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 


rwilkins on PROD1PC63 with NOTICES
30804 Federal Register / Vol. 72, No. 106 / Monday, June 4, 2007 / Notices 

http://healthit.ahrq.gov. Any 

information submitted will be made 

public. 

Do not send proprietary, commercial, 

financial, business confidential, trade 

secret, or personal information that 

should not be made public. 

FOR FURTHER INFORMATION CONTACT: P. 

Jon White, MD, Health IT Director, 

Agency for Healthcare Research and 

Quality, jonathan.white@ahrq.hhs.gov. 

SUPPLEMENTARY INFORMATION: A primary 

purpose of this RFI is to gather 

information that AHRQ can bring to the 

AQA (http://www.aqaalliance.org), a 

multistakeholder health care 

improvement organization formed to 

advance and implement clinician-level 

performance measurement. To carry out 

its statutory mandates to improve health 

care quality and specifically through 

quality measurement, AHRQ was a 

primary convener and has been a 

participant in AQA alliance from its 

inception. A full list of AQA 

participants is available at its Web site, 

referenced above. The AAQ (http:// 

www.aqaalliance.org) has extensively 

discussed, in relation to its activities 

and objectives, the utility of having a 

NHDSE. The AQA has outlined and 

recommended processes for 

performance of quality measure 

selection, as well as for the underlying 

data sharing and data aggregation 

activities necessary to develop and 

apply performance measures, and 

public reporting of performance data. 

The following framed text contains 

excerpts from AQA proposal 

documents. 

National Health Data Stewardship 

Entity 

Proposed Mission 

The public/private entity will set 

uniform operating rules and standards 

for sharing and aggregating public and 

private sector data on quality and 

efficiency; offer guidance on 

implementation of such national 

operating rules and standards; and 

provide a framework for collecting, 

aggregating and analyzing data, to afford 

means of more effective oversight of 

health care data analyses and reporting 

in the United States. 

Proposed Precepts 

In performing activities, the entity 

shall follow certain precepts: 

• To be objective in its decision 

making. 

• To weigh carefully the views of its 

constituents in developing concepts and 

operating rules and standards. 

• To bring about needed changes in 

ways that minimizes disruption to 

current aggregation efforts. 

• To review the effects of past 

decisions and interpret, amend or 

replace operating rules, standards and 

processes in a timely fashion when such 

action is indicated. 

• To follow an open, orderly process 

for setting policies, operating rules and 

standards that precludes placing any 

particular interest above the interests of 

the many stakeholders who rely on 

health care information. 

Proposed Scope of Work 

As previously noted, a wide range of 

activities need to be undertaken to 

advance health data exchange and use, 

including the development of measures 

and setting data transmission/lT 

technical standards. While all of these 

activities are important, the entity’s 

responsibilities would primarily focus 

on specific issues relating to data 

collection, aggregation, analysis, and 

sharing. 

The scope of work shall include 

setting policies, rules and standards for: 

• Data aggregation—Should address 

various data aggregation issues 

including required characteristics of 

aggregators (e.g., they should be trusted 

and respected entities), transparency of 

aggregation processes, control and 

ownership rights of the data, potential 

liability within data aggregation 

processes, and issues that arise when 

competing aggregation efforts are in a 

single market area; should ensure that 

the experience of existing aggregation 

efforts are leveraged. 

• Data collection (includes 

identification of data sources)—Should 

set policies, rules and standards for 

collecting public and private sector data 

from relevant stakeholders, including 

providers, employers, health insurance 

plans and others based on an agreedupon measurement set; should assess 

the pros and cons of using data derived 

from administrative data (e.g., claims, 

pharmacy and lab data), medical record 

review and surveys, and develop 

policies that prioritize data sources 

based on various dimensions. 

• Attribution—Should address at 

what specific level(s) data should be 

aggregated (e.g., individual physician 

level or group practice level). When 

making this determination, should 

consider sample size issues and 

physician/practice identifier issues. 

• Methodologies—Should set 

methodological rules and standards for 

aggregating data, including those 

addressing risk adjustment, measure 

weights and sample size. 

• Data analysis—Should set data 

analysis rules and standards, including 

those relating to trending, 

benchmarking, distribution, outlier 

analysis, correlation analysis and 

stratified analysis (variance between 

regions and states). 

• Data validation (audits)—Should set 

policies, rules and standards to ensure 

that the validity of the data submitted is 

independently audited. 

• Uses of data—Based on current law, 

should recommend allowable and 

nonallowable uses of data. Allowable 

data uses may include quality and 

efficiency improvement, consumer 

reporting, accountability, and pay for 

performance programs; also should, 

address allowable secondary uses of 

raw/primary data. 

• Data access—Should specify who 

should have access to data and 

applicable limitations, such as 

confidentiality and privacy rules; 

should consider policies which allow 

contributors, including both public and 

private sector entities, to have access to 

their own data as well as information 

which allows them to compare their 

data against benchmarks. 

• Data sharing and reporting—Should 

develop guiding principles for public 

reporting and reporting back 

information to clinicians. Screening 

processes to ensure valid reporting also 

should be addressed. 

Proposed Characteristics 

1. Objective—Be objective in its 

decision-making and have the ability to 

preclude placing any particular interest 

above the interests of many. 

2. Independent—Have a governing 

structure that is independent of all other 

business and professional organizations. 

3. Knowledgeable—Demonstrates 

knowledge and expertise in the area of 

health care delivery, data management, 

and security or acceptable proxy for 

this. 

4. Responsive—Insure input and use 

from key experts who possess 

knowledge of health care quality 

assessment, health data transmission, IT 

standards, physician and hospital 

systems design and a concern for the 

public interest in matters of health care 

quality analysis, reporting, and patient 

privacy. Represent key stakeholder 

groups that are measured and users of 

this information. 

5. Trustworthy—Is recognized as a 

trustworthy organization by multi 

stakeholder groups. 

6. Adaptable—Be flexible enough to 

address issues and key stakeholder 

needs as the market evolves. 

7. Transparent—Have an existing 

stable infrastructure for consensus 


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Federal Register / Vol. 72, No. 106 / Monday, June 4, 2007 / Notices 30805 

decision making that is transparent and 

involves the broad stakeholder 

communities. 

8. Timely—Have the ability to carry 

out activities and achieve goals in a 

timely manner. 

9. Collaborative—Have the ability to 

engage and work with other 

organizations to ensure effective 

implementation of rules and standards. 

10. Sustainable—Have adequate 

resources to meet long and short term 

goals. 

The concept of a national entity 

responsible for setting rules and 

standards for sharing and using 

healthcare quality measurement data 

has also been supported by the Institute 

of Medicine in their 2005 report 

Performance Measurement. IOM 

additionally proposed that this entity 

would be responsible for several other 

roles in performance measurement, 

including articulation of national goals, 

selection of measures, aggregation of 

data, reporting of results and 

performance measurement research. It is 

recognized that the role of a NHDSE 

might extend to domains beyond health 

care performance measurement. 

Respondents are encouraged to describe 

such domains and provide information 

relating to NHDSE roles and 

characteristics, with the understanding 

that any such information will be 

considered and will be presented by 

AHRQ to AQA but may not be acted on 

in the immediate future. 

Information Requested 

For the purpose of achieving a 

broader understanding of the need for a 

nationwide health data stewardship 

entity, and what form it might take, 

input is requested from interested 

parties. It is not necessary to answer all 

questions. In your response, please 

indicate which question you are 

addressing in your comments. Specific 

areas for comment include: 

1. Whether or not there is a need for 

a national health data stewardship 

entity with reasons, including value 

such an entity might bring and issues it 

might solve 

2. Desirable governmental and private 

sector roles in such an organization or 

in health data stewardship more 

generally 

3. The roles and responsibilities 

currently assumed by other existing 

entities that might be addressed by a 

NHDSE, as well as roles that should not 

be fulfilled by a NHDSE 

4. The relationship of a NHDSE and 

its work to other quality improvement 

organizations and activities 

5. The relationship of a NHDSE and 

its work to other initiatives which set 

national standards for health 

information, such as the ANSI Health IT 

Standards Panel (HITSP) 

6. Key challenges to creation and 

maintenance of a NHDSE 

7. The risks of creating a NHDSE 

8. The appropriate role(s) of a NHDSE 

in advancing quality measurement 

9. The appropriate role(s) of a NHDSE 

in characterization and evaluation of the 

comprehensiveness, accuracy and 

reliability of shared and aggregated 

health care quality measurement data 

10. The appropriate role(s) of a 

NHDSE regarding the transmission of 

shared and aggregated data 

11. The appropriate scope of activities 

for a NHDSE beyond quality 

measurement (in such domains as 

research and population health) 

12. The key stakeholders that would 

be impacted by a NHDSE and how to 

structure interactions with a NHDSE 

13. Appropriate governance model(s) 

for a NHDSE 

14. Means to assure NHDSE 

objectivity and independence 

15. Means to achieve trustworthiness 

or trust in a NHDSE, and how that 

would best be achieved 

16. Recommendations for achieving 

timeliness in NHDSE decision making 

17. Recommendations for achieving 

compliance with NHDSE 

recommendations, rules or standards 

18. The essential external inputs to a 

NHDSE 

19. Recommendations for achieving 

organizational flexibility for a NHDSE 

20. The potential organizational 

infrastructure needs of a NHDSE 

21. Potential funding requirements 

and sources of funding for a NHDSE 

22. The organizational skill set 

required of a NDHSE 

23. Priority activities for NHDSE to 

support data sharing and aggregation 

24. Issues concerning the aboveexcerpted AQA characterizations of a 

NHDSE 

25. The suitability of one or more 

existing organizations to fulfill the role 

of a NHDSE 

Potential Responders 

Responses are both requested and 

anticipated from a broad range of 

individual organizations that have 

interests in healthcare data. Examples of 

commenters from whom we would hope 

to hear include, but are not limited to: 

Health care professional societies 

Payers, including public and private 

insurers 

Health maintenance organizations 

Purchasers, including employers and 

healthcare consumers 

Consumer and patient interest groups 

Community health delivery systems 

State and local health agencies 

Interested Federal agencies 

University-based health systems 

Advocacy groups and public interest 

organizations 

Trade industry organizations 

Health information technology industry 

vendors 

Regional health information 

organizations 

Interested individuals 

We look forward to receiving 

constructive comments representing 

diverse perspectives. 

Dated: May 25, 2007. 

Carolyn M. Clancy, 

AHRQ, Director. 

[FR Doc. 07–2733 Filed 6–1–07; 8:45 am] 

BILLING CODE 4160–90–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Proposed Information Collection 

Activity; Comment Request 

Proposed Projects: 

Title: Communities Empowering 

Youth (CEY) Program Evaluation. 

OMB No.: New collection. 

Description: This proposed 

information collection activity is to 

obtain information from Communities 

Empowering Youth (CEY) grantee 

agencies and the faith-based and 

community organizations working in 

partnership with them. The CEY 

evaluation is an important opportunity 

to examine the outcomes achieved 

through this component of the 

Compassion Capital Fund in meeting its 

objective of improving the capacity of 

faith-based and community 

organizations and the partnerships they 

form to increase positive youth 

development and address youth 

violence, gang involvement, and child 

abuse/neglect. The evaluation will be 

designed to assess changes and 

improvements in the structure and 

functioning of the partnership and the 

organizational capacity of each 

participating organization. 

Respondents: CEY grantees and the 

faith-based and community 

organizations that are a part of the 

partnership approved under the CEY 

grant. 


rwilkins on PROD1PC63 with NOTICES