[Federal Register Volume 88, Number 188 (Friday, September 29, 2023)]
[Notices]
[Pages 67291-67294]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-21473]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Agency for Healthcare Research and Quality, HHS.

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: This notice announces the intention of the Agency for 
Healthcare Research and Quality (AHRQ) to request that the Office of 
Management and Budget (OMB) approve the proposed updates to the 
currently approved information collection project: ``Medical 
Expenditures Panel Survey--Household and Medical Provider Components.'' 
In accordance with the Paperwork Reduction Act of 1995, AHRQ invites 
the public to comment on this proposed information collection.

DATES: Comments on this notice must be received by November 28, 2023.

ADDRESSES: Written comments should be submitted to: Doris Lefkowitz, 
Reports Clearance Officer, AHRQ, by email at 
[email protected].

FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports 
Clearance Officer, (301) 427-1477, or by email at 
[email protected].

SUPPLEMENTARY INFORMATION: 

Proposed Project

Medical Expenditures Panel Survey--Household and Medical Provider 
Components

    AHRQ requests that OMB approve a change to AHRQ's collection of 
information for the Medical Expenditures Panel Survey--Household and 
Medical Provider Components: OMB Control number 0935-0118, expiration 
November 30, 2025. Requested changes are for the Household Component 
(MEPS-HC) only.
    The MEPS was initiated in 1996. Each year a new panel of sample 
households is selected. Recent annual MEPS-HC sample sizes average 
about 13,500 households. Data can be analyzed at either the person, 
family, or event level. The panel design of the survey, which includes 
5 rounds of interviews covering 2 full calendar years, provides data 
for examining person level changes in selected variables such as 
expenditures, health insurance coverage, and health status.
    This research has the following goals:
    (1) To produce nationally representative estimates of health care

[[Page 67292]]

use, expenditures, sources of payment, and health insurance coverage 
for the U.S. civilian noninstitutionalized population.
    (2) To produce nationally representative estimates of respondents' 
health status, demographic and socio-economic characteristics, 
employment, access to care, and satisfaction with health care.
    Proposed Changes for the Fall 2024 MEPS-HC:
     Core MEPS Interview--Seven economic burden questions will 
be added to the Core interview. Five of these questions come from the 
Preventive Care Services Self-Administered Questionnaire (PSAQ), and 
two are new to the MEPS. The specific topics of the five questions 
moving from the PSAQ are partial and late payments for bills, having 
been contacted by debt collection agencies, and ability to pay for 
unexpected expenses. The questions were modified to be asked at the 
household level. These topics are important for understanding the 
context families face in paying for health care. The new questions 
asking about medical debt are modified versions of questions used in 
the Survey of Income and Program Participation (SIPP). The SIPP asks 
the question at a person level; AHRQ has modified it to be asked at the 
household level. Collecting medical debt amounts will enable analyses 
of how medical debt is related to health care access, use, health 
outcomes, and financial status. In addition, the wording for eight food 
security questions has been slightly modified to allow for proxy 
responses; thus, all households will be asked these questions.
    Preventive Care Services Self-Administered Questionnaire (PSAQ)--
The PSAQ will have the following changes for Fall 2024:
     Removing five economic burden questions, which will be 
added to the Core interview;
     Combining the Male and Female PSAQ questionnaires into a 
single questionnaire and revising the sex-specific questions 
accordingly;
     Adding Sexual Orientation and Gender Identity (SOGI) 
questions to the end of the questionnaire;
     Changing the age-specific skips to reflect new 
recommendations for specific preventive health screening procedures;
     Creating a web-based mode of completion as an alternative 
option to the traditional pen-and-paper-based survey.
    The incorporation of SOGI questions into the PSAQ aligns with the 
objectives outlined in Executive Order 14075, titled ``Advancing 
Equality for Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex 
Individuals.'' The inclusion of these questions necessitated further 
adjustments to the questionnaires, including the consolidation of the 
traditionally segregated male and female questionnaires into a unified 
form. Optimally incorporating sex-specific preventive care questions 
(e.g., prostate cancer screening) in surveys in a manner that respects 
all gender identities requires balancing multiple competing factors. 
AHRQ consulted with federal agencies fielding surveys with SOGI and 
preventive care questions, and they have not yet modified their 
preventive care questions to account for gender minorities. For this 
initial attempt in the MEPS, AHRQ balanced the following 
considerations: respect for gender minority respondents, cognitive 
burden among cisgender respondents, minimizing skip patterns to 
maintain consistency between pen-and-paper and web-based modes of the 
PSAQ, and the strong expectation that the number of gender minority 
respondents in the relevant age ranges will be too small to support 
estimates of receipt of sex-specific preventive services in this 
population. AHRQ will continue to monitor best practices and empirical 
studies by consulting with NCHS and the National Cancer Institute (NCI) 
to revise the PSAQ when it is fielded again in the future.
     Cancer Self-Administered Questionnaire (Cancer SAQ)--The 
NCI has collaborated in previous years with AHRQ to create the MEPS 
Experiences with Cancer Supplement, which oversampled households with 
cancer survivors from the prior year National Health Interview Survey 
(NHIS) and fielded a special survey about economic burden and access to 
care in cancer survivors. Due to a change in the NHIS sample design, 
MEPS will not be able to oversample cancer survivors in the 2024 data 
collection. The current effort will field an updated version of the 
MEPS Experiences with Cancer Survey in the Fall 2024 MEPS-HC. The new 
version of the survey will include most of the same questions as the 
earlier survey to allow comparisons of trends and will replace some 
survey items that are now less critical or available from other data 
sources with new questions on employment impacts and workplace 
accommodations; survivorship care; social determinants of health; and 
social isolation and support.
    This study is being conducted by AHRQ through its contractor, 
Westat, pursuant to AHRQ's statutory authority to conduct and support 
research on healthcare and on systems for the delivery of such care, 
including activities with respect to the cost and use of health care 
services and with respect to health statistics and surveys. 42 U.S.C. 
299a(a)(3) and (8); 42 U.S.C. 299b-2.

Method of Collection

    The MEPS-HC uses a combination of computer assisted personal 
interviewing (CAPI), computer assisted video interviewing (CAVI), and 
self-administered paper and web questionnaires, to collect information 
about each household member, and the survey builds on this information 
from interview to interview. CAVI is a new data collection technology 
and offers the best of both telephone and in-person interviewing, while 
offering opportunities for cost savings and more accurate reporting.

Estimated Annual Respondent Burden

    Exhibit 1 shows the estimated annualized burden hours for the 
respondents' time to participate in the MEPS-HC and the MEPS-MPC.
    The MEPS-HC Core Interview will be completed by 11,750 ``family 
level'' respondents. Since the MEPS-HC typically consists of 5 rounds 
of interviewing covering a full two years of data, the annual average 
number of responses per respondent is 2.5 responses per year. The MEPS-
HC core requires an average response time of 88 minutes to administer. 
The Adult SAQ is completed once during the 2-year panel, in rounds 2 
and 4 during odd numbered years, making the annualized average 0.5 
times per year. The Adult SAQ will be completed by 5,688 adults and 
requires an average of 7 minutes to complete. The PSAQ is completed 
once during the 2-year panel, in rounds 2 and 4 during even numbered 
years, making the annualized average 0.5 times per year. The PSAQ will 
be completed by 5,688 adults and requires an average of 7 minutes to 
complete. The Diabetes Care Survey will be completed by 1,000 persons 
each year and requires 3 minutes to complete. The Cancer SAQ will be 
completed by 1,500 persons each year and requires 20 minutes to 
complete. Authorization forms for the MEPS-MPC and Pharmacy Survey will 
be completed by 11,750 respondents. Each respondent will complete an 
average of 4.66 forms each year, with each form requiring an average of 
3 minutes to complete. A validation interview will be conducted with 
4,225 respondents each year and requires 5 minutes to complete. The 
total burden hours for the respondents' time to participate in the 
MEPS-HC is estimated to be 47,387 hours.

[[Page 67293]]

    The MEPS-MPC Contact Guide/Screening Call will be conducted with 
54,758 providers and pharmacies each year and requires 5 minutes to 
complete. The Home Care Providers Event Form will be completed by 886 
providers, with each provider completing an average of 5.8 forms and 
each form requiring 3 minutes to complete. The Office-based Providers 
Event Form will be completed by 14,950 providers. Each provider will 
complete an average of 4.3 forms and each form requires 3 minutes to 
complete. The Separately Billing Doctors Event Form will be completed 
by 12,690 providers, with each provider completing 1.4 forms on 
average, and each form requiring 3 minutes to complete. The Hospital 
Event Form will be completed by 8,302 hospitals or HMOs. Each hospital 
or HMO will complete 7.5 forms on average, with each form requiring 3 
minutes to complete. The Institutions (non-hospital) Event Form will be 
completed by 118 institutions, with each institution completing 1.3 
forms on average, and each form requiring 3 minutes to complete. The 
Pharmacy Event Form will be completed by 9,079 pharmacies. Each 
pharmacy will complete 37.6 forms on average, with each form requiring 
3 minutes to complete. The total burden hours for the respondent's time 
to participate in the MEPS-MPC is estimated to be 29,111 hours. The 
total annual burden hours for the MEPS-HC and MPC is estimated to be 
76,498 hours.
    Exhibit 2 shows the estimated annual cost burden associated with 
the respondents' time to participate in this information collection. 
The annual cost burden for the MEPS-HC is estimated to be $1,410,236; 
the annual cost burden for the MEPS-MPC is estimated to be $569,200. 
The total annual cost burden for the MEPS-HC and MPC is estimated to be 
$1,979,436.

                                  Exhibit 1--Estimated Annualized Burden Hours
----------------------------------------------------------------------------------------------------------------
                                                                            Number of
                                                               Number of    responses    Hours per      Total
                          Form name                           respondents      per        response      burden
                                                                            respondent                  hours
----------------------------------------------------------------------------------------------------------------
                                                     MEPS-HC
----------------------------------------------------------------------------------------------------------------
MEPS-HC Core Interview......................................       11,750          2.5        88/60       43,083
Adult SAQ *.................................................        5,688          0.5         7/60          332
Preventive Care SAQ (PSAQ) **...............................        5,688          0.5         7/60          332
Diabetes Care Survey (DCS)..................................        1,000            1         3/60           50
Cancer SAQ..................................................        1,500            1        20/60          500
Authorization forms for the MEPS-MPC........................       11,750         4.66         3/60        2,738
Provider and Pharmacy Survey
MEPS Validation Interview...................................        4,225            1         5/60          352
----------------------------------------------------------------------------------------------------------------
    Subtotal for the MEPS-HC................................       41,600  ...........  ...........       47,387
----------------------------------------------------------------------------------------------------------------
                                                    MEPS-MPC
----------------------------------------------------------------------------------------------------------------
MPC Contact Guide/Screening Call............................       54,758            1         5/60        4,563
Home Care Providers Event Form..............................          886          5.8         3/60          257
Office[dash]based Providers Event Form......................       14,950          4.3         3/60        3,214
Separately Billing Doctors Event Form.......................       12,690          1.4         3/60          888
Hospitals & HMOs (Hospital Event Form)......................        8,302          7.5         3/60        3,113
Institutions (non-hospital) Event Form......................          118          1.3         3/60            8
Pharmacies Event Form.......................................        9,079         37.6         3/60       17,068
Subtotal for the MEPS-MPC...................................      100,783  ...........  ...........       29,111
                                                             ---------------------------------------------------
    Grand Total.............................................      142,383  ...........  ...........       76,498
----------------------------------------------------------------------------------------------------------------
* The Adult SAQ is completed once every two years, on the odd numbered years.
** The PSAQ is completed once every two years, on the even numbered years.


                                   Exhibit 2--Estimated Annualized Cost Burden
----------------------------------------------------------------------------------------------------------------
                                                                              Total       Average
                          Form name                            Number of      burden    hourly wage   Total cost
                                                              respondents     hours         rate        burden
----------------------------------------------------------------------------------------------------------------
                                                     MEPS-HC
----------------------------------------------------------------------------------------------------------------
MEPS-HC Core Interview......................................       11,750       43,083     * $29.76   $1,282,150
Adult SAQ...................................................        5,688          332      * 29.76        9,880
Preventive Care SAQ (PSAQ)..................................        5,688          332      * 29.76        9,880
Diabetes Care Survey (DCS)..................................        1,000           50      * 29.76        1,488
Cancer SAQ..................................................        1,500          500      * 29.76       14,880
Authorization forms for the MEPS-MPC Provider and Pharmacy         11,750        2,738      * 29.76       81,483
 Survey.....................................................
MEPS Validation Interview...................................        4,225          352      * 29.76       10,475
Subtotal for the MEPS-HC....................................       41,600       47,387  ...........    1,410,236
----------------------------------------------------------------------------------------------------------------
                                                    MEPS-MPC
----------------------------------------------------------------------------------------------------------------
MPC Contact Guide/Screening Call............................       54,758        4,563     ** 19.84       90,530
Home care Providers Event Form..............................          886          257     ** 19.84        5,099

[[Page 67294]]

 
Office[dash]based Providers Event Form......................       14,950        3,214     ** 19.84       63,766
Separately Billing Doctors (SBD) Event Form.................       12,690          888     ** 19.84       17,618
Hospitals & HMOs (Hospital Event Form.......................        8,302        3,113     ** 19.84       61,762
Institutions (non-hospital) Event Form......................          118            8     ** 19.84          159
Pharmacies Event Form.......................................        9,079       17,068    *** 19.35      330,266
Subtotal for the MEPS-MPC...................................      100,783       29,111  ...........      569,200
                                                             ---------------------------------------------------
    Grand Total.............................................      142,383       77,067  ...........    1,979,436
----------------------------------------------------------------------------------------------------------------
* Mean hourly wage for All Occupations (00-0000).
** Mean hourly wage for Medical Secretaries (43-6013).
*** Mean hourly wage for Pharmacy Technicians (29-2052).
Occupational Employment Statistics, May 2022 National Occupational Employment and Wage Estimates United States,
  U.S. Department of Labor, Bureau of Labor Statistics.

Request for Comments

    In accordance with the Paperwork Reduction Act, 44 U.S.C. 3501-
3520, comments on AHRQ's information collection are requested with 
regard to any of the following: (a) whether the proposed collection of 
information is necessary for the proper performance of AHRQ's health 
care research and health care information dissemination functions, 
including whether the information will have practical utility; (b) the 
accuracy of AHRQ's estimate of burden (including hours and costs) of 
the proposed collection(s) 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 upon 
the respondents, including the use of automated collection techniques 
or other forms of information technology.
    Comments submitted in response to this notice will be summarized 
and included in the Agency's subsequent request for OMB approval of the 
proposed information collection. All comments will become a matter of 
public record.

    Dated: September 26, 2023.
Marquita Cullom,
Associate Director.
[FR Doc. 2023-21473 Filed 9-28-23; 8:45 am]
BILLING CODE 4160-90-P