual 
orientation toward women. Gay is a man who has a romantic and/or sexual 
orientation toward men. Straight (not lesbian or gay) is a heterosexual 
person; someone having a romantic and/or sexual orientation to persons 
of the opposite sex. Bisexual is an individual who has the capacity to 
form enduring physical, romantic, and/or emotional attractions to those 
of the same gender or to those of another gender. Other is someone who 
does not identified exclusively in one of the categories for gender or 
sexual orientation and is identified with a different term.'';
    5. Number of Mental Health Professionals on the Advisory Council; 
the following was added for clarification, Other (Identify the 
professional in the Footnotes);
    6. All questions related to Age; added the clarification ``would 
not disclose'' to ``Prefer not to say'';
    7. Gender and Sexual Orientation of PAIMI-eligible Individuals 
Served; the following was added for clarification, ``Enter the number 
of individuals served by the indicated categories of gender and sexual 
orientation. Individuals should not be included in more than one of the 
categories. The total for both tables should be an unduplicated total 
of persons served based on gender and sexual orientation.'';
    8. In the Living Arrangements Section, the following definitions 
were added in the PPR Instructions for clarification:
    Community residential home for children/youth up to 18 yrs.: Group 
and residential live-in care placement in which staff are trained to 
work with children and youth whose specific needs are best addressed in 
a highly structured environment. These placements offer a higher level 
of structure and supervision than what can be provided in the youth's 
or child's home. For examples, this includes group homes where youth or 
children live with each other in a community-based setting, attend 
local schools and participate in community, cultural and social 
opportunities; and community-based residential homes that meet the Home 
and Community Based Services settings rule.
    Community residential home for adults: A broad category of 
community based residential options for adults with serious mental 
illness, including group homes, supported or supportive housing, and 
other non-inpatient or institutional settings. For example, this 
includes community-based supported or supportive homes where staff are 
trained to work with adults with significant (serious) mental illness.
    Non-medical community-based residential facility for children/
youth: Facilities where 5 or more unrelated children/youth reside and 
care, treatment, services are above the level of room and board but 
less than skilled nursing care. Such care, treatment or services is 
provided as a primary function of such facility.
    Foster care: This arrangement (also known as out-of-home care) is a 
temporary service provided by States for children who cannot live with 
their families. Children in foster care may live with relatives or with 
unrelated foster parents.
    Nursing homes, including skilled nursing facilities: Facilities for 
the residential care of elderly or disabled people. They may also be 
referred to as care homes or long-term care facilities. Often, the 
terms have slightly different meanings to indicate whether the 
institutions are public or private, and whether they provide mostly 
assisted living, or nursing care and emergency medical care. Nursing 
homes are used by people who do not need to be in a hospital but cannot 
be cared for at home.
    Intermediate care facilities (ICF): Long term care facilities that 
provide nursing and supportive care to residents on a non-continuous 
skilled nursing care basis, under a physician's direction. ICFs are 
designed to provide custodial care for those who are unable to care for 
themselves because of mental disability or declining health. ICFs are 
typically regarded as a lower-level nursing care facility when compared 
to a skilled nursing facility, but its residents require more care and 
attention than those in a

[[Page 38072]]

residential care facility for elderly or an adult residential care 
facility.
    Public and Private general hospital involving emergency rooms: A 
public hospital is owned and funded by the government. Whereas a 
private hospital is owned by an individual or group of people.
    Public institutional living arrangement: This is a broad category 
to cover all public institutional living that do not fit into other 
living arrangement categories. For examples, this includes assisted 
living facilities, adult homes, residential schools, juvenile justice 
facilities, and residential care facilities that are owned and funded 
by the government.
    Private institutional living arrangement: This is a broad category 
to cover all private institutional living that do not fit into other 
living arrangement categories. For example, this includes assisted 
living facilities, adult homes, residential schools, juvenile justice 
facilities, and residential care facilities that are owned by an 
individual or group of people.
    Psychiatric hospitals (public/private): The term ``psychiatric 
hospital'' means an institution, which is primarily engaged in 
providing, by or under the supervisor of a Doctor of Medicine or 
Osteopathy, psychiatric services for the diagnosis and treatment of 
individuals with mental illness. Some psychiatric hospitals are 
designated as ``forensic hospitals'' to serve individuals who are in 
the custody of penal authorities.
    Jails: Correctional institutions used to detain persons who are in 
the lawful custody of the government as either accuse person awaiting 
trial or convicted person serving a sentence. Jails typically refers to 
smaller, local facilities, in which people are incarcerated for a short 
period of time.
    State prisons: Institutions under State jurisdiction for 
confinement of persons convicted or serious crimes.
    Federal detention centers: Facilities that hold individuals prior 
to or during court proceedings, as well as those serving brief 
sentences or ICE immigration detention facilities that house 
noncitizens to secure their presence for immigration proceedings or 
removal from the U.S. Another name for the centers is Federal Bureau 
Prisons.
    Federal prisons: Institutions under Federal jurisdiction for 
confinement of persons convicted or serious crimes.
    Veterans' Administration hospital/clinic: Provides primary care, 
specialized care, and related medical and social support services to 
American veterans.
    Other Federal facility: This includes the Department of Homeland 
Security (DHS) and Health and Human Services (HHS) facilities used 
temporarily to house child migrants.
    Homeless: An individual with no permanent living arrangement or no 
fixed place of residence.
    Independent (in the community & PAIMI-eligible): This implies the 
person is living in his or her own home.
    Parental or other family home & PAIMI-eligible: Parental home is a 
home that a child or young adult shares with a parent, guardian; a 
person acting in the capacity of a parent or guardian; or the home of 
one's parents or guardians. Other family home is a home maintained by 
persons biologically related by biology, adoption, marriage, or common 
law, to a person.
    Unknown: Living arrangement was not provided.
    9. In the Complaints/Problems of PAIMI-eligible Individuals of 
Abuse, Neglect, and Rights Violations Section, the following 
dispositions were added;

e. Other indicators of success or outcomes that resulted from P&A 
involvement.
h. P&A withdrew due to conflict of interest or other reasons.

    10. In Areas of Alleged Rights Violations Section, the following 
choices were added for clarification;

w. The denial of access to personal possessions
x. Failure to comply with commitment regulations
y. Failure to comply with commitment time frames

    11. The choice A/N I--Abuse/Neglect Investigation was added to the 
Intervention Strategies for clarification;
    12. In the Reasons for Closing Individual Advocacy Case File 
Section, the following choices were either reorganized or added for 
clarification;

Client's objective was partially or fully met.
Case or investigation lacked merit.
Case withdrawn or terminated by the client.
Issue favorably resolved.
Issue not favorably resolved.
Other success or outcomes due to P&A involvement (i.e., provided self-
advocacy assistance)
Other representation found.
Services not needed due to client's death or relocation.
P&A withdrew due to conflict of interest or other reasons (i.e., client 
would not cooperate).

    13. In the Death Investigation Activities Section, the following 
was added for clarification, ``if zero means the P&A did not receive 
any death reports from CMS for investigation, please note this in the 
Footnotes'';
    14. In the Interventions on behalf of groups of PAIMI-eligible 
Individuals Section, Group Advocacy the term ``non-litigation'' was 
corrected;
    15. Changed the Section ``End Outcomes of P&A Activities'' to 
``Performance Measures of P&A Activities''; changed the word 
``Outcome'' to ``Specific Measures''; either revised or add the 
following measures for clarification;

(a) PAIMI-eligible individuals who access community-based mental health 
or health care services that resulted in community integration and 
independence or are better able to advocate to do so;
(b) PAIMI-eligible individuals who access benefits or services or are 
better able to advocate to do so;
(c) PAIMI-eligible individuals who live in a healthier, safer, 
improved, or more integrated settings or are better able to advocate to 
do so;
(d) PAIMI-eligible individuals are able to stay in their own home or 
better able to advocate to do so;
(e) PAIMI-eligible individuals who can secure or maintain employment 
and/or are not subject to workplace discrimination or are better able 
to advocate for to do so;
(f) PAIMI-eligible individuals who receive appropriate educational 
services and supports and/or are not subject to discrimination in 
educational settings or are better able to advocate for those outcomes;
(g) PAIMI-eligible individuals who go to school in safe and more humane 
conditions;
(h) PAIMI-eligible children (individuals) who receive appropriate 
services in the most integrated settings;
(i) PAIMI-eligible individuals who were not subject to discrimination 
in government benefits/services, housing, public accommodations, etc. 
or are better able to advocate for such outcomes;
(j) PAIMI-eligible individuals who were not subject to abuse, neglect, 
or rights violations or are better able to advocate for to do so;
(k) PAIMI-eligible individuals who can make their own decisions to the 
maximum extent feasible or are better able to advocate to do so;
(l) PAIMI-eligible individuals who had their rights enforced, retained, 
restored and/or expanded or are better able to advocate for to do so; 
and
(m) PAIMI-eligible individuals who were more able to participate in the 
voting process or are better able to advocate for to do so.

    16. Tables and instructions were added the Budget Section for 
clarification; and

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    17. In the Statement of Priorities (Goals) Section, removed the 
words ``Expected Target'' and revised the following information for 
clarification:

Report on Previous FY Statement of Priorities and Objectives (SPO)

    The Priority and Objectives target population and expected outcome 
fields will be pre-populated by the information submitted with the 
PAIMI application. The number of pre-populated items will reflect the 
number submitted in the application. A. Please indicate an actual 
outcome for each expected outcome. B. Please indicate strategies to 
implement goals and priorities. C. Provide a narrative (500-word limit) 
of P&A activities for each of the accomplishments related to each 
priority. D. Other Qualitative Narrative related to each priority: 
Provide a narrative (500 words limit) of significant activity for which 
there were no quantifiable results.
    The current report formats will be effective for the FY 2023 PPR 
reports due on January 1, 2024.

Estimates of Annualized Hour Burden

    The estimated annual burden for the PAIMI Annual PPR is summarized 
below:

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                                                                     Number of
                                                     Number of     responses per     Hours per      Total hour
                                                    respondents     respondent       response         burden
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Program Performance Report......................              57               1              20           1,140
Advisory Council Report.........................              57               1              10             570
                                                 ---------------------------------------------------------------
    Total.......................................             114  ..............  ..............           1,710
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* Based on past estimates and the fact that changes being made do not measurably impact response burden.

    Written comments and recommendations for the proposed information 
collection should be sent within 30 days of publication of this notice 
to www.reginfo.gov/public/do/PRAMain. Find this particular information 
collection by selecting ``Currently under 30-day Review--Open for 
Public Comments'' or by using the search function.

Alicia Broadus,
Public Health Advisor.
[FR Doc. 2023-12460 Filed 6-9-23; 8:45 am]
BILLING CODE 4162-20-P