[Federal Register Volume 88, Number 179 (Monday, September 18, 2023)]
[Notices]
[Pages 63963-63965]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-20102]
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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; Title V Maternal and Child
Health Services Block Grant to States Program: Guidance and Forms for
the Title V Application/Annual Report, OMB No. 0915-0172--Revision
AGENCY: Health Resources and Services Administration (HRSA), Department
of Health and Human Services.
ACTION: Notice.
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SUMMARY: In compliance with the Paperwork Reduction Act of 1995, HRSA
submitted an Information Collection Request (ICR) to the Office of
Management and Budget (OMB) for review and approval. Comments submitted
during the first public review of this ICR will be provided to OMB. OMB
will accept further comments from the public during the review and
approval period. OMB may act on HRSA's ICR only after the 30-day
comment period for this notice has closed.
DATES: Comments on this ICR should be received no later than October
18, 2023.
ADDRESSES: 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 Review--Open for
Public Comments'' or by using the search function.
FOR FURTHER INFORMATION CONTACT: To request a copy of the clearance
requests submitted to OMB for review, email Joella Roland, the HRSA
Information Collection Clearance Officer, at [email protected] or call
(301) 443-3983.
SUPPLEMENTARY INFORMATION:
Information Collection Request Title: Title V Maternal and Child
Health (MCH) Services Block Grant to States Program: Guidance and Forms
for the Title V Application/Annual Report OMB No. 0915-0172--Revision
Abstract: The Title V MCH Services Block Grant to States Program is
authorized by Sections 501-509 of Title V of the Social Security Act
(42 U.S.C. 701-709). HRSA is updating the Title V MCH Services Block
Grant to States Program: Guidance and Forms for the Title V
Application/Annual Report (``Guidance''). The updated edition will be
the tenth edition of the Guidance. This Guidance is used annually by
the 50 states and nine jurisdictions \1\ (hereafter referred to as
``state'') in applying for Block Grants under Title V of the Social
Security Act and in preparing the required Annual Report. The updates
being proposed by HRSA's Maternal and Child Health Bureau for the tenth
edition of the Guidance continue to support the federal-state
partnership that is supported by the Title V MCH Services Block Grant
and the state's role in developing a 5-Year Action Plan that addresses
its individual priority needs. These proposed updates build on and
further refine the reporting structure and vision that was outlined in
the previous ninth edition. As such, they are intended to enable a
state to articulate a comprehensive description of its Title V program
activities and its leadership efforts in advancing and assuring a
public health system that serves the MCH population. HRSA's proposed
updates to the tenth edition of the Guidance were informed by
consultation with State Title V MCH agencies, and by comments received
from State Title V program leadership, national MCH leaders, other MCH
stakeholders, and the public. A 60-day notice was published in the
Federal Register on May 5, 2023, vol. 88, No. 87; pp. 29135-37 FR
29135-37. HRSA received 170 comments on the proposed updates to the
tenth edition of the Guidance, from a variety of responders, including
state Title V Programs, other state agencies, public health
organizations, universities, members of the community, and other
stakeholders. Of the 170 comments, 80 requested that stillbirth be
addressed in the Guidance, and 71 requested that the oral health
performance measures be retained as a national performance measure. The
remainder of 19 comments included suggestions for clarifying
instructions in certain sections of the Guidance, including examples of
partnership with non-governmental organizations and family
organizations, or responding to reporting burden on the universal
performance measures. HRSA considered all public comments as part of
its deliberative process in finalizing updates to the tenth edition of
the Title V MCH Services Block Grant to States Program: Guidance and
Forms for the Title V Application/Annual Report.
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\1\ The following nine jurisdictions receive Title V Maternal
and Child Health Block Grant Program funding: the District of
Columbia, the Republic of the Marshall Islands, the Federated States
of Micronesia, the Republic of Palau, the Commonwealth of Puerto
Rico, the US Virgin Islands, Guam, American Samoa, and the
Commonwealth of the Northern Mariana Islands.
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A discussion of the public comments received during the 60-day
comment period and HRSA's response to the comments is set below:
(1) Revised Approach for Interim-Year Reporting: States and diverse
stakeholders expressed strong support for the proposed approach that
would allow states to decide whether updates are needed to numerous
sections of the guidance during interim years 2 through 5, following
submission of the 5-year Needs Assessment in year 1. In response to
these comments, HRSA will maintain this approach in the tenth edition
of the Guidance.
(2) Streamlining and Reorganizing of the Guidance: States and
diverse stakeholders expressed strong support for the proposed approach
of streamlining and reorganizing the requirements for state narrative
reporting, in order to eliminate duplication. In response to these
comments, HRSA will maintain this approach in the tenth edition of the
Guidance.
(3) Family and Community Partnership: HRSA received comments
related to clarifying expectations on reporting about family and
community partnerships. In response to these comments, expectations
around state Title V reporting on family and community partnerships
will be clarified, such as reporting on partnership with HRSA's Family-
to-Family Health Information Centers, discussion on the impact these
partnerships have on the MCH population, and their value in improving
outcomes.
(4) Health Equity: Comments received from states and stakeholders
support the stronger emphasis on health equity, including it being a
guiding principle of the Title V Program. In response to these
comments, HRSA will maintain this approach in the tenth edition of the
Guidance.
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(5) Children and Youth With Special Health Care Needs: Several
commenters provided suggestions to enhance the instructions related to
the children with special health care needs (CSHCN) domain, with a
focus on the Blueprint for Change: A National Framework for a System of
Services for Children and Youth with Special Health Care Needs, family
engagement, and the six core outcomes for a CSHCN system of care. In
response to these comments, HRSA will clarify the instructions in the
tenth edition of the Guidance for describing the CSHCN system of care
and the Annual Report and Application narrative for the CSHCN
population domain.
(6) Oral Health Performance Measure: HRSA received comments from
stakeholders that requested to retain the preventive dental visit as a
National Performance Measure (NPM), rather than classify it as a
Standardized Measure as proposed during the 60-day comment period.
Based on comments received from stakeholders and members of the
community, HRSA will retain the preventive dental visit as an NPM.
(7) Reporting on Stillbirth: Comments were received during the 60-
day comment period that requested a change to National Outcome Measure
6 from ``perinatal mortality rate per 1,000 live births plus fetal
deaths'' to a stillbirth-focused measure. HRSA will maintain the
perinatal mortality measure as defined; however, based on these
comments received from stakeholders and members of the community, HRSA
will add a National Outcome Measure for stillbirth rate defined as,
``number of fetal deaths at 20 or more weeks gestation per 1,000 live
births plus fetal deaths.'' In addition, HRSA will update the narrative
in the tenth edition of the Guidance to revise the last sentence of
III.B.3.a System of Care for Mothers, Children, and Families to include
bereavement and stillbirth, as follows: ``In describing the state's
system of care for mothers, infants, and children, the role of the
Title V program in addressing key MCH issues, which may include access
to quality services, prenatal and postpartum care, maternal morbidity
and mortality, stillbirth, newborn screening, infant mortality,
preventive and primary care services for children and adolescents,
immunizations, injury prevention, oral health, behavioral and mental
health, bereavement, and/or substance use, should be clearly
identified.'' HRSA also added an example for Form 5b, pregnant women,
around health promotion campaigns that address stillbirth and
postpartum depression. Comments were also received suggesting updates
to the Healthy People 2030 objective for stillbirth, although this was
not proposed in the 60-day notice. These comments were not accepted, as
HRSA does not have the authority to modify Healthy People 2030
objectives.
(8) Universal Measures: A few states commented that the requirement
of reporting on the two universal measures increased burden to the
states, when the universal measures do not align with state priorities.
The Title V statute authorizes the Secretary of Health and Human
Services to identify priorities of national significance and require
reporting on those priorities. The two selected universal measures,
Postpartum Visit and Medical Home, are selected as national priorities
because of their focus on access and quality of essential primary and
preventive care for mothers and children, including children with
special health care needs. To help reduce burden, instructions will
clarify that only one Evidence-based or -informed Strategy Measure is
required for Medical Home. HRSA has removed the requirement to discuss
Medical Home in the Adolescent Health Domain, emphasizing reporting in
the Child Health Domain. States may optionally report on Medical Home
in the Adolescent Health Domain in addition to the required Child
Health and CSHCN domains. HRSA did not receive specific comments on the
Postpartum Visit universal measure.
(9) Standardized Measures: No comments were submitted in response
to the proposal to update the Guidance with a new set of Standardized
Measures to select as State Performance Measures. Accordingly, HRSA
will retain this update to the tenth edition of the Guidance.
(10) Form 7 Title V Program Workforce: HRSA received comments
requesting clarifications to the instructions and data fields in Form
7: Title V Program Workforce. In response to comments received from
state Title V programs and stakeholders, Form 7 instructions will be
clarified to better define what is a full-time employee, the
relationship between the data fields, and the data being collected
about positions lost over the past 12 months.
(11) Technical Revisions: Several commenters suggested technical
revisions to the Guidance, which included edits to terminology,
provided examples of possible revisions, and clarifications to the
narrative reporting instructions. In response to these comments, HRSA
will modify the tenth edition of the Guidance to incorporate these
revisions to terminology, examples, and clarifications to instructions.
Revisions will include:
a. Part One: Background and Administrative Information:
i. IV.B: Update Figure 2 to better display the performance measure
framework.
b. Part Two: Application/Annual Report Instructions.
i. II: Clarify instructions concerning the use of State Performance
Measures to address a priority need.
ii. II: Clarify instructions on the option to select a priority
population, in addition to an NPM overall.
iii. III.B.3.b: Include the definition of a well-functioning system
of care.
iv. III.B.3.c: Include Medicaid Core Set measures as part of the
list of what to include in the state's narrative that describes areas
of coordination between the state Title V program and Medicaid, and
expanded examples of health care financing.
v. III.C.1.b.ii.c: Expand the workforce narrative to include the
number of parents and family members, including CSHCN and families, who
are on a state's Title V program staff.
vi. III.C.1.c: Include narrative on the ways stakeholders,
including families, constituents, and family-led organizations, were
involved in identifying priority needs.
vii. III.E: Reorder the columns of the State Action Plan Table to
the following order: Priority Needs, 5-Year Objectives, Strategies,
Evidence-based or -Informed Strategy Measures, National and State
Performance Measures, and National and State Outcome Measures.
c. Part Three: Reporting Forms.
i. Form 10: Use consistent terms to describe ``annual objective''.
Need and Proposed Use of the Information: Each year, all states are
required to submit an Application/Annual Report for federal funds for
their Title V MCH Services Block Grant to States Program to the HRSA's
MCHB (Section 505(a) and 506(a)(1) of Title V of the Social Security
Act). In addition, the State MCH Services Block Grant programs are
required to conduct a state-wide, comprehensive Needs Assessment every
5 years. The information and instructions for the preparation and
submission of this Application/Annual Report are contained in the Title
V Maternal and Child Health Services Block Grant to State Program:
Guidance and Forms for the Title V Application/Annual Report.
Likely Respondents: Likely respondents are state MCH agencies and
other MCH stakeholders.
Burden Statement: Burden in this context means the time expended by
persons to generate, maintain, retain,
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disclose, or provide the information requested. This includes the time
needed to review instructions; to develop, acquire, install, and
utilize technology and systems for the purpose of collecting,
validating, and verifying information, processing and maintaining
information, and disclosing and providing information; to train
personnel and to be able to respond to a collection of information; to
search data sources; to complete and review the collection of
information; and to transmit or otherwise disclose the information. The
total annual burden hours estimated for this ICR are summarized in the
table below.
Total Estimated Annualized Burden Hours
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Number of Average burden
Form name Number of responses per Total per response Total burden
respondents respondent responses (in hours) hours
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Application and Annual Report 59 1 59 115 6,785
without 5-Year Needs Assessment
Summary........................
Application and Annual Report 59 1 59 181 10,679
with 5-Year Needs Assessment
Summary........................
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Total....................... 59 .............. 59 .............. 17,464
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Maria G. Button,
Director, Executive Secretariat.
[FR Doc. 2023-20102 Filed 9-15-23; 8:45 am]
BILLING CODE 4165-15-P