85540 Federal Register / Vol. 89, No. 208 / Monday, October 28, 2024 / Notices 

information, including each proposed 

extension or reinstatement of an existing 

collection of information, and to allow 

a second opportunity for public 

comment on the notice. Interested 

persons are invited to send comments 

regarding the burden estimate or any 

other aspect of this collection of 

information, including the necessity and 

utility of the proposed information 

collection for the proper performance of 

the agency’s functions, the accuracy of 

the estimated burden, ways to enhance 

the quality, utility, and clarity of the 

information to be collected, and the use 

of automated collection techniques or 

other forms of information technology to 

minimize the information collection 

burden. 

DATES: Comments on the collection(s) of 

information must be received by the 

OMB desk officer by November 27, 

2024. 

ADDRESSES: Written comments and 

recommendations for the proposed 

information collection should be sent 

within 30 days of publication of this 

notice to www.reginfo.gov/public/do/ 

PRAMain. Find this particular 

information collection by selecting 

‘‘Currently under 30-day Review—Open 

for Public Comments’’ or by using the 

search function. 

To obtain copies of a supporting 

statement and any related forms for the 

proposed collection(s) summarized in 

this notice, please access the CMS PRA 

website by copying and pasting the 

following web address into your web 

browser: https://www.cms.gov/ 

Regulations-and-Guidance/Legislation/ 

PaperworkReductionActof1995/PRAListing. 

FOR FURTHER INFORMATION CONTACT: 

William Parham at (410) 786–4669. 

SUPPLEMENTARY INFORMATION: Under the 

Paperwork Reduction Act of 1995 (PRA) 

(44 U.S.C. 3501–3520), federal agencies 

must obtain approval from the Office of 

Management and Budget (OMB) for each 

collection of information they conduct 

or sponsor. The term ‘‘collection of 

information’’ is defined in 44 U.S.C. 

3502(3) and 5 CFR 1320.3(c) and 

includes agency requests or 

requirements that members of the public 

submit reports, keep records, or provide 

information to a third party. Section 

3506(c)(2)(A) of the PRA (44 U.S.C. 

3506(c)(2)(A)) requires federal agencies 

to publish a 30-day notice in the 

Federal Register concerning each 

proposed collection of information, 

including each proposed extension or 

reinstatement of an existing collection 

of information, before submitting the 

collection to OMB for approval. To 

comply with this requirement, CMS is 

publishing this notice that summarizes 

the following proposed collection(s) of 

information for public comment: 

1. Type of Information Collection 

Request: Revision with change of a 

currently approved collection; Title of 

Information Collection: Part C Medicare 

Advantage Reporting Requirements; 

Use: The Centers for Medicare and 

Medicaid Services (CMS) established 

reporting requirements for Medicare 

Advantage Organizations (MAOs) under 

the authority described in 42 CFR 

422.516(a). Each MAO must have an 

effective procedure to develop, compile, 

evaluate, and report to CMS, to its 

enrollees, and to the general public at 

the times and in the manner that CMS 

requires. At the same time, each MAO 

must, in accordance with 42 CFR 

422.516(a), safeguard the confidentiality 

of the provider-patient relationship. 

Health plans can use this information 

to measure and benchmark their 

performance. CMS receives inquiries 

from the industry and other interested 

stakeholders about the beneficiary use 

of available benefits, including 

supplemental benefits, grievance and 

appeals rates, cost, and other factors 

pertaining to use of government funds, 

as well the performance of MA plans. 

Form Number: CMS–10261 (OMB 

control number: 0938–1054); Frequency: 

Yearly; Affected Public: Business or 

other for-profits; Number of 

Respondents: 783; Total Annual 

Responses: 7,830; Total Annual Hours: 

225,575. (For policy questions regarding 

this collection contact Lucia Patrone at 

410–786–8621 or Lucia.Patrone@

cms.hhs.gov). 

William N. Parham, III, 

Director, Division of Information Collections 

and Regulatory Impacts, Office of Strategic 

Operations and Regulatory Affairs. 

[FR Doc. 2024–25015 Filed 10–25–24; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Request for Information: 

Administration for Children and 

Families Development of 

Interoperability Standards for Human 

Service Programs 

AGENCY: Office of the Chief Technology 

Officer, Administration of Children and 

Families, Department of Health and 

Human Services. 

ACTION: Request for information (RFI). 

SUMMARY: The Administration for 

Children and Families (ACF), in the 

U.S. Department of Health and Human 

Services (HHS), invites public 

comments to inform the use or adoption 

of interoperability standards for human 

services programs. ACF and state, local, 

and tribal governments all provide a 

number of health and human services 

programs for children, youth, families, 

communities, and individuals. ACF 

seeks public comment on the most 

effective approaches, technical 

standards, and technological tools that 

currently or could promote 

interoperability between health and 

human services programs. ACF 

collaborates with the Assistant Secretary 

for Technology Policy/Office of the 

National Coordinator for Health 

Information Technology (ASTP/ONC) as 

a critical steward and advisor for human 

services interoperability with 

responsibility for leading the 

development and harmonization of 

interoperability standards between 

health and human services in line with 

the HHS Data Strategy. The potential of 

interoperability across the full spectrum 

of health and human services is 

immense—it can enable efficient 

delivery of government services, 

enhance access to critical non-profit 

programs, and most importantly, 

improve overall individual and 

community outcomes. ACF has 

authority under the Title IV of the 

Social Security Act to designate use of 

interoperable data standards for several 

of its programs (e.g., Temporary 

Assistance for Needy Families (TANF), 

child support, child welfare, and foster 

care). The purpose of this RFI is to 

understand how ACF, in collaboration 

with ASTP/ONC, can better support 

interoperability between human 

services within and across states and 

local community resources, between 

states, and ACF. 

DATES: Comments are due within 60 

days of publication. 

ADDRESSES: Submit responses to 

DataRx@acf.hhs.gov, a federal mailbox 

allowing the public to submit comments 

on documents agencies have published 

in the Federal Register and are open for 

comment. Simply type ‘‘ACF-2024- 

Interoperability-RFI’’ in the Comment or 

Submission search box, click Go, and 

follow the instructions for submitting 

comments. 

Comments submitted in response to 

this notice are subject to the Freedom of 

Information Act and may be made 

available to the public. For this reason, 

please do not include any information 

of a confidential nature, such as 

sensitive personal information or 


lotter on DSK11XQN23PROD with NOTICES1
Federal Register / Vol. 89, No. 208 / Monday, October 28, 2024 / Notices 85541 

proprietary information. If you submit 

your email address, it will be 

automatically captured and included as 

part of the comment placed in the 

public docket. Please note that 

responses to this public comment 

request containing any routine notice 

about the confidentiality of the 

communication will be treated as public 

comments that may be made available to 

the public, notwithstanding the 

inclusion of the routine notice. 

SUPPLEMENTARY INFORMATION: 

1. Background 

The Administration for Children and 

Families (ACF) requests comments to 

inform the use of interoperable data 

standards across human services 

programs. This will improve the quality 

of service delivery and increase 

efficiency in collaborations between 

agencies administering ACF programs 

and other government and nongovernment agencies that serve the same 

populations. 

1.1 Regulation Development Process 

The data exchange standardization 

requirements under the Social Security 

Act Title IV programs of child welfare 

and foster care (Titles IV–B and IV–E), 

child support (Title IV–D), and 

Temporary Assistance for Needy 

Families (TANF, Title IV–A) result from 

Public Laws 112–34,1 112–96,2 113– 

183,3 and 115–123.4 These laws require 

the designation of interoperable 

standards for data that must be 

exchanged: (1) between states and ACF; 

and/or (2) between states under 

specified programs. 

ACF’s Office of the Chief Technology 

Officer (OCTO) will lead the drafting of 

any regulations with respect to the 

programs described above with subject 

matter expertise from ACF program 

offices including, but not limited to, the 

Children’s Bureau (CB), Family and 

Youth Services Bureau (FYSB), Office of 

Early Childhood Development (ECD), 

Office of Child Care (OCC), Office of 

Head Start (OHS), Office of Child 

Support Services (OCSS), Office of 

Community Services (OCS), Office of 

Family Assistance (OFA), and Office of 

Family Violence and Prevention 

Services (OFVPS). 

Additionally, OCTO will coordinate 

and consult on the input received in 

response to this RFI both with the 

ASTP/ONC and with other agencies 

executing programs and policies 

involving human services interoperable 

data standards, such as the Centers for 

Medicare & Medicaid Services (CMS), 

Administration for Community Living 

(ACL), and the Health Resources and 

Services Administration (HRSA). 

ASTP/ONC enable standards on 

behalf of HHS under section 3004 of the 

Public Health Service Act (PHSA) in 

45 CFR part 170 Subpart B. As lead for 

the development and harmonization of 

interoperability standards between 

health and human services, ASTP/ONC 

may enable standards for human 

services which will be available for use 

by any HHS program, including ACF. 

Adopting standards in one location for 

HHS use enables alignment across HHS 

programs to further interoperability, 

including alignment described under 

Sections 13111 and 13112 of the Health 

Information Technology for Economic 

and Clinical Health Act (‘‘HITECH Act’’) 

(Pub. L. 111–5, Title XIII, secs. 13111 

and 13112). 

1.2 For the Purposes of This Notice 

Interoperability refers to the ability of 

different information systems, devices, 

or applications to connect, in a 

coordinated way, within and beyond 

organizational boundaries to access, 

exchange, and use data in a cooperative 

way between stakeholders, with the aim 

of optimizing the health and wellbeing 

of individuals and populations (adapted 

from HIMSS, 2019).5 The definition of 

interoperability in section 4003 of the 

21st Century Cures Act calls for all 

electronically accessible information to 

be accessed, exchanged, and used 

without special effort on the user’s part 

(Pub. L. 114–255). 

Standards, for the purposes of this 

RFI, refer to any documented, 

consistent, and repeatable method for 

exchanging data through technical or 

non-technical means. There are 

technical standards for electronic data 

exchange, such as through data 

exchange standards, including Health 

Level Seven (HL7) Fast Healthcare 

Interoperability Resources (FHIR®). 

There are also standards of practice in 

the context of business processes, such 

as protocols for encryption, hashing, or 

establishment of accessible websites. 

These standards of practice are often 

codified in policies, interagency 

agreements, memoranda of 

understanding, service-level 

agreements, etc. 

Human Services Interoperability 

refers to the ability of health and human 

service systems to exchange data for 

service planning, coordination, delivery, 

monitoring, and evaluation in an 

automated, standards-based, and 

integrated manner that improves 

outcomes for children, families, and 

communities. Human services refer to 

programs that may not exclusively be 

provided or funded by HHS but may 

include those funded through other 

federal agencies. Human services 

include a wide variety of programs and 

services to enhance the quality of life, 

promote well-being, and address the 

needs of individuals and communities. 

1.3 Purpose of Interoperable Data 

Standardization for Interoperability 

The purpose of designating 

interoperable data standards is to ensure 

all parts of the human services delivery 

ecosystem can effectively and efficiently 

exchange information between and 

among programs for seamless service 

delivery. Effective and efficient 

information exchange can help 

appropriately reach people and deliver 

the right benefits, supporting 

coordinated case management, benefits 

enrollment, and new service delivery 

models. Interoperability promotes many 

objectives, from the availability of 

higher quality, more recent data that can 

be used to appropriately reach people 

and deliver the right benefits to 

coordinated case management, benefits 

enrollment, and new service delivery 

models. 

Using timely and quality data, for 

example, a child welfare caseworker 

might be able to retrieve a family’s 

current address from child support data 

to locate the family for an in-person 

visit or locate the non-custodial parent 

for possible placement of the children. 

Interoperable data standards between a 

public child welfare agency with care 

and custody of a child and a foster care 

placing agency could ensure both 

agencies have the most current 

information on the child in care. 

Interoperability can also help identify if 

household composition has changed, or 

a recipient has moved out of state, and 

changes to benefits levels are needed. 

For example, if a parent was reunited 

with their children exiting foster care, 

data sharing across information systems 

would allow the TANF agency to update 

the benefit eligibility for the family. 

Widespread adherence to data standards 

can enable better interoperability and 

reduce the burden of connecting 

disparate systems containing the 

information described in this example. 

Interoperable data standards can also 

help to facilitate initiatives. For 

example, a Medicaid applicant works 

with a health insurance navigator 

during the annual Marketplace 

enrollment period and participates in a 

Social Determinants of Health (SDOH) 

questionnaire with the navigator, who 

recognizes that the applicant is 

experiencing challenges in securing 

adequate food and necessary clothing. 

The navigator could pre-fill an 

enrollment application for SNAP 

benefits and provide information to 

complete the enrollment. Also, the 


lotter on DSK11XQN23PROD with NOTICES1
85542 Federal Register / Vol. 89, No. 208 / Monday, October 28, 2024 / Notices 

navigator can provide the Medicaid 

applicant with the local food bank’s 

name, location, phone number, and a 

resource for the community clothing 

closet. Further, with the Medicaid 

applicant’s consent, the navigator can 

send an electronic message or alert to 

the local non-profits identified in a 

statewide network of non-profit 

community resources, allowing 

receiving organizations to reach out to 

the applicant to determine if they need 

additional support to get connected 

with services. Common standards can 

help simplify the complex interactions 

between different systems described in 

this scenario and ensure scalability as 

new entities seek to participate in the 

exchange. 

ACF believes that designating 

nationally recognized interoperable data 

standards in the programs described 

above will make it easier to share data 

across multiple organizations. While 

likely more effective and cost-effective 

in the long run, ACF also recognizes 

that this approach may initially involve 

financial and time costs related to 

updating proprietary systems to use 

open standards. Therefore, as part of 

any future ACF programmatic and 

policy development, and in 

coordination with ASTP/ONC, ACF 

seeks to strike the appropriate balance 

between the benefits of interoperability 

and standardization and ease of 

implementation. 

2. Legal Authority 

Federal statutes require ACF to 

designate interoperable data standards 

to promote data exchange in state 

human services programs at the state 

level and with the federal government. 

Most recently, the Family First 

Prevention Services Act (FFPSA), 

enacted as part of Public Law (Pub. L.) 

115–123, authorized optional Title IV– 

E funding for time-limited prevention 

services for mental health, substance 

abuse, and in-home parent skill-based 

programs for children or youth who are 

candidates for foster care, pregnant or 

parenting youth in foster care, and the 

parents or kin caregivers of those 

children and youth. This law amended 

Title IV–B of the Social Security Act to 

require that ACF must ‘‘designate data 

exchange standards to govern . . . (1) 

necessary categories of information that 

State agencies operating programs under 

State plans approved under this part are 

required under applicable Federal law 

to exchange with another State agency 

electronically; and (2) Federal reporting 

and data exchange required under 

applicable Federal law’’ (42 U.S.C. 

629m(a)). 

The statute further provides that ACF 

shall incorporate, to the extent practical, 

interoperable standards developed and 

maintained by intergovernmental 

partnerships and federal agencies with 

authority over contracting and financial 

assistance. The data exchange reporting 

standards shall incorporate a widely 

accepted, nonproprietary, searchable, 

computer-readable format; be consistent 

with and implement applicable 

accounting principles; be implemented 

in a manner that is cost-effective and 

improves program efficiency and 

effectiveness; and be capable of being 

continually upgraded as necessary (42 

U.S.C. 629m(b)). 

Additionally, ACF coordinates with 

the ASTP/ONC in a manner consistent 

with Sections 13111 and 13112 of the 

HITECH Act to ensure alignment across 

HHS and non-HHS agencies around 

health IT standards ASTP/ONC adopts 

on behalf of HHS under section 3004 of 

the PHSA in 45 CFR part 170 Subpart 

B. ACF coordinates with ASTP/ONC 

pursuant to the provisions of the 

HITECH Act above when adopting, 

implementing, or upgrading health IT 

systems used for the direct exchange of 

individually identifiable health 

information between agencies and nonFederal entities. 

The extent of data elements that need 

to be shared to enable improved service 

delivery and program management often 

exceeds the minimum legal 

requirements. As described throughout 

ACF’s Confidentiality Toolkit 6 in the 

Applicable Federal Legislation sections, 

data sharing beyond the minimum 

regulatory requirements (as referenced 

throughout this RFI) is permissible and 

encouraged when practical use cases 

exist. 

3. Current Interoperability Standards 

and Initiatives 

3.1 FHIR and Gravity Project 

HL7® Fast Healthcare Interoperability 

Resources (FHIR®) is a rapidly maturing 

interoperability standard based on 

modern internet technology approaches. 

FHIR goes beyond document-level 

interoperability to data element-level 

exchange. It uses standardized 

application programming interface (API) 

standards to facilitate interoperable data 

standards, enabling more efficient 

application development across 

multiple device types. There is a 

growing open-source community 

developing around FHIR 

implementation.7

Today, several stakeholder efforts are 

underway to extend the use of FHIR to 

support the interoperability of human 

services information. For instance, the 

Gravity Project 8 is a stakeholder-led 

initiative to identify and harmonize 

social risk factor data for interoperable 

electronic health information exchange. 

The HL7 Gravity Accelerator 9

established codes for data elements such 

as housing instability, food insecurity, 

transportation insecurity, etc. It creates 

a common terminology for exchanging 

content related to non-medical factors 

influencing health and human services 

outcomes. Another HL7 group is the 

Health and Social Services (HSS) Work 

Group, supported by ACF, which is 

focused on facilitating human services 

data content further. A project 

description of Enhancing the FHIR for 

Social Services and Social Determinants 

(EFSS) and a list of use cases can be 

found in Appendices 1 and 2. 

3.2 United States Core Data for 

Interoperability (USCDI/USCDI+) 

In the 21st Century Cures Act: 

Interoperability, Information Blocking, 

and the ONC Health IT Certification 

Program final rule (85 FR 25642) 10

published in May 2020, ASTP/ONC 

adopted the United States Core Data for 

Interoperability (USCDI) 11 standard, 

which describes a standardized set of 

health data and constituent data 

elements for nationwide, interoperable 

health information exchange (85 FR 

25669). USCDI is implemented in FHIR 

by mapping data elements and value 

sets to FHIR resources and 

implementation guides through the US 

Core Implementation Guide.12 ASTP/ 

ONC published Version 3 of the USCDI 

in July 2022 13 and subsequently 

adopted Version 3 as the new baseline 

for the ASTP/ONC Certification Program 

in the Health Data, Technology, and 

Interoperability: Certification Program 

Updates, Algorithm Transparency, and 

Information Sharing (HTI–1) Final Rule 

(89 FR 1210). Version 3 included new 

data elements for social determinants of 

health (SDOH), which includes SDOH 

Problems/Health Concerns, SDOH 

Interventions, SDOH Goals, and SDOH 

Assessments. USCDI Version 4, 

published in July 2023,14 added 20 data 

elements to help address and mitigate 

health and healthcare inequities and 

disparities. Additional priorities for 

USCD v4 were to address underserved 

communities’ needs, behavioral health 

integration with primary care and other 

physical care, and public health 

interoperability needs of reporting, 

investigation, and emergency response. 

Further, ASTP/ONC oversees the 

USCDI+ 15 initiative to support 

identifying and establishing domain, or 

program-specific, datasets that build on 

the existing USCDI. Specifically, 

USCDI+ is a service that ASTP/ONC 


lotter on DSK11XQN23PROD with NOTICES1
Federal Register / Vol. 89, No. 208 / Monday, October 28, 2024 / Notices 85543 

provides to federal and industry 

partners to establish, harmonize, and 

advance the use of interoperable 

datasets that extend beyond the core 

data in the USCDI to meet specific 

programmatic and/or use case 

requirements. This approach allows 

ASTP/ONC to assure that new datasets 

build from the same core USCDI 

foundation, and allows for alignment of 

similar data needs across agency 

programs and corresponding data users 

and/or participants at the state and local 

levels. 

3.3 Human Services Interoperability 

Innovations (HSII) Demonstration 

Program 

ACF has focused on programmatic 

investments to advance human services 

interoperability. ACF’s Human Services 

Interoperability Innovations (HSII) 

demonstration program 16 was intended 

to expand data-sharing efforts by state 

and local governments, tribes, and 

territories to improve human services 

program delivery and to identify novel 

data-sharing approaches that can be 

replicated in other jurisdictions. These 

investments enabled ACF to fund 

entities to focus on addressing 

longstanding barriers to interoperability 

through cooperative agreements for the 

HL7 Care Plan for Maternal Opioid 

Misuse and the implementation of FHIR 

operating systems necessary to support 

Centers for Medicare and Medicaid 

Innovation (CMMI) Integrated Care for 

Kids model grantees in both New Jersey 

and Connecticut. 

3.4 HL7 Human and Social Services 

(HSS) Workgroup 

ACF led the creation of the HL7 

Human and Social Services (HSS) 

Workgroup.17 The HSS Workgroup’s 

mission is to provide a space to design 

and validate HL7 interoperable human 

services data standards. The group is 

also developing a common format for 

social services provider directory 

information. This project maps the 

definitions from Open Referral to the 

FHIR standard using an FHIR Facade 

before the Human Services Data API 

(HSDA). 

4. Proposed Direction for Developing 

Interoperable Data Standards 

The health sector has increasingly 

looked to FHIR as a core standard, 

catalyzed by the industry’s embrace of 

FHIR and codified through the 

incorporation of ASTP/ONC-certified 

health IT systems featuring FHIR APIs 

into CMS program requirements for use 

of certified electronic health record 

technology (CEHRT) (for instance, 

Medicare Promoting Interoperability 

Program and the Promoting 

Interoperability performance category of 

the Merit-Based Incentive Payment 

System (MIPS)),18 and ASTP/ONC’s 

efforts to incorporate FHIR as part of the 

technical requirements for the Trusted 

Exchange Framework Common 

Agreement (TEFCA).19 Given the need 

for human services data to be 

interoperable with health data to 

support integrated case management at 

the person level and in light of the 

opportunity to significantly leverage 

health sector infrastructure such as 

Qualified Health Information Networks 

(QHINs) and existing data exchange 

pathways using FHIR, ACF is 

considering the HL7 FHIR standard as 

the foundation of data interoperability 

for ACF-covered domains. 

5. Request for Information 

ACF seeks a more interoperable 

human services data ecosystem with 

available and shareable data between 

care providers, programs, and the 

government to drive improved outcomes 

for children and families. To deliver 

that goal, more consistent use of 

interoperable standards and practices is 

needed at all levels. ACF recognizes that 

organizations may be limited in major 

IT system transitions without significant 

new funding. However, without 

government-backed standards, pilots, 

and processes, the current and future IT 

systems will maintain and even 

accelerate their current degree of 

fragmentation. Therefore, ACF is 

seeking input on how to support a drive 

toward interoperability across the field 

in economical, efficient, effective, and 

reasonable ways. 

ACF also seeks feedback on proposed 

initial domain focus areas for standards 

development and pilots. These focus 

areas may encompass areas where HHS/ 

ASTP/ONC and ACF have formal 

regulatory powers to set standards for 

child welfare and foster care as well as 

prevention, adoption and guardianship 

(Title IV–B and IV–E), child support 

(Title IV–D), and Temporary Assistance 

for Needy Families (TANF, Title IV–A). 

It also includes areas where ACF could 

engage more actively with standards 

development organizations, such as the 

HL7 Human and Social Services (HSS) 

Workgroup (currently focusing on food, 

housing, and economic insecurity as its 

priority use cases). We are interested in 

receiving input affecting additional 

programs. 

ACF requests comments on the 

following topics. Please comment or 

respond to any questions that apply 

from the perspective of your agency, 

organization, program, or setting; 

commenters are not required to respond 

to every question: 

Input on specific topics 

1. Practical enablers of/or barriers to 

interoperability: 

1.1 Provide examples of the key 

enablers and/or inhibitors to using 

interoperable human services data 

standards (including data content and 

data exchange) in your program or 

agency. 

1.2 How is the ability to exchange 

human services data impacted by state 

or federal law, policies, or other 

governing frameworks (including CMS 

Interoperability rules)? 

1.3 What is the highest priority 

legal, policy, or governance issues to be 

addressed when moving to an 

interoperable ACF environment? (e.g., 

minor consent, guardianship, Family 

Education Rights and Privacy Act 

(FERPA), privacy, security, sensitive 

data, parental controls, etc.) 

1.4 Describe any mitigation 

strategies or policy levers that have 

effectively moved interoperable human 

services data exchange forward in your 

organization, state, or program. 

2. Impact of lack of human services 

interoperable data standardization: 

Provide examples of existing and 

planned human services interoperable 

data efforts and to what degree, if any, 

does a lack of standardization negatively 

impact them. 

2.1 What interoperable data 

standards are being used today in ACFfunded programs? 

2.2 Describe any impediments 

experienced in current systems when 

accessing, analyzing, or sending data to 

the federal level. 

2.3 What are the benefits of moving 

to a common interoperable data 

standard like Fast Healthcare 

Interoperability Resources (FHIR)? 

3. Care coordination: ACF seeks 

comments on current care coordination 

activities and data standards to support 

the interoperable data exchange for 

service delivery, operations, and 

reporting. 

3.1 How do you currently use 

interoperable data to support care 

coordination across human services, 

both between human services programs 

and between human services and health 

services? For example, are you able to 

collect medical data for children who 

have medical issues? 

3.2 Describe use cases that benefit 

from interoperable data standards for 

advancing service coordination 

activities among state and federal 

programs (e.g., clinical, administrative, 

operations). Tell us about systems 

currently used that are API-enabled. 


lotter on DSK11XQN23PROD with NOTICES1
85544 Federal Register / Vol. 89, No. 208 / Monday, October 28, 2024 / Notices 

3.3 What are the most important use 

cases where interoperable data 

standards or exchange protocols must be 

piloted/validated? 

3.4 What federal support would be 

necessary or helpful to catalyze those 

efforts? 

4. Interoperable data standards 

needed for operations and reporting: 

ACF recognizes that not all systems 

operate using interoperable data 

standards, and as a result, not all 

applications are capable of data 

exchange. Since 2021, ACF has 

sponsored an HL7 Human and Social 

Services (HSS) workgroup to develop 

data standards using FHIR 

specifications for Human and Social 

Services. 

4.1 What ACF domains or programs 

would benefit from using an 

interoperable data standard for business 

operation and reporting? 

4.2 To what extent is the HL7 or the 

HL7 FHIR standard used in ACF 

programs today? 

4.3 Will your organization 

experience specific benefits or 

drawbacks if an interoperable data 

standard like FHIR is widely used in 

ACF programs? 

4.4 Should any domain or program 

be exempt from using a standard like 

FHIR? 

5. Standards in practice: In cases 

where human services data systems 

currently use interoperable data 

standards, describe how they do or do 

not incorporate the following: 

5.1 Interoperable standards 

developed and maintained by an 

international voluntary consensus 

standards body such as HL7. 

5.2 Interoperable standards 

developed and maintained by 

intergovernmental partnerships such as 

the National Information Exchange 

Model (NIEM). 

5.3 Interoperable standards 

developed and maintained by specific 

federal agencies with authority over 

contracting and financial assistance. 

6. Intra- and inter-state human 

services data sharing: Describe the types 

of human services agencies in your state 

that electronically exchange with other 

states, state agencies, or community 

organizations in healthcare or human 

services within your state. 

6.1 How are they aligned, or not, 

with a specific industry standard(s), e.g., 

FHIR, to ensure ease of access and use 

of interoperable data? 

6.2 What types of systems and nonproprietary, open-data standards are 

used to facilitate interoperability across 

programs? 

6.3 Are there tools in use for 

normalizing and/or harmonizing data to 

standards? 

6.4 Tell us about any significant data 

quality and matching issues to be 

addressed to make the data exchange 

meaningful. 

6.5 What additional infrastructure 

would need to be developed to ensure 

that data is interoperable and actively 

exchanged? 

7. Funding: Describe current funding 

mechanisms that support or hinder 

interoperable data systems’ design, 

development, and implementation. 

7.1 What types of funding have you 

leveraged to design, develop, and 

implement interoperable data systems 

(e.g., Advance Planning Documents and 

grants)? 

7.2 What incentives or requirements 

would be needed to drive key use cases 

of data exchange once systems are 

interoperable (e.g., data quality and/or 

identity management)? 

7.3 What barriers or challenges have 

you encountered with these funding 

mechanisms? 

8. Technical Assistance: What 

technical assistance have you leveraged 

in designing, developing, and 

implementing interoperable data 

systems? 

8.1 What technical assistance (such 

as subject matter expertise in data 

standards and coding/software 

development) would be necessary to 

move to an interoperable standard like 

FHIR? 

8.2 What top actions should the 

federal government take to provide 

technical assistance to encourage 

human services interoperability? 

9. United States Core Data for 

Interoperability (USCDI/USCDI+): 

Provide input to inform how ACF may 

identify, create, and standardize human 

services data elements leveraging the 

ASTP/ONC USCDI+ initiative, HL7 

FHIR, and relevant HHS policy levers, 

including applicable regulations, to 

improve interoperability for human 

services programs. 9.1 How could an 

initiative such as USCDI+ be leveraged 

to harmonize human services data 

needed for care coordination, program 

evaluations, and reporting 

requirements? 

9.2 What is the highest priority use 

case(s) that need further development in 

USCDI+ and FHIR to address ACF’s 

stakeholders’ needs? 

9.3 What data elements are a high 

priority to enable comprehensive case 

management, including whole-person 

care, referrals, and research? 

9.4 What technical and policy 

approaches effectively link human 

services data to health IT codes and 

value sets to help improve 

interoperability, and use across multiple 

systems and domains? 

10. General questions—Provide input 

on the current state of data that your 

organization receives and/or exchanges. 

10.1 What information do you 

exchange, if any, and from whom? 

10.2 What information to you 

currently collect and from whom? 

10.3 What information do you need 

to exchange, that you have trouble 

exchanging and with whom? How does 

that challenge impact your work, 

community, etc.? 

11. Other considerations: ACF 

welcomes comments on other aspects of 

recognizing and establishing 

interoperable data standards for human 

services programs you wish to provide. 

Kevin M. Duvall, 

Chief Technology Officer, Administration of 

Children and Families. 

Endnotes 

1Public Law 112–34—Child and Family 

Service Improvement and Innovation Act. 

(2011). Retrieved from https://

www.govinfo.gov/app/details/PLAW112publ34/summary. 2Public Law 112–96—Middle Class Tax 

Relief and Job Creation Act. (2012). Retrieved 

from https://www.govinfo.gov/app/details/ 

PLAW-112publ96/summary. 3Public Law 113–183—Preventing Sex 

Trafficking and Strengthening Families Act. 

(2014). Retrieved from https://

www.govinfo.gov/app/details/PLAW113publ183/summary. 4Public Law 115–123—Bipartisan Budget 

Act of 2018. (2018). Retrieved from https:// 

www.govinfo.gov/app/details/PLAW115publ123/summary. 5Health Information Management Systems 

Society: Interoperability Definition. (2021). 

Retrieved from HIMSS writes new definition 

of interoperability—Digital-health. 6Administration of Children and Families 

(ACF): Confidentiality Toolkit. (2021). 

Retrieved from https://www.acf.hhs.gov/ 

opre/report/confidentiality-toolkit. 7Redox. Popular Open Source FHIR 

Libraries. (2021). Retrieved from https://

www.redoxengine.com/blog/popular-opensource-fhir-libraries/. 8Health Level Seven (HL7) Confluence. 

(2023). The Gravity Project. Consensusdriven standards on social determinants of 

health. Retrieved from https://

confluence.hl7.org/display/GRAV/ 

The+Gravity+Project. 9HealthITbuzz. (2022). FAST Continues 

FHIR Scalability Work as a New HL7 FHIR 

Accelerator. Retrieved from https://

www.healthit.gov/buzz-blog/health-it/fastcontinues-fhir-scalability-work-as-a-new-hl7- 

fhir-accelerator. 10National Archives Federal Register. 

(2020). 21st Century Cures Act: 

Interoperability, Information Blocking, and 

the ONC Health IT Certification Program. 

Retrieved from https://

www.federalregister.gov/documents/2020/05/ 


lotter on DSK11XQN23PROD with NOTICES1
Federal Register / Vol. 89, No. 208 / Monday, October 28, 2024 / Notices 85545 

01/2020-07419/21st-century-cures-actinteroperability-information-blocking-andthe-onc-health-it-certification. 11Office of the National Coordinator for 

Health IT. (2023). United States Core Data for 

Interoperability (USCDI). Retrieved from 

https://www.healthit.gov/isa/united-statescore-data-interoperability-uscdi. 12Office of the National Coordinator for 

Health IT. (2023) United States Core (US 

Core) Fast Healthcare Interoperability 

Resources (FHIR) Retrieved from https://

hl7.org/fhir/us/core/history.html. 13Office of the National Coordinator for 

Health IT. (2023) United States Core (US 

Core) Fast Healthcare Interoperability 

Resources (FHIR) Retrieved from https://

hl7.org/fhir/us/core/history.html. 14Office of the National Coordinator for 

Health IT. (2023). United States Core Data for 

Interoperability. Retrieved from https://

www.healthit.gov/isa/sites/isa/files/2023-10/ 

USCDI-Version-4-October-2023-ErrataFinal.pdf. 15Office of the National Coordinator for 

Health IT. (2023). United States Core Data for 

Interoperability Plus (USCDI+). Retrieved 

from https://www.healthit.gov/topic/ 

interoperability/uscdi-plus. 16Office of Planning, Research and 

Evaluation an Office of the Administration of 

Children & Families. (2023). Human Services 

Interoperability Innovations (HSII). Retrieved 

from https://www.acf.hhs.gov/opre/project/ 

human-services-interoperability-innovationshsii-2020-2021. 17Health Level Seven (HL7) Confluence. 

(2023). Human and Social Services Home. 

Retrieved from https://confluence.hl7.org/ 

display/HSS/ 

Human+and+Social+Services+Home. 18Centers for Medicare & Medicaid 

Services. (2020). CMS Interoperability and 

Patient Access Final Rule (CMS–9115–F). 

Retrieved from https://www.cms.gov/ 

interoperability/policies-and-regulations/ 

cms-interoperability-and-patient-accessfinal-rule-cms-9115-f. 19The Sequoia Project. (2022). FHIR 

Roadmap v1.0. Retrieved from https://

rce.sequoiaproject.org/wp-content/uploads/ 

2022/01/FHIR-Roadmap-v1.0_updated.pdf. 

[FR Doc. 2024–24924 Filed 10–25–24; 8:45 am] 

BILLING CODE 4184–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Health Resources and Services 

Administration 

Agency Information Collection 

Activities: Proposed Collection: Public 

Comment Request; Information 

Collection Request Title: Behavioral 

Health Integration Evidence Based 

Telehealth Network Program Outcome 

Measures 

AGENCY: Health Resources and Services 

Administration (HRSA), Department of 

Health and Human Services. 

ACTION: Notice. 

SUMMARY: In compliance with the 

requirement for opportunity for public 

comment on proposed data collection 

projects of the Paperwork Reduction Act 

of 1995, HRSA announces plans to 

submit an Information Collection 

Request (ICR), described below, to the 

Office of Management and Budget 

(OMB). Prior to submitting the ICR to 

OMB, HRSA seeks comments from the 

public regarding the burden estimate, 

below, or any other aspect of the ICR. 

DATES: Comments on this ICR should be 

received no later than December 27, 

2024. 

ADDRESSES: Submit your comments to 

paperwork@hrsa.gov or mail the HRSA 

Information Collection Clearance 

Officer, Room 14NWH04, 5600 Fishers 

Lane, Rockville, Maryland, 20857. 

FOR FURTHER INFORMATION CONTACT: To 

request more information on the 

proposed project or to obtain a copy of 

the data collection plans and draft 

instruments, email paperwork@hrsa.gov 

or call Joella Roland, the HRSA 

Information Collection Clearance 

Officer, at (301) 443–3983. 

SUPPLEMENTARY INFORMATION: When 

submitting comments or requesting 

information, please include the ICR title 

for reference. 

Information Collection Request Title: 

Behavioral Health Integration Evidence 

Based Telehealth Network Program 

Outcome Measures, OMB No. 0906– 

xxxx—New. 

Abstract: This clearance request is for 

OMB approval of a new information 

collection, the Behavioral Health 

Integration Evidence Based Telehealth 

Network Program (BHI EB-TNP) 

Outcome Measures. Under the BHI EBTNP, HRSA administers grants in 

accordance with section 330I(d)(1) of 

the Public Health Service Act (42 U.S.C. 

254c–14(d)(1)). The purpose of this 

program is to integrate behavioral health 

services into primary care settings using 

telehealth technology through telehealth 

networks and evaluate the effectiveness 

of such integration. This program 

supports evidence-based projects that 

utilize telehealth technologies through 

telehealth networks in rural and 

underserved areas to (1) improve access 

to integrated behavioral health services 

in primary care settings; and (2) expand 

and improve the quality of health 

information available to health care 

providers by evaluating the 

effectiveness of integrating 

telebehavioral health services into 

primary care settings and establishing 

an evidence-based model that can assist 

health care providers. HRSA created a 

set of outcome measures to evaluate the 

effectiveness of grantees’ services 

programs and monitor their progress 

using performance reporting data. The 

measures address behavioral health and 

substance use disorder priorities, 

originating and distant sites, specialties 

and services by site, volume of services 

by site and specialty, patient travel 

miles saved, and other uses of the 

telehealth network. 

Need and Proposed Use of the 

Information: HRSA’s goals for the 

program are to improve access to 

needed services, reduce rural 

practitioner isolation, improve health 

system productivity and efficiency, and 

improve patient outcomes. HRSA 

worked with program grantees to 

develop outcome measures to evaluate 

and monitor the progress of the grantees 

in each of these categories, with specific 

indicators to be reported annually 

through a performance monitoring data 

collection platform/website. Measures 

capture awardee-level and aggregate 

data that illustrate the impact and scope 

of program funding along with assessing 

these efforts. The measures are intended 

to inform HRSA’s progress toward 

meeting program goals, specifically 

improving access to telebehavioral 

health services that support primary 

care providers. 

Likely Respondents: BHI EB-TNP 

grantees. 

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. 


lotter on DSK11XQN23PROD with NOTICES1