[Federal Register Volume 83, Number 171 (Tuesday, September 4, 2018)]
[Notices]
[Pages 44877-44881]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-19027]


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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.

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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 ``Medical Expenditure Panel Survey (MEPS) Household Component 
and the MEPS Medical Provider Component.''
    This proposed information collection was previously published in 
the Federal Register on June 4, 2018 and allowed 60 days for public 
comment. AHRQ did not receive substantive comments from members of the 
public. The purpose of this notice is to allow an additional 30 days 
for public comment.

DATES: Comments on this notice must be received by October 4, 2018.

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 <a href="/cdn-cgi/l/email-protection#7f30362d3e200c0a1d12160c0c1610113f10121d511a100f51181009"><span class="__cf_email__" data-cfemail="7936302b38260a0c1b14100a0a1016173916141b571c1609571e160f">[email protected]</span></a> (attention: AHRQ's desk officer).

FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports 
Clearance Officer, (301) 427-1477, or by email at 
<a href="/cdn-cgi/l/email-protection#6c08031e051f4200090a07031b0518162c2d243e3d4204041f420b031a"><span class="__cf_email__" data-cfemail="75111a071c065b1910131e1a021c010f35343d27245b1d1d065b121a03">[email protected]</span></a>.

SUPPLEMENTARY INFORMATION: 

Proposed Project

Medical Expenditure Panel Survey (MEPS) Household Component (HC)

    In accordance with the Paperwork Reduction Act, 44 U.S.C. 3501-
3521, AHRQ invites the public the comment on this proposed information 
collection. For over thirty years, results from the MEPS and its 
predecessor surveys (the 1977 National Medical Care Expenditure Survey, 
the 1980 National Medical Care Utilization and Expenditure Survey and 
the 1987 National Medical Expenditure Survey) have been used by OMB, 
DHHS, Congress and a wide number of health services researchers to 
analyze health care use, expenses and health policy.
    Major changes continue to take place in the health care delivery 
system. The MEPS is needed to provide information about the current 
state of the health care system as well as to track changes over time. 
The MEPS permits annual estimates of use of health care and 
expenditures and sources of payment for that health care. It also 
permits tracking individual change in employment, income, health 
insurance and health status over two years. The use of the NHIS as a 
sampling frame expands the MEPS analytic capacity by providing another 
data point for comparisons over time.
    Households selected for participation in the MEPS-HC are 
interviewed five times in person. These rounds of interviewing are 
spaced about 5 months apart. The interview will take place with a 
family respondent who will report for him/herself and for other family 
members.
    The MEPS-HC has the following goal:
    [ssquf] To provide nationally representative estimates for the U.S. 
civilian noninstitutionalized population for:

[cir] Health care use, expenditures, sources of payment
[cir] health insurance coverage

Medical Expenditure Panel Survey (MEPS) Medical Provider Component 
(MPC)

    The MEPS-MPC will contact medical providers (hospitals, physicians, 
home health agencies and institutions) identified by household 
respondents in the MEPS-HC as sources of medical care for the time 
period covered by the interview, and all pharmacies providing 
prescription drugs to household members during the covered time period. 
The MEPS-MPC is not designed to yield national estimates as a stand-
alone survey. The sample is designed to target the types of individuals 
and providers for whom household reported expenditure data was expected 
to be insufficient. For example, Medicaid enrollees are targeted for 
inclusion in the MEPS-MPC because this group is expected to have 
limited information about payments for their medical care.
    The MEPS-MPC collects event level data about medical care received 
by sampled persons during the relevant time period. The data collected 
from medical providers include:

<bullet> Dates on which medical encounters during the reference period 
occurred
<bullet> Data on the medical content of each encounter, including ICD-
10 codes
<bullet> Data on the charges associated with each encounter, the 
sources paying for the medical care-including the patient/family, 
public sources, and private insurance, and amounts paid by each source

    Data collected from pharmacies include:

<bullet> Date of prescription fill
<bullet> National drug code (NDC) or prescription name, strength and 
form
<bullet> Quantity
<bullet> Payments, by source

    The MEPS-MPC has the following goal:
    <bullet> To serve as an imputation source for and to supplement/
replace household reported expenditure and source of payment 
information. This data will supplement, replace and verify information 
provided by household respondents about the charges,

[[Page 44878]]

payments, and sources of payment associated with specific health care 
encounters.
    This study is being conducted by AHRQ through its contractors, 
Westat and RTI International, pursuant to AHRQ's statutory authority to 
conduct and support research on health care 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

    To achieve the goals of the MEPS-HC the following data collections 
are implemented:
    1. Household Component Core Instrument. The core instrument 
collects data about persons in sample households. Topical areas asked 
in each round of interviewing include priority condition enumeration, 
health status, health care utilization including prescribed medicines, 
expenses and payments, employment, and health insurance. Other topical 
areas that are asked only once a year include access to care, income, 
assets, satisfaction with providers, and children's health. While many 
of the questions are asked about the entire reporting unit (RU), which 
is typically a family, only one person normally provides this 
information. All sections of the current core instrument are available 
on the AHRQ website at http://meps.ahrq.gov/mepsweb/survey_comp/survey_questionnaires.jsp.
    2. Adult Self-Administered Questionnaire. A brief self-administered 
questionnaire (SAQ) will be used to collect self-reported (rather than 
through household proxy) on health opinions and satisfaction with 
health care, and information on health status, preventive care and 
health care quality measures for adults 18 and. The satisfaction with 
health care items are a subset of items from the Consumer Assessment of 
Healthcare Providers and Systems (CAHPS[supreg]). The health status 
items are from the Veterans Rand 12 item health survey (VR-12), a 
generic instrument developed with the support of the Department of 
Veterans Affairs and the Centers for Medicare and Medicaid Services. 
Additionally, there are questions addressing adult preventive care for 
both males and females. This questionnaire is revised from the previous 
OMB clearance.
    3. Veteran SAQ. MEPS includes a new self-administered questionnaire 
for spring of 2019 data collection targeting the veteran population. 
The questionnaire asks questions in the following domains of interest: 
If a veteran is eligible for VA health care; if a Veteran is enrolled 
in VA health care; coordination of care in and out of the VA health 
care system, services provided to Veterans in and out of the VA health 
care system, and VA eligibility priority groups, for Veterans enrolled 
in VA health care and for Veterans eligible for VA health care. To 
assist in the correct identification of priority groups, the 
questionnaire may also include items assessing the following: Presence 
of service-connected disability; service-connected disability rating; 
presence of presumptive-conditions; timing and era of active duty; and 
VA receipt of disability compensation benefits. AHRQ worked with the 
Veteran Health Administration to develop the questionnaire content.
    4. Diabetes Care SAQ. A brief self-administered paper-and-pencil 
questionnaire on the quality of diabetes care is administered once a 
year (during rounds 3 and 5) to persons identified as having diabetes. 
Included are questions about the number of times the respondent 
reported having a hemoglobin A1c blood test, whether the respondent 
reported having his or her feet checked for sores or irritations, 
whether the respondent reported having an eye exam in which the pupils 
were dilated, the last time the respondent had his or her blood 
cholesterol checked and whether the diabetes has caused kidney or eye 
problems. Respondents are also asked if their diabetes is being treated 
with diet, oral medications or insulin. This questionnaire is unchanged 
from the previous OMB clearance.
    5. Authorization forms for the MEPS-MPC Provider and Pharmacy 
Survey. As in previous panels of the MEPS, we will ask respondents for 
authorization to obtain supplemental information from their medical 
providers (hospitals, physicians, home health agencies and 
institutions) and pharmacies.
    6. MEPS Validation Interview. Each interviewer is required to have 
at least 15 percent of his/her caseload validated to insure that the 
computer assisted personal interview (CAPI) questionnaire content was 
asked appropriately and procedures followed, for example the use of 
show cards. Validation flags are set programmatically for cases pre-
selected by data processing staff before each round of interviewing. 
Home office and field management may also request that other cases be 
validated throughout the field period. When an interviewer fails a 
validation their work is subject to 100 percent validation. 
Additionally, any case completed in less than 30 minutes is validated. 
A validation abstract form containing selected data collected in the 
CAPI interview is generated and used by the validator to guide the 
validation interview.
    To achieve the goal of the MEPS-MPC the following data collections 
are implemented:
    1. MPC Contact Guide/Screening Call. An initial screening call is 
placed to determine the type of facility, whether the practice or 
facility is in scope for the MEPS-MPC, the appropriate MEPS-MPC 
respondent and some details about the organization and availability of 
medical records and billing at the practice/facility. All hospitals, 
physician offices, home health agencies, institutions and pharmacies 
are screened by telephone. A unique screening instrument is used for 
each of these seven provider types in the MEPS-MPC, except for the two 
home care provider types which use the same screening form.
    2. Home Care Provider Questionnaire for Health Care Providers. This 
questionnaire is used to collect data from home health care agencies 
which provide medical care services to household respondents. 
Information collected includes type of personnel providing care, hours 
or visits provided per month, and the charges and payments for services 
received. Some HMOs may be included in this provider type.
    3. Home Care Provider Questionnaire for Non-Health Care Providers. 
This questionnaire is used to collect information about services 
provided in the home by non-health care workers to household 
respondents because of a medical condition; for example, cleaning or 
yard work, transportation, shopping, or child care.
    4. Medical Event Questionnaire for Office-Based Providers. This 
questionnaire is for office-based physicians, including doctors of 
medicine (MDs) and osteopathy (DOs), as well as providers practicing 
under the direction or supervision of an MD or DO (e.g., physician 
assistants and nurse practitioners working in clinics). Providers of 
care in private offices as well as staff model HMOs are included.
    5. Medical Event Questionnaire for Separately Billing Doctors. This 
questionnaire collects information from physicians identified by 
hospitals (during the Hospital Event data collection) as providing care 
to sampled persons during the course of inpatient, outpatient 
department or emergency room care, but who bill separately from the 
hospital.
    6. Hospital Event Questionnaire. This questionnaire is used to 
collect information about hospital events, including inpatient stays, 
outpatient

[[Page 44879]]

department, and emergency room visits. Hospital data are collected not 
only from the billing department, but from medical records and 
administrative records departments as well. Medical records departments 
are contacted to determine the names of all the doctors who treated the 
patient during a stay or visit. In many cases, the hospital 
administrative office also has to be contacted to determine whether the 
doctors identified by medical records billed separately from the 
hospital; doctors that do bill separately from the hospital will be 
contacted as part of the Medical Event Questionnaire for Separately 
Billing Doctors. HMOs are included in this provider type.
    7. Institutions Event Questionnaire. This questionnaire is used to 
collect information about institution events, including nursing homes, 
rehabilitation facilities and skilled nursing facilities. Institution 
data are collected not only from the billing department, but from 
medical records and administrative records departments as well. Medical 
records departments are contacted to determine the names of all the 
doctors who treated the patient during a stay. In many cases, the 
institution's administrative office also has to be contacted to 
determine whether the doctors identified by medical records billed 
separately from the institution itself. Some HMOs may be included in 
this provider type.
    8. Pharmacy Data Collection Questionnaire. This questionnaire 
requests the NDC and when that is not available the prescription name, 
strength and form as well as the date prescription was filled, payments 
by source, the quantity, and person for whom the prescription was 
filled. When the NDC is available, we do not ask for prescription name, 
strength or form because that information is embedded in the NDC; this 
reduces burden on the respondent. Most pharmacies have the requested 
information available in electronic format and respond by providing a 
computer generated printout of the patient's prescription information. 
If the computerized form is unavailable, the pharmacy can report their 
data to a telephone interviewer. Pharmacies are also able to provide a 
CD-ROM with the requested information if that is preferred. HMOs are 
included in this provider type.
    Dentists, optometrists, psychologists, podiatrists, chiropractors, 
and others not providing care under the supervision of a MD or DO are 
considered out of scope for the MEPS-MPC.

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 13,338* (see note 
below Exhibit 1) ``family level'' respondents, also referred to as RU 
respondents. Since the MEPS-HC 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 92 minutes to administer. The 
Adult Female SAQ will be completed once a year by each female person in 
the RU that is 18 years old and older, an estimated 12,984 persons. The 
Adult Male SAQ will be completed once a year by each male person in the 
RU that is 18 years old and older, an estimated 11,985 persons. The 
Adult SAQs each require an average of 7 minutes to complete. The 
Diabetes care SAQ will be completed once a year by each person in the 
RU identified as having diabetes, an estimated 2,072 persons, and takes 
about 3 minutes to complete. The Veteran SAQ will be completed once by 
each in-scope person who is a veteran of the U.S. military identified 
in the Round 1, Panel 23 interview, an estimated 1,350 persons. The 
Veteran SAQ requires an average of 15 minutes to complete. The 
authorization form for the MEPS-MPC Provider Survey will be completed 
once for each medical provider seen by any RU member. The 12,804 RUs in 
the MEPS-HC will complete an average of 5.4 forms, which require about 
3 minutes each to complete. The authorization form for the MEPS-MPC 
Pharmacy Survey will be completed once for each pharmacy for any RU 
member who has obtained a prescription medication. RUs will complete an 
average of 3.1 forms, which take about 3 minutes to complete. About one 
third of all interviewed RUs will complete a validation interview as 
part of the MEPS-HC quality control, which takes an average of 5 
minutes to complete. The total annual burden hours for the MEPS-HC are 
estimated to be 60,278 hours.
    All medical providers and pharmacies included in the MEPS-MPC will 
receive a screening call and the MEPS-MPC uses 7 different 
questionnaires; 6 for medical providers and 1 for pharmacies. Each 
questionnaire is relatively short and requires 2 to 19 minutes to 
complete. The total annual burden hours for the MEPS-MPC are estimated 
to be 17,388 hours. The total annual burden for the MEPS-HC and MPC is 
estimated to be 77,666 hours.

                                  Exhibit 1--Estimated Annualized Burden Hours
----------------------------------------------------------------------------------------------------------------
                                                                     Number of
                    Form name                        Number of     responses per    Hours  per     Total burden
                                                    respondents     respondent       response          hours
----------------------------------------------------------------------------------------------------------------
                                                     MEPS-HC
----------------------------------------------------------------------------------------------------------------
MEPS-HC Core Interview..........................      \*\ 13,338             2.5           92/60          51,129
Adult Female SAQ................................          12,984               1            7/60           1,515
Adult Male SAQ..................................          11,985               1            7/60           1,398
Diabetes care SAQ...............................           2,072               1            3/60             104
Veteran SAQ.....................................           1,350               1           15/60             338
Authorization form for the MEPS-MPC Provider              12,804             5.4            3/60           3,457
 Survey.........................................
Authorization form for the MEPS-MPC Pharmacy              12,804             3.1            3/60           1,985
 Survey.........................................
MEPS-HC Validation Interview....................           4,225               1            5/60             352
Subtotal for the MEPS-HC........................          71,562              na              na          60,278
----------------------------------------------------------------------------------------------------------------
                                                    MEPS-MPC
----------------------------------------------------------------------------------------------------------------
MPC Contact Guide/Screening Call **.............          36,598               1            2/60           1,220
Home care for health care providers                          635            1.53            9/60             146
 questionnaire..................................
Home care for non[dash]health care providers                  11               1           11/60               2
 questionnaire..................................
Office[dash]based providers questionnaire.......          11,210            1.65           10/60           3,083

[[Page 44880]]

 
Separately billing doctors questionnaire........          12,397            3.46           13/60           9,294
Hospitals questionnaire.........................           5,310            3.26            9/60           2,597
Institutions (non-hospital) questionnaire.......             116            2.05            9/60              36
Pharmacies questionnaire........................           6,919            2.92            3/60           1,010
                                                 ---------------------------------------------------------------
    Subtotal for the MEPS-MPC...................          73,196              na              na          17,388
                                                 ---------------------------------------------------------------
        Grand Total.............................         144,758              na              na          77,666
----------------------------------------------------------------------------------------------------------------
* While the expected number of responding units for the annual estimates is 12,804, it is necessary to adjust
  for survey attrition of initial respondents by a factor of 0.96 (13,338 = 12,804/0.96).
** There are 6 different contact guides; one for office based, separately billing doctor, hospital, institution,
  and pharmacy provider types, and the two home care provider types use the same contact guide.

    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 $1,467,167; 
the annual cost burden for the MEPS-MPC is estimated to be $298,580. 
The total annual cost burden for the MEPS-HC and MPC is estimated to be 
$1,765,746.

                                   Exhibit 2--Estimated Annualized Cost Burden
----------------------------------------------------------------------------------------------------------------
                                                     Number of     Total burden   Average hourly    Total cost
                    Form name                       respondents        hours         wage rate        burden
----------------------------------------------------------------------------------------------------------------
                                                     MEPS-HC
----------------------------------------------------------------------------------------------------------------
MEPS-HC Core Interview..........................          13,338          51,129        * $24.34      $1,244,480
Adult Female SAQ................................          12,984           1,515         * 24.34          36,875
Adult Male SAQ..................................          11,985           1,398         * 24.34          34,027
Diabetes care SAQ...............................           2,072             104         * 24.34           2,531
Veteran SAQ.....................................           1,350             338         * 24.34           8,227
Authorization forms for the MEPS-MPC Provider             12,804           3,457         * 24.34          84,143
 Survey.........................................
Authorization form for the MEPS-MPC Pharmacy              12,804           1,985         * 24.34          48,315
 Survey.........................................
MEPS-HC Validation Interview....................           4,225             352         * 24.34           8,568
                                                 ---------------------------------------------------------------
    Subtotal for the MEPS-HC....................          71,562          60,278              na       1,467,167
----------------------------------------------------------------------------------------------------------------
                                                    MEPS-MPC
----------------------------------------------------------------------------------------------------------------
MPC Contact Guide/Screening Call................          36,598           1,220        ** 17.25          21,045
Home care for health care providers                          635             146        ** 17.25           2,519
 questionnaire..................................
Home care for non[dash]health care providers                  11               2        ** 17.25              35
 questionnaire..................................
Office[dash]based providers questionnaire.......          11,210           3,083        ** 17.25          53,182
Separately billing doctors questionnaire........          12,397           9,294        ** 17.25         160,322
Hospitals questionnaire.........................           5,310           2,597        ** 17.25          44,798
Institutions (non-hospital) questionnaire.......             116              36        ** 17.25             621
Pharmacies questionnaire........................           6,919           1,010       *** 15.90          16,059
                                                 ---------------------------------------------------------------
    Subtotal for the MEPS-MPC...................          73,196          17,388              na         298,580
                                                 ---------------------------------------------------------------
        Grand Total.............................         144,758          77,666              na       1,765,746
----------------------------------------------------------------------------------------------------------------
* 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 2017 National Occupational Employment and Wage Estimates United States,
  U.S. Department of Labor, Bureau of Labor Statistics. https://www.bls.gov/oes/current/oes_nat.htm#b29-0000.

Request for Comments

    In accordance with the Paperwork Reduction Act, 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

[[Page 44881]]

comments will become a matter of public record.

Francis D. Chesley, Jr.,
Acting Deputy Director.
[FR Doc. 2018-19027 Filed 8-31-18; 8:45 am]
 BILLING CODE 4160-90-P


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