Attachment A-2 -- Federal Register Notice

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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: March 19, 2010.
Carolyn M. Clancy,
Director.
[FR Doc. 2010–6778 Filed 3–30–10; 8:45 am]
BILLING CODE 4160–90–M

DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Agency for Healthcare Research and
Quality
Agency Information Collection
Activities: Proposed Collection;
Comment Request

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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
information collection project:
‘‘Collection of Information for Agency
for Healthcare Research and Quality’s
(AHRQ) Consumer Assessment of
Healthcare Providers and Systems
(CAHPS®) Health Plan Survey
Comparative Database.’’ In accordance
with the Paperwork Reduction Act, 44
U.S.C. 3501–3520, AHRQ invites the
public to comment on this proposed
information collection.
This proposed information collection
was previously published in the Federal
Register on January 25th, 2010 and
allowed 60 days for public comment. No
comments were received. The purpose
of this notice is to allow an additional
30 days for public comment.
DATES: Comments on this notice must be
received by April 30, 2010.
ADDRESSES: Written comments should
be submitted to: AHRQ’s OMB Desk
Officer by fax at (202) 395–6974
(attention: AHRQ’s desk officer) or by email at [email protected]
(attention: AHRQ’s desk officer).
Copies of the proposed collection
plans, data collection instruments, and

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specific details on the estimated burden
can be obtained from the AHRQ Reports
Clearance Officer.
FOR FURTHER INFORMATION CONTACT:
Doris Lefkowitz, AHRQ Reports
Clearance Officer, (301) 427–1477, or by
e-mail at
[email protected].
SUPPLEMENTARY INFORMATION:

Proposed Project
Collection of Information for Agency
for Healthcare Research and Quality’s
(AHRQ) Consumer Assessment of
Healthcare Providers and Systems
(CAHPS) Health Plan Survey
Comparative Database
The Agency for Healthcare Research
and Quality (AHRQ) requests that the
Office of Management and Budget
(OMB) approve, under the Paperwork
Reduction Act of 1995, AHRQ’s
collection of information for the AHRQ
Consumer Assessment of Healthcare
Providers and Systems (CAHPS)
Database for Health Plans. The CAHPS
Health Plan Database consists of data
from the AHRQ CAHPS Health Plan
Survey.
Health plans in the U.S. are asked to
voluntarily submit data from the survey
to AHRQ, through its contractor, Westat.
The CAHPS Database was developed by
AHRQ in 1998 in response to requests
from health plans, purchasers, and the
Centers for Medicare & Medicaid
Services (CMS) to provide comparative
data to support public reporting of
health plan ratings, health plan
accreditation and quality improvement.
The CAHPS Health Plan Survey is a
tool for collecting standardized
information on enrollees’ experiences
with health plans and their services.
The development of the CAHPS Health
Plan Survey began in 1995, when AHRQ
awarded the first set of CAHPS grants to
Harvard, RTI, and RAND. In 1997 the
CAHPS 1.0 survey was released by the
CAHPS Consortium. The CAHPS
Consortium refers to the research
organizations involved in the
development, dissemination, and
support of CAHPS products. The
current Consortium includes AHRQ,
CMS, RAND, Yale School of Public
Health, and Westat.
Since that time, the Consortium has
clarified and updated the survey
instrument to reflect field test results;
feedback from industry experts; reports
from health plan participants, data
collection vendors, and other users; and
evidence from cognitive testing and
focus groups. In November 2006, the
CAHPS Consortium released the latest
version of the instrument: The CAHPS
Health Plan Survey 4.0. The

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development of this update to the
Health Plan Survey has been part of the
‘‘Ambulatory CAHPS (A–CAHPS)
Initiative,’’ which arose as a result of
extensive research conducted with
users. AHRQ released the CAHPS
Health Plan Survey 4.0, along with
guidance on how to customize and
administer it. The National Quality
Forum endorsed the 4.0 version of the
Health Plan Survey in July 2007.
The CAHPS Health Plan Database
uses data from AHRQ’s standardized
CAHPS Health plan survey to provide
comparative results to health care
purchasers, consumers, regulators and
policy makers across the country. The
Database also provides data for AHRQ’s
annual National Healthcare Quality and
National Healthcare Disparities Reports.
Voluntary participants include public
and private employers, State Medicaid
agencies, State Children’s Health
Insurance Programs (SCHIP), CMS, and
individual health plans.
The collection of information for the
CAHPS Database for Health Plans is
being conducted pursuant to AHRQ’s
statutory authority to conduct and
support research on health care and
systems for the delivery of such care,
including activities with respect to the
quality, effectiveness, efficiency,
appropriateness and value of health care
services. See 42 U.S.C. 299a(a)(1).
Method of Collection
Information for the CAHPS Health
Plan Database has been collected by
AHRQ through its contractor Westat on
an annual basis since 1998. Health plans
are asked to voluntarily submit their
data to the comparative database in June
of each year. The data are cleaned with
standardized programs, then aggregated
and used to produce comparative results
for commercial (adult and child),
Medicaid (adult and child), and
Medicare (adult) populations for the two
most recent years. In addition,
individual participant reports are
produced that display the participating
organizations’ own results compared to
appropriate comparisons derived from
the National, regional and product-type
distributions on a password-protected
section of the online reporting system.
The CAHPS Health Plan Database
receives the data from three sources.
First, commercial health plan data is
purchased by the CAHPS Health Plan
Database directly from the National
Committee for Quality Assurance
(NCQA). The data is collected by NCQA
from those who participate in its
accreditation program. Second,
Medicare data is provided by CMS
through an agency data use agreement.
The Medicare data is collected by CMS

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Federal Register / Vol. 75, No. 61 / Wednesday, March 31, 2010 / Notices
and their contractor from beneficiaries
who were enrolled in a managed care
health plan. Third, Medicaid data is
collected by the CAHPS Health Plan
Database. Medicaid agencies and their
vendors directly submit their Medicaid
health plan survey data to the CAHPS
Health Plan Database through an online
data submission system. Data submitted
by Medicaid plans are compiled along
with the data received from CMS and
NCQA to comprise the CAHPS Health
Plan Survey comparative database.
Estimated Annual Respondent Burden
Each year State Medicaid agencies
and individual health plans decide
whether to participate in the database
and prepare their materials and dataset
for submission to the CAHPS Health
Plan Database. Participating
organizations are typically State
Medicaid agencies with multiple health
plans. However, individual health plans
are also encouraged to submit their data
to the CAHPS Database. The number of
data submissions per registrant varies
from participant to participant and year
to year because some participants
submit data for multiple health plans,
while others may only submit survey
data for one plan.
Each organization that decides to
participate in the database must have
their POC complete a registration form

providing their contact information for
access to the on-line data submission
system, sign and submit a data use
agreement (DUA), and provide health
plan characteristics such as health plan
name, product type, type of population
surveyed, health plan state, and plan
name to appear in the reporting of their
results.
Each vendor that submits files on
behalf of a Medicaid agency or
individual health plan must also
complete the registration form in order
to obtain access to the on-line
submission system. The vendor, on
behalf of their client, may also complete
additional information about survey
administration (CAHPS survey version
used, mode of survey administration,
total enrollment count, description of
how the sample was selected), submit a
copy of the questionnaire used, and
submit one data file per health plan.
Commercial health plan data is received
directly from NCQA. Medicare health
plan data is received from CMS.
The burden hours and costs below
pertain only to the collection of
Medicaid data from State Medicaid
agencies and individual Medicaid
health plans because those are the only
entities that submit data through the
data submission process (other data are
obtained directly from NCQA and CMS
as noted earlier in Section 2). In 2009,

a total of 60 participants, representing
45 individual organizations and 15
vendors, submitted data for 244 health
plans (an average of about 4 health
plans per participant).
Exhibits 1 and 2 are based on the
estimated number of individual
participants (participating organizations
and/or vendors) who will complete the
database submission steps and forms in
the coming years, and is not based on
the total number of health plans that are
submitted. The number of respondents
and burden hours are based on an
estimated slight increase in the number
of participants to 70 in 2010 and 2011.
In Exhibit 1, the 70 participants that
will complete the registration form and
submit information to the CAHPS
Health Plan Database are a combination
of an estimated 50 State Medicaid
agencies and individual health plans,
and 20 estimated vendors. The 50 State
Medicaid agencies or individual health
plans will sign and submit a DUA.
Vendors do not sign or submit DUAs.
Health plan information and data files
are submitted for each health plan.
Exhibit 1 shows an estimated total of
280 health plans (70 estimated
participants with 4 health plans per
participant). The total burden hours for
completing the registration, DUA and
data submission process are estimated
to be 722 hours.

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS
Number of
respondents/
POCs

Form name

Number of
responses
per POC

Hours per
response

Total burden
hours

Registration Form and Data Submission * .......................................................
Data Use Agreement ** ....................................................................................
Health Plan Information *** ..............................................................................

70
50
70

1
1
4

7.6
1
30/60

532
50
140

Total ..........................................................................................................

190

NA

NA

722

* The online Registration Form requires about 5 minutes to complete; however over 7 hours is required to plan/prepare for the data submission. This includes the amount of time the participating organization, and others (CEO, lawyer, vendor) typically spend deciding whether to participate in the database and preparing their materials and dataset for submission to the CAHPS Health Plan Database and performing the submission.
** The Data Use Agreement requires about 3 minutes to complete; however about 57 minutes is required for the participating organization to
review the agreement prior to signing. This includes the review by the organization’s CEO or legal department.
*** A few health plans may submit their data directly, however most health plan data will be submitted by the POC.

Exhibit 2 shows the estimated
annualized cost burden based on the
respondents’ time to complete the

submission process. The cost burden is
estimated to be $31,046 annually.

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN
Number of
respondents

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Form name
Registration Form and Data Submission * .......................................................
Data Use Agreement .......................................................................................
Health Plan Information ...................................................................................

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Total burden
hours

70
50
70

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Average hourly wage rate **

532
50
140

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$43.00
43.00
43.00

Total cost
burden
$22,876
2,150
6,020

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EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN—Continued
Number of
respondents

Form name
Total ..........................................................................................................

Total burden
hours

190

Average hourly wage rate **

722

NA

Total cost
burden
31,046

* Wage

rates were calculated using the mean hourly wage based on occupational employment and wage estimates from the Dept of Labor,
Bureau of Labor Statistics’ May 2008 National Industry-Specific Occupational Employment and Wage Estimates NAICS 622000—located at
http://www.bls.gov/oes/current/oes_nat.htm.
** Wage rate of $43.00 is based on the mean hourly wages for Medical and Health Services Managers. Wage rate of $42.67 is the weighted
mean hourly wage for: Medical and Health Services Managers ($42.67 × 2.6 hours = $110.95), Lawyers ($59.98 × .5 hours = $29.99), Chief Executives ($89.16 × .5 hours = $44.58), and Computer programmer ($35.32 × 4 hours = $141.28) [Weighted mean = ($110.95 + 29.99 + 44.58 =
141.28)/7.6 hours = $326.80/7.6 hours = $43.00/hour].

Estimated Annual Costs to the Federal
Government
Exhibit 3 shows the estimated
annualized cost to the government for
developing, maintaining and managing
the Health Plan Database and analyzing
the data and reporting results. The cost
is estimated to be $260,000 annually.
Annualized costs for collecting and
processing the CAHPS Health Plan
Database are based upon 10 years of
historical project costs. Start-up costs
were present in the early years of the
database only.

EXHIBIT 3—ESTIMATED ANNUALIZED
COST
Cost component

Dated: March 19, 2010.
Carolyn M. Clancy,
Director.
[FR Doc. 2010–6780 Filed 3–30–10; 8:45 am]
BILLING CODE 4160–90–M

DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Health Resources and Services
Administration
Agency Information Collection
Activities: Proposed Collection:
Comment Request

In compliance with the requirement
for opportunity for public comment on
proposed data collection projects
(section 3506(c)(2)(A) of Title 44, United
States Code, as amended by the
Total ...............................
260,000
Paperwork Reduction Act of 1995, Pub.
L. 104–13), the Health Resources and
Request for Comments
Services Administration (HRSA)
In accordance with the above-cited
publishes periodic summaries of
Paperwork Reduction Act legislation,
proposed projects being developed for
comments on AHRQ’s information
submission to Office of Management
collection are requested with regard to
and Budget (OMB) under the Paperwork
any of the following: (a) Whether the
Reduction Act of 1995. To request more
proposed collection of information is
information on the proposed project or
necessary for the proper performance of to obtain a copy of the data collection
AHRQ healthcare research and
plans and draft instruments, call the
healthcare information dissemination
HRSA Reports Clearance Officer on
functions, including whether the
(301) 443–1129.
information will have practical utility;
Comments are invited on: (a) Whether
(b) the accuracy of AHRQ’s estimate of
the proposed collection of information
burden (including hours and costs) of
is necessary for the proper performance
the proposed collection(s) of
of the functions of the agency, including
information; (c) ways to enhance the
whether the information shall have
quality, utility, and clarity of the
practical utility; (b) the accuracy of the
information to be collected; and (d)
agency’s estimate of the burden of the
ways to minimize the burden of the
proposed collection of information; (c)
collection of information upon the
ways to enhance the quality, utility, and
respondents, including the use of
clarity of the information to be
automated collection techniques or
collected; and (d) ways to minimize the
other forms of information technology.
burden of the collection of information
Comments submitted in response to
on respondents, including through the
this notice will be summarized and
included in the Agency’s subsequent
use of automated collection techniques
request for OMB approval of the
or other forms of information
proposed information collection. All
technology.
Database Maintenance .........
Data Submission ..................
Data Analysis and Reporting

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Annualized
cost

comments will become a matter of
public record.

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$50,000
100,000
110,000

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Proposed Project: The Health Education
Assistance Loan (HEAL) Program:
Physician’s Certification of Borrower’s
Total and Permanent Disability Form
(OMB No. 0915–0204)—Extension
The Health Education Assistance
Loan (HEAL) program provided
federally-insured loans to students in
schools of allopathic medicine,
osteopathic medicine, dentistry,
veterinary medicine, optometry,
podiatric medicine, pharmacy, public
health, allied health, or chiropractic,
and graduate students in health
administration or clinical psychology
through September 30, 1998. Eligible
lenders, such as banks, savings and loan
associations, credit unions, pension
funds, State agencies, HEAL schools,
and insurance companies, made new
refinanced HEAL loans which are
insured by the Federal Government
against loss due to borrower’s death,
disability, bankruptcy, and default. The
basic purpose of the program was to
assure the availability of funds for loans
to eligible students who needed to
borrow money to pay for their
educational loans. Currently, the
program monitors the federal liability,
and assists in default prevention
activities.
The HEAL borrower, the borrower’s
physician, and the holder of the loan
completes the Physician’s Certification
form to certify that the HEAL borrower
meets the total and permanent disability
provisions. The Department uses this
form to obtain detailed information
about disability claims which includes
the following: (1) The borrower’s
consent to release medical records to the
Department of Health and Human
Services and to the holder of the
borrower’s HEAL loans, (2) pertinent
information supplied by the certifying
physician, (3) the physician’s
certification that the borrower is unable
to engage in any substantial gainful
activity because of a medically
determinable impairment that is
expected to continue for a long and
indefinite period of time or to result in
death, and (4) information from the

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