[Federal Register Volume 89, Number 211 (Thursday, October 31, 2024)]
[Notices]
[Pages 86807-86809]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-25358]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration for Community Living


Agency Information Collection Activities: Submission for OMB 
Review; Public Comment Request; for the State Annual Long-Term Care 
Ombudsman Report (OMB Control Number 0985-0005)

AGENCY: Administration for Community Living, HHS.

ACTION: Notice.

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SUMMARY: The Administration for Community Living (ACL) is announcing 
that the proposed collection of information listed above has been 
submitted to the Office of Management and Budget (OMB) for review and 
clearance as required under section 506(c)(2)(A) of the Paperwork 
Reduction Act of 1995. This 30-day notice collects comments on the 
information collection requirements related to the proposed new 
information collection requirements relating to the State Annual Long-
Term Care Ombudsman Report (OMB Control Number 0985-0005).

DATES: Comments on the collection of information must be submitted 
electronically by 11:59 p.m. (ET) or postmarked. December 2, 2024.

ADDRESSES: Submit written comments and recommendations for the proposed 
information collection within 30 days of publication of this notice to 
www.reginfo.gov/public/do/PRAMain.
    Find the information collection by selecting ``Currently under 30-
day Review--Open for Public Comments'' or by using the search function. 
By mail to the Office of Information and Regulatory Affairs, OMB, New 
Executive Office Bldg., 725 17th St. NW, Rm. 10235, Washington, DC 
20503, Attention: OMB Desk Officer for ACL.

FOR FURTHER INFORMATION CONTACT: Beverly Laubert, 
<a href="/cdn-cgi/l/email-protection#1052756675627c693e5c7165727562645071737c3e7878633e777f66"><span class="__cf_email__" data-cfemail="de9cbba8bbacb2a7f092bfabbcbbacaa9ebfbdb2f0b6b6adf0b9b1a8">[email protected]</span></a>, (202) 795-7364.

SUPPLEMENTARY INFORMATION: In compliance with 44 U.S.C. 3507, ACL has 
submitted the following proposed collection of information to OMB for 
review and clearance. The State Annual

[[Page 86808]]

Long-Term Care Ombudsman Report is needed to comply with Administration 
for Community Living/Administration on Aging reporting requirements in 
the Older Americans Act (OAA); and 45 CFR 1324.21(b) (1) and (b)(2)(v). 
The Long-Term Care Ombudsman Report is used to measure the services and 
strategies that are provided to assist residents in the protection of 
their health, safety, welfare, or rights; advocate at the state and 
federal levels for changes needed to improve the quality of life and 
care in long-term care facilities; and effectively manage the Long-Term 
Care Ombudsman Program at the state and federal level. The National 
Ombudsman Reporting System (NORS) was developed in response to these 
needs and directives. Section 712(c) of the OAA requires the state 
agency to establish a statewide uniform reporting system to:
    (1) Collect and analyze data relating to resident complaints and 
conditions in long-term care facilities for the purpose of identifying 
and resolving significant problems.
    and
    (2) Submit the data on a regular basis to the state licensing/
certifying agency, other state and federal entities that the Ombudsman 
determines to be appropriate, the Assistant Secretary for Aging, and 
the National Long-Term Care Ombudsman Resource Center.

Comments in Response to the 60-Day Federal Register Notice

    In accordance with 5 CFR 1320.8(d), ACL published a 60-day Notice 
in the Federal Register on August 6, 2024, at 89 FR 63955-63956.
    Please see public comments received during the 60-day notice and 
ACLs response to comments listed below.
    ACL received comments from individuals and groups including the 
National Association of State Ombudsman Programs (NASOP); the National 
Association of Local Long-Term Care Ombudsmen (NALLTCO), the California 
Long-Term Care Ombudsman Association (CLTCOA), National Ombudsman 
Resource Center (NORC), and a gerontologist/researcher.
    Commenters who addressed the utility of the data and burden 
estimates supported the continuation of the NORS collection. NALLTCO 
recommended that ACL conduct a future study of the documentation burden 
on local long-term care Ombudsmen.
    NASOP recommended that changes in data elements be undertaken with 
ample time to adjust state systems and receive training before 
implementation, with a request for ACL grant funding for implementation 
costs. Both recommendations were deferred for future consideration if 
funding is available. Regarding recommendations specific to adding or 
removing data elements, ACL opts to hold those suggestions for future 
revision after further consideration and analysis of impact of the 
changes; including the impact on State Ombudsman programs that would 
need to change their data collection systems. Comments that ACL 
accepted were changes to instructions and examples and reporting tips 
for clarity.
    Most of the comments were requests to modify instructional examples 
and reporting tips. Some of the recommendations indicated 
misunderstandings that can be resolved with technical assistance, the 
below nine comments/recommendations were accepted.
    Comment 1: One respondent requested clarification on how to code 
complaint disposition when a resident dies before an outcome of the 
complaint has been obtained.
    Response 1: Reporting tips were changed to instruct the Ombudsman 
to report such instances as withdrawn when there is not a resident 
representative to determine resolution.
    Comment 2: One respondent requested revision to complaint type 
F01--Accidents and falls to update language from describing a resident 
who self-propels to a resident who uses a wheelchair independently.
    Response 2: The example was updated accordingly.
    Comment 3, 4: Two respondents recommended changing how volunteer 
representatives are counted to include all volunteers who were 
representatives during the reporting year. Current instructions are to 
count volunteers as the number on September 30 of the fiscal year.
    Response 3,4: The description was updated to ensure that all 
volunteer representatives are counted.
    Comment 5: One respondent requested that ACL allow newsletters and 
other forms of media to be counted as community education.
    Response 5: As use of social media and other electronic means of 
imparting information has increased, community education activities are 
under-reported within current instructions. A revision to the 
instructions was made to accommodate the request.
    Comment 6, 7: Two respondents recommended a change to the 
description of complaint type I03--Supplies, storage, and furnishings 
to include facility failure to properly store hazardous chemicals and 
other hazards.
    Response 6, 7: I03 is a complaint type about shortage of supplies. 
Instead, the examples and reporting tips for I01--Environment were 
revised to accommodate the comments.
    Comment 8: One respondent suggested modifying the description of 
program activity elements S64 and S65--Resident council participation 
to include instances of training to resident groups that might not be 
formal resident councils.
    Response 8: The modification was made to accommodate the 
suggestion. A corresponding change was made to S66 and S67--Family 
council participation.
    Comment 9: One respondent requested that ACL remove the requirement 
to report expenditures in NORS or, in the alternative, specify that 
expenditures be reported as obligated.
    Response 9: ACL has worked to reconcile multiple means of financial 
reporting. The NORS requirement will not be removed because NORS is the 
source of publicly reported information about Ombudsman program 
resources. However, the examples and reporting tips were modified to 
instruct states to report using consistent accounting methods.
    ACL received the following comments and did not accept them for 
inclusion in NORS.
    Comment: One respondent recommended including ``fear'' of 
retaliation in the complaint type where retaliation is reported and 
adding a complaint code for theft of medications.
    Response: Because such problems can be captured within existing 
complaint codes, it is not necessary to add to the collection.
    Comment: One respondent suggested adding to the definition of 
complainant to capture referrals from legislators.
    Response: ACL will provide technical assistance about reporting 
entities that make referrals, which is different from complainants.
    Comment: Two respondents suggested removing the verification data 
element because Ombudsman programs work to resolve all problems 
expressed by residents.
    Response: Verification is key to the purpose of investigation and 
ACL will provide technical assistance if needed to supplement training 
provided by the NORC.
    Comment: One respondent suggested changing language from 
``perpetrator'' to ``aggressor'' when a complaint involves a resident 
living with dementia.
    Response: In the example described in the comment, the use of the 
abuse complaint type could be incorrect; ACL and NORC will provide 
technical assistance on how to code complaints to

[[Page 86809]]

reflect resident experience rather than changing a term that is 
commonly used in abuse investigations by other entities.
    Comment: Three respondents recommended modification to the 
psychological abuse complaint code to include social media posts and 
posting of photographs.
    Response: The current reporting tips include oral, written, or 
gestured language and are sufficient to include social media posts. 
Photos are also included in the reporting tips.
    Comment: Three respondents recommended adding language to complaint 
types in the category of autonomy, choice, and rights to address 
emergence of artificial intelligence to monitor residents.
    Response: This issue requires further review and will be considered 
for future revisions.
    Comment: One respondent suggested adding a reporting tip to 
complaint type F10- Rehabilitation services to instruct Ombudsmen how 
to report contractures as gross neglect.
    Response: Further review is needed, and this suggestion will be 
considered for future revisions.
    Comment: One respondent recommended that instruction be added to 
select staffing as a secondary complaint and to broaden the definition 
of staffing.
    Response: The use of secondary complaint codes when a resident or 
complainant has not expressed staffing as a complaint would be a 
significant change in practice with potential unintended consequences. 
This requires further review and may be considered in future revisions. 
The existing definition of J03--Staffing is sufficiently inclusive of 
staffing vacancies.
    Comment: Two respondents recommended adding language to the 
definition and examples for complaint type L01--Resident representative 
or family conflict to include other visitors with different types of 
relationships.
    Response: The complaint type as currently defined is specific to 
the nature of the relationships of family members and individuals that 
residents choose to be their representative; adding others could dilute 
the meaning of the data element.
    Comment: Two respondents requested the addition of a new complaint 
type for reporting resident-to-resident altercations that are not 
willful abuse.
    Response: ACL is not adding or removing data elements with this 
renewal but will consider this recommendation in the future after 
analysis of impact and alternatives within the existing collection.
    Comment: Three respondents recommended adding a new category of 
complaints and individual complaint types about discrimination.
    Response: ACL is not adding or removing elements but will seek 
additional input and consider this change in the future after analysis 
of impact.
    Comment: Two respondents suggested adding a new complaint category 
to allow for short-term collection of data for a special purpose.
    Response: ACL is not adding or removing elements with this renewal 
but will consider the recommendation after analysis of impact and 
alternatives.
    Comment: One respondent asserted that complaint/case terminology in 
data elements S01-S06 is confusing.
    Response: The data elements are text fields and provide flexibility 
for the State Ombudsman to describe complaints as they determine best. 
Technical assistance will be provided.
    Comment: One respondent requested clarification about reporting 
hours donated by volunteers when the volunteer receives travel 
reimbursement.
    Response: The Older Americans Act allows for reimbursement and 
travel is included in the current examples and reporting tips.
    Comment: One respondent requested clarification about removal or 
remediation of conflicts of interest.
    Response: How conflicts of interest are addressed is a matter of 
rule (45 CFR 1324.21(b)) implementation and technical assistance will 
be provided as part of broader regulatory guidance.
    Comment: One respondent suggested the addition of a code for a 
specific type of expenditure.
    Response: ACL is not adding or removing data elements with this 
revision of NORS but will consider this change in the future.
    Comment: One respondent suggested clarification of local funds 
expended.
    Response: The instruction is written as intended and technical 
assistance will be provided.
    Comment: Four respondents recommended changes to routine access 
visitation reporting.
    Response: Routine access visits as defined are an important measure 
of resident access to their advocate separate from visits to handle 
complaints, as well as a measure of the impact of program funding. ACL 
will explore this request further and consider a change in the future; 
data elements are not being changed in this revision.
    Comment: Three respondents commented that instructions are vague 
about how to report the number of facilities and that closures have an 
impact on how routine access visits are measured on a quarterly basis.
    Response: The examples and tips are specific that the count of 
facilities is as of the last day of the federal fiscal year. Routine 
access is based upon the count of facilities as of the last day of the 
fiscal year. The data element is defined as intended, routine access 
does not include facilities that open after the first quarter or close 
before the fourth quarter of the fiscal year. Technical assistance will 
be provided.
    Comment: One respondent requested a new data element for reporting 
facility closures.
    Response: At this time ACL is not adding or removing elements but 
will consider this change in the future after analysis of impact and 
alternatives.
    Comment: Two respondents requested new Ombudsman program staffing 
data elements--statewide turnover rates, years of experience of 
Ombudsman representatives, and the staff-to-bed ratio of staff.
    Response: At this time ACL is not adding or removing elements but 
will consider this change in the future after analysis of potential 
methods of collection.

Estimated Program Burden

    ACL estimates the burden of this collection of information as 
follows:
    Fifty-two grantees report to ACL using NORS.

a. Number of respondents--52
b. Frequency of response--1
c. Total annual responses--52
d. Hours per response--214
e. Total burden hours--11,153

    Dated: October 28, 2024.
Maura Calsyn,
Principal Deputy Administrator for the Administration for Community 
Living, performing the delegable duties of the Administrator and the 
Assistant Secretary for Aging.
[FR Doc. 2024-25358 Filed 10-30-24; 8:45 am]
BILLING CODE 4154-01-P


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