[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.

[[Page 63964]]

    (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,

[[Page 63965]]

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