30800 Federal Register / Vol. 72, No. 106 / Monday, June 4, 2007 / Notices 

owned by the bank holding company, 

including the companies listed below. 

The applications listed below, as well 

as other related filings required by the 

Board, are available for immediate 

inspection at the Federal Reserve Bank 

indicated. The application also will be 

available for inspection at the offices of 

the Board of Governors. Interested 

persons may express their views in 

writing on the standards enumerated in 

the BHC Act (12 U.S.C. 1842(c)). If the 

proposal also involves the acquisition of 

a nonbanking company, the review also 

includes whether the acquisition of the 

nonbanking company complies with the 

standards in section 4 of the BHC Act 

(12 U.S.C. 1843). Unless otherwise 

noted, nonbanking activities will be 

conducted throughout the United States. 

Additional information on all bank 

holding companies may be obtained 

from the National Information Center 

website at www.ffiec.gov/nic/. 

Unless otherwise noted, comments 

regarding each of these applications 

must be received at the Reserve Bank 

indicated or the offices of the Board of 

Governors not later than June 29, 2007. 

A. Federal Reserve Bank of Kansas 

City (Donna J. Ward, Assistant Vice 

President) 925 Grand Avenue, Kansas 

City, Missouri 64198-0001: 

1. FirstBank Holding Company, 

Lakewood, Colorado; to acquire up to 

100 percent of the voting shares of 

FirstBank of Arizona, Phoenix, Arizona 

(in organization). 

Board of Governors of the Federal Reserve 

System, May 30, 2007. 

Robert deV. Frierson, 

Deputy Secretary of the Board. 

[FR Doc. E7–10677 Filed 6–1–07; 8:45 am] 

BILLING CODE 6210–01–S 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Agency for Healthcare Research and 

Quality 

Request for Quality Measures for 

Medicaid Home and Community-Based 

Services 

AGENCY: Agency for Healthcare Research 

and Quality (AHRQ), DHHS. 

ACTION: Notice of request for measures. 

SUMMARY: The Agency for Healthcare 

Research and Quality (AHRQ) is 

soliciting the submission of survey 

instruments and items that could be 

used to measure the quality of Medicaid 

home and community-based service 

(HCBS) programs. Specifically, AHRQ is 

interested in metrics related to assessing 

the performance of such programs, 

client functional outcomes and client 

experience of, and satisfaction with, 

Medicaid HCBS services and supports. 

This initiative is in response to the 

mandate within the Deficit Reduction 

Act (DRA) of 2005, Public Law 109–171, 

Section 6086(b) that AHRQ develop 

such measures, in consultation with 

relevant stakeholders. In preparation for 

this task, AHRQ is conducting an 

environmental scan of existing tools that 

could be adapted or used for assessing 

the quality of Medicaid HCBS services 

and supports. 

Based on the agency’s initial 

methodological work, there are several 

quality domains the resulting measure 

set could assess, including: timeliness of 

determining need and providing 

services and supports, personcenteredness, safety, equity, efficiency 

and, effectiveness of services and 

supports, qualifications of providers, 

client health and welfare, program 

administrative oversight, access, unmet 

need among current program 

participants, and coordination of longterm care services with other service 

providers. For example, relevant 

measures might include items from a 

consumer survey that ask about receipt 

of services or experience with select 

providers, or metrics that use program 

administrative data to determine if 

providers meet program qualifications 

or if assessments are done on a timely 

basis. 

DATES: Please submit data collection 

instruments and supporting information 

about their development and/or use no 

later than 30 days after publication of 

this notice. AHRQ will not respond 

individually to submitters, but will 

consider all submitted items and 

instruments and publicly report the 

results of the review of the submission 

in an aggregated form. 

ADDRESSES: Submission should include 

a brief cover letter, a copy of the 

instrument or items for consideration 

and supporting information (e.g., a 

users’ guide, citation(s) or copies of 

supporting article(s)) as specified under 

the Submission Criteria below. 

Submissions may be in the form of a 

letter or e-mail, preferably with an 

electronic file(s) as an e-mail 

attachment. Responses to this request 

should be submitted to: D.E.B. Potter, 

Center for Financing, Access and Cost 

Trends; Agency for Healthcare Research 

and Quality, 540 Gaither Road, Suite 

500, Rockville, MD 20850, Phone: (301) 

427–1564, Fax: (301) 427–1276; E-mail: 

D.E.B.Potter@ahrq.hhs.gov. 

To facilitate handling of submissions, 

please include full information about 

the instrument developer and/or a 

designated contact. 

• Name 

• Title 

• Organization 

• Mailing address 

• Telephone number 

• Fax number 

• E-mail address 

Also, please submit a copy of the 

instrument or items for consideration, 

and evidence that it meets the 

submission criteria below. It is 

requested (but not required) that citation 

of a peer-reviewed journal article 

pertaining to the instrument, to include 

the title of the article, author(s), 

publication year, journal name, volume, 

issue, and page numbers where article 

appears be included. 

Submitters must also provide a 

statement of willingness to grant to 

AHRQ the right to use and authorize 

others to use submitted measures and 

their documentation as part of any 

future instrument or measure set that 

may result from developing the 

statutorily-mandated Medicaid HCBS 

measure set. Electronic submissions are 

encouraged. 

FOR FURTHER INFORMATION CONTACT: 

D.E.B. Potter at the address above. 

SUPPLEMENTARY INFORMATION

Submission Criteria 

Items and instruments submitted 

must focus on evaluating the 

performance of home and communitybased services, client experience of, and 

satisfaction with, these home and 

community-based services and 

supports, as well as related client 

functional outcomes. Such services are 

defined broadly to include at a 

minimum the array of services included 

as HCBS under Section 1915(b), (c), or 

(b) and (c) of the Social Security Act 

(the Act), HCBS as a State plan option 

under Section 1915(i), as well as selfdirected personal assistance services 

under Section 1915(j), and HCBS under 

Section 1115 of the Act, and HCBS 

demonstrations, as authorized under 

Section 6071 of the Deficit Reduction 

Act of 2005. For the purpose of this call 

for measures, the listed services are 

interpreted broadly to include Medicaid 

home health care services, Medicaid 

personal care services, and Medicaid 

targeted case management services. 

Submitted materials should be 

designed to measure (i.e., quantify) 

program performance, client functional 

outcomes (including social role 

functioning), and/or client experience 

related to any of the following areas: 

The timeliness of determining need and 

providing services and supports, 


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person-centeredness, safety, equity, 

efficiency and effectiveness of services 

and supports, qualifications of 

providers, client health and welfare, 

program administrative oversight, 

access, unmet need among current 

program participants, and coordination 

of long-term care services with other 

service providers. 

Measures submitted must be relevant 

or readily adaptable to collection of 

information on the Medicaid HCBS 

service experience of people with 

chronic disabilities, including the 

following populations: 

• Physically- and/or cognitivelyimpaired elders, including those with 

dementia; 

• Adults or children with intellectual 

or developmental disabilities; 

• Children whose physical, 

intellectual and/or mental health 

disabilities significantly impair their 

ability to participate in age-appropriate 

activities (e.g., schooling and play), 

including children with special health 

care needs; 

• Adults with severe and persistent 

mental illness; 

• Adults with acquired brain injuries; 

and, 

• Adults with physical disabilities 

and/or chronic conditions (such as HIV/ 

AIDS) that place them at risk of 

institutional care. 

Unless such measures can be adapted 

to HCBS, measures related exclusively 

to institutional services, specifically 

those provided in a skilled nursing 

facility, nursing home, State hospital, or 

intermediate care facility for the 

mentally-retarded (ICF/MR), will not be 

considered, although those that apply to 

alternative residential settings eligible 

for Medicaid HCBS funding, such as 

small group homes and assisted living 

facilities will be. Measures specific to 

the process of applying for Medicaid 

HCBS services (e.g., waiting lists) are 

also within the scope of this request. In 

addition, measures should be designed 

to quantify the experience of current 

Medicaid HCBS service recipients; 

including caregivers who receive such 

services directly (e.g., respite care or 

family therapy). Measures related to 

non-service recipients, including 

measures of staff satisfaction (including 

family caregivers as secondary 

recipients—as distinguished from direct 

recipients) are considered to be outside 

the scope of this effort. For a more 

detailed list of the home and 

community based services, see the 

SUPPLEMENTARY INFORMATION section 

below entitled ‘‘Types of Home and 

Community-Based Services’’: 

AHRQ is particularly interested in 

soliciting information from three types 

of submitters: 

1. Organizations (or persons) who use 

(or contract for the use of) another 

organization’s survey (or survey item(s)) 

and the survey/items used are 

applicable to (or could be adapted to) 

HCBS. 

2. Organizations (or persons) who 

developed a survey (or survey item(s)) 

and the survey/items are applicable to 

(or could be adapted to) HCBS. 

3. Organizations (or persons) who use 

another organization’s survey but have 

modified the original survey (added 

items to, taken items away or changed 

the wording) and the resulting hybrid 

survey is applicable to (or could be 

adapted to) HCBS. 

Additional Submission Instructions 

Submitter Type 1 

Each submission should include the 

following information: 

• Name of the measure(s)/ 

instrument(s)/survey(s) used by (or 

contracted for by) your organization 

• Brief description of the measure(s)/ 

instrument(s)/survey(s) 

• Population intended for 

measurement 

• Care provider type (e.g., home 

health agency, consumer directed 

caregiver, assisted living facility, adult 

day care provider, skills training 

counselor)] 

• Service setting (e.g., group home, 

client’s home, school, assisted living 

facility) 

• Domain(s) (i.e., content areas) 

• Language(s) the measure(s)/ 

survey(s) (e.g., number of HCBS 

programs, program size(s)) 

• Where the Submitter’s organization 

has used (fielded), and/or is currently 

using, the measure(s)/instrument(s)/ 

survey(s) (e.g., number of HCBS 

programs, program size(s)) 

Submission of copies of existing 

report formats developed by the Agency 

using the survey to disclose findings to 

consumers and providers is desirable, 

but not required. Additionally, 

information about existing database(s) 

(particularly at the state level) for 

collecting results gathered using the 

instrument(s) or items submitted is 

helpful, but not required for submission. 

A partial response by a Submitter 

Type 1 could be ‘‘* * * our Agency 

uses the National Core Indicator’s (NCI) 

Child Family Survey (Phase VII version) 

for our State’s 1915(c) waiver for 

children with special health care needs 

* * * for our HCBS program for elders 

with Alzheimer’s we use the Participant 

Experience Survey (PES) Elder/Disabled 

Version (Version 1) * * *’’

Submitter Type 2 

Information about the instrument that 

you and/or your organization developed 

may be provided (in part) through 

submission of peer-reviewed journal 

articles). Each submission should 

include the following information. 

• Name of the measure(s)/ 

instrument(s)/survey(s) developed 

• Description of the measure(s)/ 

instrument(s)/surveys(s) 

• Population intended for 

measurement 

• Care provider type(s) (e.g., home 

health agency, consumer directed 

caregiver, assisted living facility, adult 

day care) 

• Service setting (e.g., group home, 

client’s home, school, assisted living 

facility) 

• Copy of the relevant measure(s)/ 

instrument(s)/survey)s) (e.g., individual 

items and response categories) 

• Domain(s) (i.e., content areas) 

• Language(s) the measure(s)/ 

instrument(s)/survey(s) is available in 

• Reliability of the measure(s)/ 

instrument(s)/survey(s) (e.g., internal 

consistency, test-retest, etc). 

• Validity of the measure(s)/ 

instrument(s)/survey(s) (e.g., content, 

construct, criterion-related) 

• Response rate(s) obtained when 

measure(s)/instrument(s)/survey(s) is 

used to measure on the intended 

population 

• Methods and results of any 

cognitive testing associated with the 

measure(s), instrument(s) and/or 

survey(s) 

• Methods and results of any fieldtesting associate with the measure(s), 

instrument(s) and/or survey(s) 

• Data collection protocols (including 

mode and respondents) 

• Description of sampling strategies 

used for data collection 

• Where the Submitter’s organization 

has used (fielded), and/or is currently 

using, the measure(s)/instrument(s)/ 

survey(s) (e.g., number of HCBS 

programs, program size(s)) 

• Information about any professional 

or organizations endorsements 

associated with the measure(s)/ 

instrument(s)/survey(s) 

Submission of copies of existing 

report formats developed to disclose 

findings to consumers and providers is 

desirable, but not required. 

Additionally, information about existing 

database(s) collecting results gathered 

using the instrument(s) or items 

submitted is helpful, but not required 

for submission. Information about the 

instrument may be provided through 

submission of peer-reviewed journal 

article, if applicable or through the best 


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30802 Federal Register / Vol. 72, No. 106 / Monday, June 4, 2007 / Notices 

evidence available at the time of 

submission. 

In submitting measures, submitters 

agree to relinquish ownership of any 

items developed by the submitter/ 

organization that are selected to be pat 

of the measure set(s) developed by 

AHRQ for public use (beginning in 2008 

as required by Section 6086(b) of the 

DRA). However, item ownership will be 

protected during the initial measure 

can, and during any subsequent 

measure development efforts AHRQ 

might undertake. 

Submitter Type 3 

Information about the original survey 

measures and the nature of any survey 

measure modifications (including new, 

changed or deleted items) is requested 

for submission. 

For the measures/items based directly 

on an existing survey/measure(s) (and 

without any changes to the items), the 

information described under 

Submission Submitter Type 1 is 

requested along with copies of the 

relevant measures that are actually used 

(e.g., individual items and response 

categories). 

In addition to the original measures 

information (requested in the previously 

paragraph), information about the 

modified measures/items is requested. 

Modifications may include question 

wording changes, the addition of new 

items/measures, and/or the deletion or 

original survey items. For the modified 

items, the following is requested: 

For measures/items based directly on 

the original survey items, but modified 

with question wording changes, 

information (if available) described 

under Submission Submitter Type 2 is 

requested for modified items. The 

reason(s) for question wording change(s) 

is also requested, but not required. At a 

minimum, a copy of the modified 

measures, how the measures are used 

and some information about how the 

measures were developed is required. 

For new items added to an existing 

survey, information described under 

Submission Submitter Type 2 is 

requested. Also requested, but not 

required, is (are) the reason(s) for the 

addition of the new items. An example 

of the latter might be along the lines of 

‘‘* * * for our HCBS program for elders 

with Alzheimer’s we use the PES Elder/ 

Disabled Version (Version 1) but have 

also added a module to capture 

information about medication 

management/administration for clients 

in a residential settings.* * *’’ At a 

minimum, a copy of the modified 

measures, now the measures are used 

and some information about how the 

measures were developed is required. 

In situations where the modifications 

to the original survey are simply a 

deletion(s) of original survey items (and 

with new items added) a description on 

of what items were deleted and why is 

also requested. An example of the latter 

might be ‘‘* * * for our HCBS program 

for elders we use the ABC Survey but 

drop questions 34–42 at the Agency 

does not use this information.’’

In submitting modified measures, 

submitters agree to relinquish 

ownership of any items developed by 

the submitter/organization and that are 

selected for use in the measure set(s) 

developed and adopted by AHRQ 

(beginning in 2008 as required by 

Section 6086(b) of the DRA). However, 

item ownership will be protected during 

the initial measure scan, and during any 

subsequent measure development 

efforts AHRQ might undertake. 

Submitters Types 1, 2 and 3 

It is not necessary to submit any 

actual data generated from using the 

survey instruments. 

Types of Home and Community-Based 

Services 

Both the type and extent of home and 

community-based services provided 

under Medicaid can vary from program 

to program. Below is a partial list of the 

broad range of services that have been 

provided by States under their Medicaid 

HCBS programs; States may provide 

additional services. 

• 24 Hour Supervision/Monitoring 

• Activities Therapy 

• Adaptive Health and Wellness 

Services 

• Adult Companion Services 

• Adult Day Care 

• Adult Day Health 

• Adult Foster Care 

• Adult Residential Care 

• Alternative Living/Alternative Care 

Facility 

• Assisted Living 

• Assistive Technology 

• Assistive Technology Evaluation 

• Assistive Technology Repairs 

• Attendant Care 

• Attendant Care—Rent/Food for 

Unrelated Live-In Caretaker 

• Augmentative Communication 

• Behavior Management and 

Consultation 

• Bereavement Counseling 

• Case Management 

• Case Management Aide 

• Chore/Home Maintenance 

• Clinic Services 

• Clinical Supports 

• Coaching/Cueing 

• Cognitive/Behavior Services 

• Cognitive Rehabilitation 

• Community Access 

• Community Connection 

• Community Integration Training 

• Community Membership 

• Community Specialist 

• Community Transition Services 

• Companion Services 

• Congregate Meals 

• Consolidated Developmental 

Services 

• Consultative Clinical and 

Therapeutic Services 

• Consumer/Family/Caregiver 

Training 

• Counseling 

• Crisis Intervention Services/ 

Support 

• Day Habilitation 

• Day Program 

• Dental 

• Developmental Day Care 

• Early Intervention 

• Educational Services Habilitation 

• Electronic Home Response 

• Emergency Move 

• Environmental Adaptations/Home 

Modifications 

• Environmental Engineering 

• Escort/Outings 

• Exercise Therapy 

• Family Counseling 

• Financial Counseling and Training 

• Financial Risk Reduction 

• Fiscal/Employer Agent/ 

Management Services 

• Group Homes 

• Habilitation 

• Home Accessibility Adaptations 

• Home-Based Supportive Care 

• Home Delivered Meals 

• Home Health Aide 

• Home Health Care 

• Home Maintenance/Repair 

• Homemaker Services 

• Hospice 

• Housing Access Coordination 

• Housing Start-Up 

• Independent Living Provider 

• Independent Living Skills Training 

• Individual Directed Goods and 

Services 

• Integrated Therapeutic Network 

• Interdisciplinary Team 

• Life Skills Training 

• Live-in Caregiver 

• Meal Services 

• Medical Equipment/Supplies 

• Medical Nutritional Support 

• Medically-Related Direct Therapies 

• Medication Administration 

• Medication Management 

• Mental Health Day Treatment 

Services 

• Mental Illness/Clinic 

• Mental Illness/Day Treatment/ 

Partial Hospitalization 

• Mental Illness/Psychosocial 

Rehabilitation 

• Money Management 

• Moving Assistance 


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Federal Register / Vol. 72, No. 106 / Monday, June 4, 2007 / Notices 30803 

• Night Supervision 

• Non-Legend/Non-Formulary Drugs 

• Non-Medical Transportation 

• Nursing Home Diversion Program 

• Nutrition Therapy 

• Nutritional Counseling/Assistance 

• Nutritional Risk 

• Nutritional Supplements 

• Occupational Therapy 

• Optometry Services 

• Over-the-Counter Drugs 

• Pediatric Community Transitional 

Home Services 

• Periodic Nursing Evaluations 

• Person Centered Planning 

• Personal Adjustment Counseling 

• Personal Agent 

• Personal Care 

• Personal Care Assistance 

• Personal Care Coordination 

• Personal Care—Rent/Food for 

Unrelated Live-In Caretaker 

• Personalized Emergency Response 

Systems 

• Phone Reassurance Monitoring 

• Physical Risk Reduction 

• Physical Therapy 

• Physical Therapy—Extended State 

Plan Services 

• Physician Services 

• Podiatry Services 

• Prescribed Drugs 

• Prescription Drug Co-Pay 

• Preventative/Consultative 

• Prevocational Services Habilitation 

• Private Duty Nursing 

• Professional Care Assistant 

• Professional Services 

• Protective Services 

• Psychiatrist Services 

• Psychologist Services 

• Psychosocial Counseling 

• Psychosocial Nutrition 

• Psychosocial Rehabilitation 

• Rehabilitation Engineering 

• Renal Dialysis 

• Residential Care 

• Residential Habilitation 

• Respiratory Therapy 

• Respite Care 

• Restorative Assistance 

• Retainer Payment for Personal 

Caregivers 

• Shared Nursing 

• Skill Building 

• Skilled Nursing 

• Socialization/Recreation 

• Social Reassurance Therapeutic 

Counseling 

• Social Work Services 

• Special Therapeutic Services 

• Specialized Child Care 

• Specialized Consultation Services 

• Specialized Medical Equipment and 

Supplies 

• Specialized Psychiatric Services 

• Specialized Therapies 

• Speech, Hearing, and Language 

• Staff/Family Consultation Training 

• Subsidized Housing 

• Substance Abuse Treatment/ 

Counseling 

• Support Brokerage 

• Support Coordination 

• Support Services 

• Supported Employment 

Habilitation 

• Supported Living 

• Therapeutic Counseling 

• Therapeutic Living 

• Therapeutic Management 

• Therapeutic Massage 

• Therapeutic Resources 

• Therapeutic Social and Recreational 

Program 

• Therapeutic Supplies 

• Training and Counseling Services 

for Unpaid Caregivers 

• Transitional Case Management 

• Transitional Living 

• Transportation 

• Vehicle Modifications 

• Visual/Mobility Therapy 

• Wandering Alarm System 

• Wellness Monitoring 

• Wrap-Around Services 

• Extended State Plan Services: 

Æ Home health care services 

Æ Physical therapy 

Æ Occupational therapy 

Æ Speech, hearing and language 

services 

Æ Prescribed drugs, except drugs 

furnished to participants who are 

eligible for Medicare Part D benefits 

Æ Dental services 

For additional information on HCBS 

service, please refer to Appendix C: 

Participant Services (pages 99 to 162) of 

the Application for a section 1915(c) 

Home and Community-Based Waiver 

[Version 3.4] Instructions, Technical 

Guide and Review Criteria Release Date: 

November 2006, Disabled and Elderly 

Health Programs Group, Center for 

Medicaid and State Operations, Centers 

for Medicare & Medicaid Services, 

Department of Health and Human 

Services, available at: http:// 

www.cms.hhs.gov/HCBS/ 

02_QualityToolkit.asp#TopOfPage. 

Dated: May 27, 2007. 

Carolyn M. Clancy, 

Director. 

[FR Doc. 07–2732 Filed 6–1–07; 8:45 am] 

BILLING CODE 4160–90–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Agency for Healthcare Research and 

Quality 

National Health Data Stewardship 

AGENCY: Agency for Healthcare Research 

and Quality (AHRQ), HHS. 

ACTION: Request for information. 

SUMMARY: There is a growing demand 

for healthcare data from many sectors. 

Key drivers for this demand have been 

surging interest in healthcare 

performance measurement and the 

information systems needed to 

aggregate, process and transmit 

healthcare data from which measures of 

health care quality may be derived and 

to which the measures could be applied. 

This need has raised the question of 

responsibility for safeguarding the data 

beyond the original care setting. This 

issue has led various stakeholders to 

propose the formation of a publicprivate national health care data 

stewardship organization with oversight 

of the various uses of healthcare data, as 

described below. 

For the purpose of achieving a 

broader understanding of the issues that 

establishment of such an entity may 

present, input is requested from the 

public and private sectors on the 

concept of a national health data 

stewardship entity (NHDSE). The 

primary purpose of this RFI is to gather 

information to foster broad stakeholder 

discussion; there are no current plans to 

issue a related request for proposals 

(RFP). 

DATES: Responses to this RFI are due no 

later than July 27, 2007. 

ADDRESSES: Electronic responses are 

preferred and may be addressed to: 

steward@ahrq.hhs.gov. Written 

responses should be addressed to: P. Jon 

White, MD, 540 Gaither Road, Rockville, 

MD 20850. 

A copy of this RFI is also available on 

the AHRQ and AQA Web sites. Please 

follow the instructions for submitting 

responses. 

If a response to this RFI is planned, 

notification is requested in advance by 

a simple response to one of the above 

addresses. Such notification is 

nonbinding and will not be made 

public. 

The submission of written materials 

in response to the RFI should not 

exceed 50 pages, including appendices 

and supplemental documents. 

Responders may submit other forms of 

electronic materials to demonstrate or 

exhibit key concepts of their written 

responses. If the response is over 20 

pages, an executive summary is 

requested of the comments, no longer 

than 5 pages. 

Public access: Responses to this RFI 

will be available to the public at AHRQ. 

Please call 301–427–1505 between 9 

a.m. and 5 p.m. to arrange access. The 

RFI and all responses will also be made 

available on the AHRQ Web site at 


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