[Federal Register Volume 89, Number 208 (Monday, October 28, 2024)]
[Notices]
[Pages 85540-85545]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-24924]


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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).

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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 <a href="/cdn-cgi/l/email-protection#3672574257644e76575550185e5e4518515940"><span class="__cf_email__" data-cfemail="f9bd988d98ab81b9989a9fd791918ad79e968f">[email protected]</span></a>, 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

[[Page 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 non-government 
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[supreg]). 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

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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 non-
Federal 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[supreg] Fast Healthcare Interoperability Resources 
(FHIR[supreg]) 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

[[Page 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 ACF-
funded 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.

[[Page 85544]]

    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 non-proprietary, 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

    \1\ Public Law 112-34--Child and Family Service Improvement and 
Innovation Act. (2011). Retrieved from https://www.govinfo.gov/app/details/PLAW-112publ34/summary.
    \2\ Public Law 112-96--Middle Class Tax Relief and Job Creation 
Act. (2012). Retrieved from https://www.govinfo.gov/app/details/PLAW-112publ96/summary.
    \3\ Public Law 113-183--Preventing Sex Trafficking and 
Strengthening Families Act. (2014). Retrieved from https://www.govinfo.gov/app/details/PLAW-113publ183/summary.
    \4\ Public Law 115-123--Bipartisan Budget Act of 2018. (2018). 
Retrieved from https://www.govinfo.gov/app/details/PLAW-115publ123/summary.
    \5\ Health Information Management Systems Society: 
Interoperability Definition. (2021). Retrieved from HIMSS writes new 
definition of interoperability--Digital-health.
    \6\ Administration of Children and Families (ACF): 
Confidentiality Toolkit. (2021). Retrieved from https://www.acf.hhs.gov/opre/report/confidentiality-toolkit.
    \7\ Redox. Popular Open Source FHIR Libraries. (2021). Retrieved 
from https://www.redoxengine.com/blog/popular-open-source-fhir-libraries/.
    \8\ Health Level Seven (HL7) Confluence. (2023). The Gravity 
Project. Consensus-driven standards on social determinants of 
health. Retrieved from https://confluence.hl7.org/display/GRAV/The+Gravity+Project.
    \9\ HealthITbuzz. (2022). FAST Continues FHIR Scalability Work 
as a New HL7 FHIR Accelerator. Retrieved from https://www.healthit.gov/buzz-blog/health-it/fast-continues-fhir-scalability-work-as-a-new-hl7-fhir-accelerator.
    \10\ National 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/

[[Page 85545]]

01/2020-07419/21st-century-cures-act-interoperability-information-
blocking-and-the-onc-health-it-certification.
    \11\ Office of the National Coordinator for Health IT. (2023). 
United States Core Data for Interoperability (USCDI). Retrieved from 
https://www.healthit.gov/isa/united-states-core-data-interoperability-uscdi.
    \12\ Office 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.
    \13\ Office 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.
    \14\ Office 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-Errata-Final.pdf.
    \15\ Office 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.
    \16\ Office 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-innovations-hsii-2020-2021.
    \17\ Health Level Seven (HL7) Confluence. (2023). Human and 
Social Services Home. Retrieved from https://confluence.hl7.org/display/HSS/Human+and+Social+Services+Home.
    \18\ Centers 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-access-final-rule-cms-9115-f.
    \19\ The 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


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