Non-Substantive Change Memo

DATE: August 30, 2018

TO: Allen Beckmann, OMB Desk Officer

FROM: Lisa Wright-Solomon, HRSA Information Collection Clearance Officer

_____________________________________________________________________________

Request: The Health Resources and Services Administration’s (HRSA) Bureau of Health Workforce (BHW) requests approval for non-substantive changes to the National Health Service Corps (NHSC) Loan Repayment Program (LRP) Application and Program Guidance (APG) documents (OMB #0915-0127, expires 02/29/2020). The APG package includes 1) the NHSC LRP Online Application User Guide, which asks for personal, professional, and financial information needed to determine the applicant's eligibility to participate in the NHSC LRP as a new recipient or through a continuation award and 2) the NHSC LRP Site Application User Guide, which includes the In-Service Verification (ISV) form which is used to determine if a participant is in compliance with their NHSC contract.

Purpose: The purpose of these proposed changes is to align the APG, Online Application User Guide, and the ISV with the current Administration’s priority of combating the opioid epidemic via medication-assisted treatment and substance use disorder services, as well as the evolving health care landscape in telehealth.

Time Sensitivity: Updates to the BHW Management Information Systems Solution (BMISS) are essential prior to the beginning of any application period (for both the new and continuation NHSC LRP application cycles by the end of FY 2018.

Applicants submit their NHSC LRP applications within the Customer Service Portal that houses the application during critical periods of the year for both continuations and new applicants. Designed to be compatible with the narrative and data requirements that are outlined in the APG, the inclusion of these additional questions are contingent upon the approval of the non-substantive changes outlined in this memo. Given the upcoming release date, delayed updates related to the Customer Service Portal will inhibit the collection of pertinent data that will help us to measure key indicators associated with both substance abuse disorder service and telehealth activities.

Burden: It is anticipated that the revisions included herein will have minimal impact on the burden of the NHSC LRP application process or the ISV. No new forms will be required and the additional questions will be inserted into the larger, already-approved NHSC LRP application and ISV form.

PROPOSED CHANGES FOR THE NHSC LRP NEW AND CONTINUATION APG AND APPLICATION USER GUIDE DOCUMENTS:

Adding a total of 7 new questions to be more in line with Administration priorities as well as the evolving health care landscape. (See questions below)

Questions include the following:

Questions for FY19 NHSC LRP New Award Application

MAT/SUD Questions:

1. Do you provide substance use disorder services (e.g. Buprenorphine treatment or substance abuse counseling) at your site?

   1. Yes, Buprenorphine Treatment

   2. Yes, Substance Abuse Counseling

   3. Yes, both treatment options

   4. No

2. Are you licensed or certified in your state to provide substance use disorder treatment?

   1. If yes, please upload your credentials in the Supporting Documents section*Yes

   2. No

3. Do you possess a DATA2000 Waiver?

   1. Yes, DW30

   2. Yes, DW100

   3. Yes, DW275

   4. No

4. Will you have substance use disorder training or certification by July 18, 2019?

   1. Yes

   2. No

Telehealth Questions:

1. Do you or will you personally provide some form of telehealth in your clinical practice? (With “Tool Tip” which is currently on new award for FY 2018.)

1. Yes

2. No

3. I don’t know

2. When providing telehealth:

1. I am the clinician at the originating site whose patient is receiving the consult/care

2. I am the clinician at the distant site providing the consult/care

3. I don’t know

4. Other

3. What percentage of your clinical practice is/will be spent providing telehealth services?

1. <10%

2. 10-24%

3. 25-49%

4. 50%>

5. I don’t know

Questions for FY19 NHSC LRP Continuation Application:

MAT/SUD Questions:

1. Do you provide substance use disorder services (e.g. Buprenorphine treatment or substance abuse counseling) at your site?

   1. Yes, Buprenorphine Treatment

   2. Yes, Substance Abuse Counseling

   3. Yes, both treatment options

   4. No

2. Are you licensed or certified in your state to provide substance use disorder treatment?

   1. If yes, please upload your credentials in the Supporting Documents section* Yes

   2. No

3. Do you possess a DATA2000 Waiver?

   1. Yes, DW30

   2. Yes, DW100

   3. Yes, DW275

   4. No

4. Will you have a MAT Certification within the next 12 months?

   1. Yes

   2. No

Telehealth Questions:

1. Do you or will you personally provide some form of telehealth in your clinical practice? (With “Tool Tip” which is currently on new award for FY 2018.)

1. Yes

2. No

3. I don’t know

2. When providing telehealth:

1. I am the clinician at the originating site whose patient is receiving the consult/care

2. I am the clinician at the distant site providing the consult/care

3. I don’t know

4. Other

3. What percentage of your clinical practice is/will be spent providing telehealth services?

1. <10%

2. 10-24%

3. 25-49%

4. 50%>

5. I don’t know

PROPOSED CHANGES FOR THE NHSC IN-SERVICE VERIFICATION DOCUMENTS:

Adding a total of 4 new questions to be more in line with Administration priorities as well as the evolving health care landscape. (See questions below)

Questions include:

1. Do you or will you personally provide some form of telehealth in your clinical practice?

1. Yes

2. No

3. I don’t know

2. When providing telehealth:

1. I am the clinician at the originating site whose patient is receiving the consult/care

2. I am the clinician at the distant site providing the consult/care

3. I don’t know

4. Other

3. What telehealth technologies did you use? (Select all that apply)

1. Real-time telehealth (e.g., video conference)

2. Store-and-forward telehealth (e.g., secure email with photos or videos of patient examinations)

3. Remote patient monitoring

4. Mobile Health (mHealth)

4. What percentage of your clinical practice is/will be spent providing telehealth services?

1. <10%

2. 10-24%

3. 25-49%

4. 50%>

5. I don’t know

Attachments:

1. NHSC LRP Online Application User Guide

   1. MAT FY18 Questions Screenshot

   2. Telehealth FY18 Questions Screenshot

2. NHSC Site Application User Guide

   1. In-Service Verification Screenshot

Requested Changes to NHSC LRP Application and Online Application User Guide (OMB #0915-0127, expires 2/20/2020), Page 6