Federal Register / Vol. 89, No. 4 / Friday, January 5, 2024 / Notices 789 

Ryan White Conference on HIV Care 

and Treatment and the Federal Cervical 

Cancer Collaborative Post-Roundtable 

Evaluation helping HRSA to gain better 

understanding of participants’ 

experiences. 

• Focus groups of HRSA grantees to 

learn more about their needs and 

concerns (e.g., professional 

development, technical assistance, and 

current or expected issues with program 

operations). Focus groups may also be 

conducted to learn more about how the 

people served by HRSA programs react 

to messaging related to HRSA program 

activities. Focus groups may be 

conducted online or in person. The 

HRSA focus group generic fast track ICR 

that is expected to be included in this 

generic umbrella ICR includes the 

HRSA Division of Transplantation 

Formative Evaluation Minority Organ 

Donation Outreach consisting of a group 

of online focus groups designed to 

gather feedback on several campaign 

concepts. 

A 60-day notice published in the 

Federal Register on October 20, 2023, 

88 FR 72494–95. 

Need and Proposed Use of the 

Information: Results of these surveys 

will be used to plan and redirect 

resources and efforts as needed to 

improve services and processes. Focus 

groups may also be used to gain partner 

input into the design of mail and 

telephone surveys. 

Likely Respondents: HRSA partners 

are typically state or local governments, 

tribes and tribal organizations, health 

care facilities, health care consortia, 

health care providers, and researchers. 

HRSA partners may also include 

individuals served by HRSA programs 

and/or funding recipients. Participation 

in any collections under this clearance 

will be entirely voluntary, and the 

privacy of respondents will be 

preserved to the extent requested by 

participants and as permitted by law. 

Burden Statement: Burden in this 

context means the time expended by 

persons to generate, maintain, retain, 

disclose, or provide the information 

requested. This includes the time 

needed to review instructions; to 

develop, acquire, install, and utilize 

technology and systems for the purpose 

of collecting, validating, and verifying 

information, processing and 

maintaining information, and disclosing 

and providing information; to train 

personnel and to be able to respond to 

a collection of information; to search 

data sources; to complete and review 

the collection of information; and to 

transmit or otherwise disclose the 

information. The total annual burden 

hours estimated for this ICR are 

summarized in the table below. 

TOTAL ESTIMATED ANNUALIZED BURDEN HOURS

Instrument Number of 

respondents 

Number of 

responses per 

respondent 

Total 

responses 

Average 

burden per 

response 

(in hours) 

Total burden 

hours 

Evaluation forms .................................................................. 41,000 1 41,000 0.05 84,050,000 

Surveys (telephone, online) ................................................. 55,000 1 55,000 0.10 5,500 

Focus groups ....................................................................... 2,000 1 2,000 1.50 3,000 

Total .............................................................................. 98,000 ........................ 98,000 ........................ 84,058,500 

Maria G. Button, 

Director, Executive Secretariat. 

[FR Doc. 2024–00003 Filed 1–4–24; 8:45 am] 

BILLING CODE 4165–15–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Health Resources and Services 

Administration 

Update to the Bright Futures 

Periodicity Schedule as Part of the 

HRSA-Supported Preventive Services 

Guidelines for Infants, Children, and 

Adolescents 

AGENCY: Health Resources and Services 

Administration (HRSA), Department of 

Health and Human Services. 

ACTION: Notice. 

SUMMARY: A Federal Register notice 

published on October 24, 2023, detailed 

and sought public comment on 

recommendations under development 

by the Infant, Child, and Adolescent 

Preventive Services (ICAPS) Program, 

regarding updates to the HRSAsupported preventive services 

guidelines for infants, children, and 

adolescents in the Bright Futures 

Periodicity Schedule footnotes. The 

proposed updates are related to six 

existing footnotes. The ICAPS Program 

convenes health professionals to 

develop draft recommendations for 

HRSA’s consideration. Twenty-five 

respondents provided comments which 

were received and considered as 

detailed below. On December 29, 2023, 

HRSA accepted as final the ICAPS 

Program’s recommended update to the 

six footnotes. None of the footnote 

updates change the HRSA-supported 

clinical recommendations and therefore 

none of these updates make any changes 

to coverage without cost-sharing, as 

each of the footnotes merely update 

references to the supporting evidence 

base for existing recommendations or 

adds additional descriptive text. 

Please see https://mchb.hrsa.gov/ 

programs-impact/bright-futures for 

additional information. 

FOR FURTHER INFORMATION CONTACT: 

Savannah Kidd, Sr. Public Health 

Advisor, HRSA, Maternal and Child 

Health Bureau, telephone: (301) 287– 

2601, email: SKidd@hrsa.gov. 

SUPPLEMENTARY INFORMATION: Under the 

Patient Protection and Affordable Care 

Act, Public Law 111–148, the preventive 

care and screenings set forth in HRSAsupported guidelines are required to be 

covered without cost-sharing by certain 

group health plans and health insurance 

issuers. The Department adopted the 

Bright Futures Periodicity Schedule as a 

HRSA-supported guideline for infants, 

children, and adolescents under section 

2713 of the Public Health Service Act. 

See 75 FR 41726, 41740 (July 19, 2010). 

The Bright Futures Periodicity Schedule 

is a schedule of clinical 

recommendations for preventive 

screenings and assessments at each 

well-child visit from infancy through 

adolescence. 

To develop recommendations for 

HRSA’s consideration, the ICAPS 

Program, carried out by the American 

Academy of Pediatrics (AAP) under a 

cooperative agreement with HRSA, 

convenes a panel of pediatric primary 

care experts to conduct rigorous reviews 

of current scientific evidence, solicit 

and consider public input, and make 

recommendations to HRSA regarding 

screenings and assessments 

recommended at each well-child visit 

from infancy through adolescence. 

HRSA then determines whether to 


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790 Federal Register / Vol. 89, No. 4 / Friday, January 5, 2024 / Notices 

support, in whole or in part, the 

recommended updates. The schedule of 

preventive care and screenings for 

infants, children, and adolescents is 

detailed in the Bright Futures 

Periodicity Schedule. The ICAPS 

Program also disseminates final HRSAsupported recommendations through 

the annual publication of the updated 

Bright Futures Periodicity Schedule, 

with associated resources for 

practitioners and families. 

The ICAPS Program bases its 

recommended updates to the Guidelines 

on review and synthesis of existing 

clinical guidelines and new scientific 

evidence. Additionally, HRSA requires 

that the ICAPS Program incorporate 

processes to assure opportunity for 

public comment in the development of 

the updated Bright Futures Periodicity 

Schedule. 

The ICAPS Program proposed and 

HRSA has accepted recommended 

updates to footnotes to the Bright 

Futures Periodicity Schedule. None of 

these footnote updates change the 

HRSA-supported clinical 

recommendations and associated 

requirement for coverage without costsharing, as each of the footnotes merely 

update references to the supporting 

evidence base for these 

recommendations. The footnote updates 

are as follows: 

1. Footnote 4, relating to the 3–5 Day 

Visit, is being updated by replacing the 

previous reference with a new reference 

that aligns with the Bright Futures 

recommendation regarding providers 

helping families that choose to 

breastfeed. 

2. Footnote 5, relating to Body Mass 

Index, is being updated by replacing the 

previous reference with an updated 

reference to the Clinical Practice 

Guideline for the Evaluation and 

Treatment of Children and Adolescents 

with Obesity (https://doi.org/10.1542/ 

peds.2022-060640), published in the 

January 2023 issue of Pediatrics. This 

updated footnote reference aligns with 

the Bright Futures recommendation 

regarding measuring body mass index 

starting at the 24-month visit through 

the 21-year visit and provides nonstigmatizing recommendations for 

evaluating and treating children who are 

experiencing weight gains. 

The updated footnote now reads: 

Screen per ‘‘Clinical Practice 

Guideline for the Evaluation and 

Treatment of Children and Adolescents 

with Obesity’’ (https://doi.org/10.1542/ 

peds.2022-060640). 

3. Footnote 14, relating to Behavioral/ 

Social/Emotional Screening, is being 

updated by adding a reference to the 

U.S. Preventive Services Task Force 

Recommendation Statement, Screening 

for Anxiety in Children and Adolescents 

(https://www.uspreventiveservices

taskforce.org/uspstf/recommendation/ 

screening-anxiety-children-adolescents), 

published in the October 2022 issue of 

the Journal of the American Medical 

Association. This additional reference 

aligns with the Bright Futures 

recommendation to use screening 

instruments to better identify children 

experiencing anxiety, followed by a 

confirmatory diagnostic assessment and 

follow-up. 

The updated footnote now reads: 

Screen for behavioral and socialemotional problems per ‘‘Promoting 

Optimal Development: Screening for 

Behavioral and Emotional Problems’’ 

(https://doi.org/10.1542/peds.2014- 

3716), ‘‘Mental Health Competencies for 

Pediatric Practice’’ (https://doi.org/ 

10.1542/peds.2019-2757), ‘‘Clinical 

Practice Guideline for the Assessment 

and Treatment of Children and 

Adolescents With Anxiety Disorders’’ 

(https://pubmed.ncbi.nlm.nih.gov/

32439401), ‘‘Screening for Anxiety in 

Adolescent and Adult Women: A 

Recommendation From the Women’s 

Preventive Services Initiative’’ (https://

pubmed.ncbi.nlm.nih.gov/32510990), 

and ‘‘Anxiety in Children and 

Adolescents: Screening’’ (https://

www.uspreventiveservicestaskforce.org/ 

uspstf/recommendation/screeninganxiety-children-adolescents). The 

screening should be family centered and 

may include asking about caregiver 

emotional and mental health concerns 

and social determinants of health, 

racism, poverty, and relational health. 

See ‘‘Poverty and Child Health in the 

United States’’ (https://doi.org/10.1542/ 

peds.2016-0339), ’’The Impact of Racism 

on Child and Adolescent Health’’ 

(https://doi.org/10.1542/peds.2019- 

1765), and ‘‘Preventing Childhood Toxic 

Stress: Partnering With Families and 

Communities to Promote Relational 

Health’’ (https://doi.org/10.1542/ 

peds.2021-052582). 

4. Footnote 15, relating to Tobacco, 

Alcohol, or Drug Use Assessment, is 

being updated by adding clarifying 

information about providers’ use of 

validated screening tools and 

recommending or prescribing naloxone 

and by adding new references to the 

Centers for Disease Control and 

Prevention’s Evidence-Based Strategies 

for Preventing Opioid Overdose: What’s 

Working in the United States (https://

www.cdc.gov/drugoverdose/pdf/pubs/ 

2018-evidence-based-strategies.pdf) and 

the National Institute on Drug Abuse’s 

policy brief, Naloxone for Opioid 

Overdose: Life-Saving Science (https://

nida.nih.gov/publications/naloxoneopioid-overdose-life-saving-science). 

This updated footnote aligns with the 

Bright Futures recommendation to 

assess patients for substance use with a 

validated screening tool and describes 

the utility of providers recommending 

or prescribing naloxone if there is 

concern for substance or opioid use. 

The updated footnote now reads: 

A recommended tool to assess use of 

alcohol, tobacco and nicotine, and 

marijuana is available at http://

crafft.org. In addition, CDC and the 

National Institute of Drug Abuse (NIDA) 

recommend assessing patients for 

opioid use using a validated screening 

tool and if positive, providers should 

consider recommending or prescribing 

naloxone (see https://www.cdc.gov/ 

drugoverdose/pdf/pubs/2018-evidencebased-strategies.pdf and https://

nida.nih.gov/publications/naloxoneopioid-overdose-life-saving-science). 

5. Footnote 21, relating to Newborn 

Bilirubin Screening, is being updated by 

replacing the previous reference with a 

new reference to Management of 

Hyperbilirubinemia in the Newborn 

Infant 35 or More Weeks of Gestation 

(https://doi.org/10.1542/peds.2022- 

058859), published in the August 2022 

issue of Pediatrics. This updated 

reference aligns with the Bright Futures 

recommendation for universal bilirubin 

screening for all newborn infants 

between 24 and 28 hours after birth. 

The updated footnote now reads: 

Confirm initial screening was 

accomplished, verify results, and follow 

up, as appropriate. 

See Clinical Practice Guideline 

Revision: ‘‘Management of 

Hyperbilirubinemia in the Newborn 

Infant 35 or More Weeks of Gestation’’ 

(https://doi.org/10.1542/peds.2022- 

058859). 

6. Footnotes 35 and 36, relating to 

Oral Health, are being updated by 

replacing the previous reference with a 

new reference to Maintaining and 

Improving the Oral Health of Young 

Children (https://doi.org/10.1542/ 

peds.2022-060417), published in the 

December 2022 issue of Pediatrics. This 

reference aligns with the Bright Futures 

recommendation that every child has a 

dental home by 1 year of age (footnote 

35). Additionally, the new reference 

encourages providers to screen for social 

determinants of health, as well as access 

to medical and dental care, as they 

influence oral health status and oral 

health inequities (footnote 36). These 

footnotes refer to the same updated 

reference. 

The updated footnotes now read: 

Assess whether the child has a dental 

home. If no dental home is identified, 

perform a risk assessment (https:// 


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Federal Register / Vol. 89, No. 4 / Friday, January 5, 2024 / Notices 791 

1See https://www.federalregister.gov/documents/ 

2023/10/24/2023-23396/notice-of-request-forpublic-comment-on-proposed-update-to-the-brightfutures-periodicity-schedule. 

www.aap.org/en/patient-care/oralhealth/oral-health-practice-tools/ and 

refer to a dental home. Recommend 

brushing with fluoride toothpaste in the 

proper dosage for age. See ‘‘Maintaining 

and Improving the Oral Health of Young 

Children’’ (https://doi.org/10.1542/ 

peds.2022-060417). 

and 

Perform a risk assessment (https://

www.aap.org/en/patient-care/oralhealth/oral-health-practice-tools/). See 

‘‘Maintaining and Improving the Oral 

Health of Young Children’’ (https://

doi.org/10.1542/peds.2022-060417). 

Discussion of Recommended Updated 

Guidelines 

A Federal Register notice on October 

24, 2023, sought public comment on 

these proposed footnote updates (88 FR 

73034).1 The ICAPS Program considered 

all public comments as part of its 

deliberative process and provided the 

comments to HRSA for its 

consideration. A total of 25 respondents 

commented on one or more of the six 

proposed footnote updates. From the 25 

respondents, 119 responses were 

provided. Of these, 107 responses (89 

percent) expressed agreement and 13 

responses (11 percent) provided other 

comments or concerns. HRSA 

appreciates the comments in support of 

the updates. The additional comments 

and responses are summarized below. 

1. Footnote 4, relating to the first 

week well-child visit, also called the 3– 

5 Day Visit. 

20 respondents responded to this 

proposed footnote update, and 19 

indicated agreement. One respondent 

expressed concern that formal 

breastfeeding evaluation is not possible 

in every situation and suggested the 

proposed footnote include a qualified 

statement such as, ‘‘if services are 

available.’’ As this suggestion pertains 

to implementation and not the updated 

reference, the proposed footnote update 

will not be modified. 

2. Footnote 5, relating to Body Mass 

Index. 

18 respondents responded to this 

proposed footnote update, and 17 

indicated agreement. One respondent 

expressed concern regarding the use of 

BMI at the individual level to determine 

intervention for children. This 

suggestion does not align with the 

recommendation in the clinical practice 

guidelines, which is the updated 

reference within the proposed footnote 

change. The proposed footnote update 

will not be modified. 

3. Footnote 14, relating to Behavioral/ 

Social/Emotional Screening. 

20 respondents responded to this 

proposed footnote update, and 15 

indicated agreement. One respondent 

comment did not specifically address 

the proposed footnotes or the Bright 

Futures Periodicity Schedule and is 

therefore beyond the scope of the 

proposed updates. Three respondents 

expressed concerns related to 

implementation resources. As these 

suggestions pertain to implementation 

and not the additional reference that 

was added, the proposed footnote 

update will not be modified. One 

respondent suggested including the 

screening for anxiety in children under 

8 years of age. This suggestion does not 

align with the AAP clinical guidance or 

the updated USPSTF reference. The 

footnote update will be finalized as 

proposed. 

4. Footnote 15, relating to Tobacco, 

Alcohol, or Drug Use Assessment. 

20 respondents responded to this 

proposed footnote update and 17 

indicated agreement. Of the three 

respondents expressing concern, one 

respondent noted the need to ensure 

insurance companies do not violate the 

adolescent’s privacy to safely perform 

recommended preventive services. This 

suggestion is beyond the scope of the 

proposed footnote update and the 

proposed footnote update will not be 

modified. One respondent expressed 

concern with overprescribing naloxone 

and the potential to create drug shortage 

as well as suggesting the need for 

oversight with how to administer. The 

AAP has not found evidence supporting 

the concern of overprescribing in the 

pediatric primary care setting. The 

footnote will be finalized as proposed. 

Another respondent suggested removing 

‘‘prescribing’’ from the proposed 

footnote since naloxone is also available 

over the counter. This comment is 

reflected in the updated footnote 

language stating that providers should 

consider recommending or prescribing 

naloxone. The footnote will be finalized 

as proposed. 

5. Footnote 21, relating to Newborn 

Bilirubin Screening. 

20 respondents responded to this 

proposed footnote update and 18 

indicated agreement. Two respondents 

expressed concern about the 

implementation of this screening due to 

the cost and time for the primary care 

provider to obtain patient hospital 

records. As these suggestions pertain to 

implementation and not the updated 

reference. The proposed footnote update 

will not be modified. 

6. Footnote 35 and 36, relating to Oral 

Health. 

22 respondents responded to this 

proposed footnote update and 21 

indicated agreement. One respondent 

suggested adding the American 

Academy of Pediatric Dentistry (AAPD) 

recommendation that the first oral exam 

occur by age 12 months and that the 

interval of exams be based on the child’s 

individual needs or risk status and 

susceptibility to disease. The proposed 

footnote simply adds an updated 

reference to the latest AAP clinical 

report, which recommends a dental visit 

for children by 1 year of age. The 

proposed footnote update will not be 

modified in response to this comment. 

After consideration of public 

comment, the ICAPS Program submitted 

recommended footnote updates to 

HRSA for consideration, as detailed 

above. On December 29, 2023, the 

HRSA Administrator accepted the 

ICAPS Program recommendations and, 

as such, updated the HRSA-supported 

guidelines as set forth in the Bright 

Futures Periodicity Schedule. While 

non-grandfathered group health plans 

and health insurance issuers offering 

group or individual health insurance 

coverage must cover without costsharing the services and screenings 

listed as the HRSA-supported 

preventive services guidelines for 

infants, children, and adolescents as 

indicated above, these updates to the 

Bright Futures Periodicity Schedule 

footnotes do not change the clinical 

recommendations or the requirements 

for coverage without cost-sharing under 

section 2713 of the Public Health 

Service Act. Additional information 

regarding the ICAPS Program can be 

accessed at the following link: https://

mchb.hrsa.gov/maternal-child-healthtopics/child-health/bright-futures.html. 

Authority: Section 2713(a)(4) of the 

Public Health Service Act, 42 U.S.C. 

300gg–13(a)(4). 

Carole Johnson, 

Administrator. 

[FR Doc. 2024–00024 Filed 1–4–24; 8:45 am] 

BILLING CODE 4165–15–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Advisory Council on Alzheimer’s 

Research, Care, and Services; Meeting 

AGENCY: Assistant Secretary for 

Planning and Evaluation, HHS. 

ACTION: Notice of meeting. 

SUMMARY: This notice announces the 

public meeting of the Advisory Council 

on Alzheimer’s Research, Care, and 

Services (Advisory Council). The 

Advisory Council provides advice on 


lotter on DSK11XQN23PROD with NOTICES1