10106 Federal Register / Vol. 80, No. 37 / Wednesday, February 25, 2015 / Notices 

their benefits justify their costs 

(recognizing that some benefits and 

costs are difficult to quantify); 

(2) Tailor its regulations to impose the 

least burden on society, consistent with 

obtaining regulatory objectives and 

taking into account—among other things 

and to the extent practicable—the costs 

of cumulative regulations; 

(3) In choosing among alternative 

regulatory approaches, select those 

approaches that maximize net benefits 

(including potential economic, 

environmental, public health and safety, 

and other advantages; distributive 

impacts; and equity); 

(4) To the extent feasible, specify 

performance objectives, rather than the 

behavior or manner of compliance a 

regulated entity must adopt; and 

(5) Identify and assess available 

alternatives to direct regulation, 

including economic incentives—such as 

user fees or marketable permits—to 

encourage the desired behavior, or 

provide information that enables the 

public to make choices. 

Executive Order 13563 also requires 

an agency ‘‘to use the best available 

techniques to quantify anticipated 

present and future benefits and costs as 

accurately as possible.’’ The Office of 

Information and Regulatory Affairs of 

OMB has emphasized that these 

techniques may include ‘‘identifying 

changing future compliance costs that 

might result from technological 

innovation or anticipated behavioral 

changes.’’ 

We are issuing this proposed priority 

only upon a reasoned determination 

that its benefits would justify its costs. 

In choosing among alternative 

regulatory approaches, we selected 

those approaches that would maximize 

net benefits. Based on the analysis that 

follows, the Department believes that 

this proposed priority is consistent with 

the principles in Executive Order 13563. 

We also have determined that this 

regulatory action would not unduly 

interfere with State, local, and tribal 

governments in the exercise of their 

governmental functions. 

In accordance with both Executive 

Orders, the Department has assessed the 

potential costs and benefits, both 

quantitative and qualitative, of this 

regulatory action. The potential costs 

are those resulting from statutory 

requirements and those we have 

determined as necessary for 

administering the Department’s 

programs and activities. 

The benefits of the Disability and 

Rehabilitation Research Projects and 

Centers Program have been well 

established over the years. Projects 

similar to one envisioned by the 

proposed priority have been completed 

successfully, and the proposed priority 

would generate new knowledge through 

research. The new RRTC would 

generate, disseminate, and promote the 

use of new information that would 

improve employment outcomes for 

individuals with blindness or other 

visual impairments. 

Intergovernmental Review: This 

program is not subject to Executive 

Order 12372. 

Electronic Access to This Document: 

The official version of this document is 

the document published in the Federal 

Register. Free Internet access to the 

official edition of the Federal Register 

and the Code of Federal Regulations is 

available via the Federal Digital System 

at: www.gpo.gov/fdsys. At this site you 

can view this document, as well as all 

other documents of this Department 

published in the Federal Register, in 

text or Adobe Portable Document 

Format (PDF). To use PDF you must 

have Adobe Acrobat Reader, which is 

available free at the site. 

You may also access documents of the 

Department published in the Federal 

Register by using the article search 

feature at: www.federalregister.gov. 

Specifically, through the advanced 

search feature at this site, you can limit 

your search to documents published by 

the Department. 

Dated: February 19, 2015. 

Kathy Greenlee, 

Administrator. 

[FR Doc. 2015–03885 Filed 2–24–15; 8:45 am] 

BILLING CODE 4154–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Community Living 

[CFDA Number: 84.133B–4] 

Proposed Priority—National Institute 

on Disability, Independent Living, and 

Rehabilitation Research— 

Rehabilitation Research and Training 

Centers 

AGENCY: Administration for Community 

Living. 

ACTION: Notice of proposed priority. 

SUMMARY: The Administrator of the 

Administration for Community Living 

proposes a priority for the 

Rehabilitation Research and Training 

Center (RRTC) Program administered by 

the National Institute on Disability, 

Independent Living, and Rehabilitation 

Research (NIDILRR). Specifically, this 

notice proposes a priority for an RRTC 

on Self-Directed Care to Promote 

Recovery, Health, and Wellness for 

Individuals with Serious Mental Illness. 

We take this action to focus research 

attention on an area of national need. 

We intend this priority to contribute to 

improved employment for individuals 

with serious mental illness (SMI) and 

co-occurring conditions. 

DATES: We must receive your comments 

on or before March 27, 2015. 

ADDRESSES: Submit your comments 

through the Federal eRulemaking Portal 

or via postal mail, commercial delivery, 

or hand delivery. We will not accept 

comments submitted by fax or by email 

or those submitted after the comment 

period. To ensure that we do not receive 

duplicate copies, please submit your 

comments only once. In addition, please 

include the Docket ID at the top of your 

comments. 

• Federal eRulemaking Portal: Go to 

www.regulations.gov to submit your 

comments electronically. Information 

on using Regulations.gov, including 

instructions for accessing agency 

documents, submitting comments, and 

viewing the docket, is available on the 

site under ‘‘Are you new to the site?’’ 

• Postal Mail, Commercial Delivery, 

or Hand Delivery: If you mail or deliver 

your comments about these proposed 

regulations, address them to Patricia 

Barrett, U.S. Department of Health and 

Human Services, 400 Maryland Avenue 

SW., Room 5142, Potomac Center Plaza 

(PCP), Washington, DC 20202–2700. 

Privacy Note: The Department’s policy is 

to make all comments received from 

members of the public available for public 

viewing in their entirety on the Federal 

eRulemaking Portal at www.regulations.gov. 

Therefore, commenters should be careful to 

include in their comments only information 

that they wish to make publicly available. 

FOR FURTHER INFORMATION CONTACT: 

Patricia Barrett. Telephone: (202) 245– 

6211 or by email: 

patricia.barrett@ed.gov. 

If you use a telecommunications 

device for the deaf (TDD) or a text 

telephone (TTY), call the Federal Relay 

Service (FRS), toll free, at 1–800–877– 

8339. 

SUPPLEMENTARY INFORMATION: This 

notice of proposed priority is in concert 

with NIDRR’s currently approved LongRange Plan (Plan). The Plan, which was 

published in the Federal Register on 

April 4, 2013 (78 FR 20299), can be 

accessed on the Internet at the following 

site: www.ed.gov/about/offices/list/ 

osers/nidrr/policy.html. 

The Plan identifies a need for research 

and training regarding employment of 

individuals with disabilities. To address 

this need, NIDILRR seeks to: (1) Improve 

the quality and utility of disability and 


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Federal Register / Vol. 80, No. 37 / Wednesday, February 25, 2015 / Notices 10107 

rehabilitation research; (2) foster an 

exchange of research findings, expertise, 

and other information to advance 

knowledge and understanding of the 

needs of individuals with disabilities 

and their family members, including 

those from among traditionally 

underserved populations; (3) determine 

effective practices, programs, and 

policies to improve community living 

and participation, employment, and 

health and function outcomes for 

individuals with disabilities of all ages; 

(4) identify research gaps and areas for 

promising research investments; (5) 

identify and promote effective 

mechanisms for integrating research and 

practice; and (6) disseminate research 

findings to all major stakeholder groups, 

including individuals with disabilities 

and their family members in formats 

that are appropriate and meaningful to 

them. 

This notice proposes one priority that 

NIDILRR intends to use for one or more 

competitions in fiscal year (FY) 2015 

and possibly later years. NIDILRR is 

under no obligation to make an award 

under this priority. The decision to 

make an award will be based on the 

quality of applications received and 

available funding. NIDILRR may publish 

additional priorities, as needed. 

Invitation to Comment: We invite you 

to submit comments regarding this 

proposed priority. To ensure that your 

comments have maximum effect in 

developing the final priority, we urge 

you to identify clearly the specific topic 

within the priority that each comment 

addresses. 

We invite you to assist us in 

complying with the specific 

requirements of Executive Orders 12866 

and 13563 and their overall requirement 

of reducing regulatory burden that 

might result from this proposed priority. 

Please let us know of any further ways 

we could reduce potential costs or 

increase potential benefits while 

preserving the effective and efficient 

administration of the program. 

During and after the comment period, 

you may inspect all public comments by 

following the instructions found under 

the ‘‘Are you new to the site?’’ portion 

of the Federal eRulemaking Portal at 

wwww.regulations.gov. Any comments 

sent to NIDILRR via postal mail, 

commercial deliver, or hand delivery 

can be viewed in room 5142, 550 12th 

Street SW., PCP, Washington, DC, 

between the hours of 8:30 a.m. and 4:00 

p.m., Washington, DC time, Monday 

through Friday of each week except 

Federal holidays. 

Assistance to Individuals With 

Disabilities in Reviewing the 

Rulemaking Record: On request we will 

provide an appropriate accommodation 

or auxiliary aid to an individual with a 

disability who needs assistance to 

review the comments or other 

documents in the public rulemaking 

record for this notice. If you want to 

schedule an appointment for this type of 

accommodation or auxiliary aid, please 

contact the person listed under FOR

FURTHER INFORMATION CONTACT. 

Purpose of Program: The purpose of 

the Disability and Rehabilitation 

Research Projects and Centers Program 

is to plan and conduct research, 

demonstration projects, training, and 

related activities, including 

international activities, to develop 

methods, procedures, and rehabilitation 

technology that maximize the full 

inclusion and integration into society, 

employment, independent living, family 

support, and economic and social selfsufficiency of individuals with 

disabilities, especially individuals with 

the most severe disabilities, and to 

improve the effectiveness of services 

authorized under the Rehabilitation Act 

of 1973, as amended (Rehabilitation 

Act). 

Rehabilitation Research and Training 

Centers 

The purpose of the RRTCs, which are 

funded through the Disability and 

Rehabilitation Research Projects and 

Centers Program, is to achieve the goals 

of, and improve the effectiveness of, 

services authorized under the 

Rehabilitation Act through welldesigned research, training, technical 

assistance, and dissemination activities 

in important topical areas as specified 

by NIDILRR. These activities are 

designed to benefit rehabilitation 

service providers, individuals with 

disabilities, family members, 

policymakers and other research 

stakeholders. Additional information on 

the RRTC program can be found at: 

http://www2.ed.gov/programs/rrtc/ 

index.html#types. 

Program Authority: 29 U.S.C. 762(g) 

and 764(b)(2). 

Applicable Program Regulations: 34 

CFR part 350. 

Proposed Priority: This notice 

contains one proposed priority. 

RRTC on Self-Directed Care To Promote 

Recovery, Health, and Wellness for 

Individuals With Serious Mental Illness 

Background 

Mental health disorders are one of the 

leading causes of disability in the 

United States. In 2012, there were an 

estimated 9.6 million adults aged 18 or 

older in the U.S. with serious mental 

illness, representing 4.1 percent of all 

U.S. adults (U.S. Department of Health 

and Human Services, 2012a). Most 

individuals with mental illness today 

live in community settings—a result of 

the deinstitutionalization movement of 

the 1960s to 1980s, the Americans with 

Disabilities Act of 1990, and the 1999 

U.S. Supreme Court Olmstead decision 

(National Council on Disability, 2008; 

Olmstead v. L.C., 527 U.S. 581 (1999); 

Salzer, Kaplan, & Atay, 2006). 

Individuals with mental illness are less 

likely to achieve successful employment 

outcomes than individuals without 

mental illness (Cook, 2006). For those 

who are employed, mental illness is 

associated with decreased productivity 

and lower levels of job retention (Cook, 

2006; Lerner et al., 2012). In addition, 

individuals with mental illness 

experience higher mortality rates and 

poorer physical health than individuals 

without mental illness (Banham & 

Gilbody, 2010). This disparity in general 

health is exacerbated by barriers to 

healthcare delivery services for 

individuals with mental illness, at both 

the system and the individual levels 

(Kelly et al., 2014). Furthermore, 

employment outcomes and health are 

related in this population. At the 

individual level, mental illness 

symptoms and comorbid medical 

conditions are associated with poorer 

employment outcomes (Cook et al., 

2007; Frey et al., 2008). At the system 

level, the relations among health care 

systems, and those between 

employment service systems and health 

care systems, are complex (Frey et al., 

2008; Kelly et al., 2014). 

Over the last few decades, the concept 

of self-determination has become more 

widespread in the design and 

conceptualization of services for 

individuals with mental illness. In this 

context, self-determination refers to 

individuals’ rights to direct their own 

services, to be involved in decisions that 

impact their wellbeing, to be 

meaningfully involved in the design, 

delivery and evaluation of services and 

supports, and to develop and use their 

own personal goals to guide their lives 

and actions (Cook & Jonikas, 2002). Selfdetermination is a central component of 

the Substance Abuse and Mental Health 

Services Administration’s definition of 

recovery (U.S. Department of Health and 

Human Services, 2012b) and has 

become an important component of 

recovery-oriented mental health 

treatment and services. It is closely 

related to the guiding principle of 

informed choice in vocational 

rehabilitation and supported 

employment (Drake, Bond & Becker, 

2012; Workforce Innovation and 


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10108 Federal Register / Vol. 80, No. 37 / Wednesday, February 25, 2015 / Notices 

Opportunity Act of 2014). In the field of 

general health care, self-determination 

principles are reflected in the concept of 

self-direction (e.g., Centers for Medicare 

and Medicaid Services, no date). 

Principles of self-determination can be 

incorporated into many types of services 

and supports for individuals with 

mental illness and into efforts to address 

system and individual-level barriers to 

health and employment services. 

At the system level, the selfdetermination approach in health care 

has informed systems in which 

individuals with disabilities control the 

services they receive. These systems are 

known by a variety of names, (e.g., 

person-centered funding, persondirected services, participant-directed 

services, cash and counseling) (Barczyk 

& Lincove, 2010; O’Brien et al., 2005; 

Powers & Sowers, 2006; Robert Wood 

Johnson Foundation, 2006). When the 

system is designed for individuals with 

serious mental illness, this type of 

service is frequently referred to as selfdirected care. It uses public funds to 

provide individuals with the cash value 

of services and allows individuals to 

choose, organize, and purchase services 

(Alakeson, 2008), thereby providing 

both self-direction and a mechanism to 

purchase services and goods 

traditionally covered by different 

funding sources. Individuals may 

choose services and supports that are 

not traditionally provided in the mental 

health system, such as wellness 

services, transportation, medical or 

dental services, and tangible items that 

support community participation (Cook 

et al., 2008). Individuals are provided 

with assistance to help them develop 

their own individual service plans and 

budgets. The mechanism involved can 

vary, (e.g., direct payments, individual 

budgets, flexible funds). Early data on 

the effectiveness of this approach for 

individuals with mental illness suggest 

that self-directed care can yield positive 

results for a variety of outcomes, 

including employment, quality of life, 

and service use (Alakeson, 2008; Cook 

et al., 2008; O’Brien et al., 2005; Webber 

et al., 2014). However, self-directed care 

has been implemented in few States, 

and very little is known about the 

effectiveness of this approach for many 

recovery-oriented outcomes, such as 

employment. 

Other system-level approaches to 

improving both access to health care 

and the health of individuals with 

mental illness have incorporated 

principles of care coordination to 

integrate mental health services with 

general medical services (Barry & 

Huskamp, 2014; Croft & Parish, 2012; 

Druss et al., 2010; Kelly et al., 2014; 

Mechanic, 2014). Services provided 

through care coordination models can 

bridge the gap between mental health 

and general health services and improve 

outcomes both in mental and in general 

medical health (Woltmann et al., 2012). 

Although care coordination 

organizations do not necessarily 

incorporate self-determination features, 

they can do so. For example, care 

coordination models may include 

illness self management programs, 

which train individuals on how to 

manage their symptoms and improve 

their functioning and quality of life. In 

fact, the Improving Chronic Illness Care 

Initiative includes illness selfmanagement as a core feature (Kelly et 

al., 2014; McDonald et al., 2007; 

Woltmann et al., 2012). Illness selfmanagement interventions can be 

effective for people with mental illness 

dealing with general medical problems 

(Kelly et al., 2014) or mental illness (Roe 

et al., 2009). In addition, there is 

preliminary evidence that mental illness 

self-management may have positive 

effects on employment outcomes 

(Michon, 2011). 

However, coordinated care systems 

can be complex for consumers to 

negotiate. Therefore, many systems 

provide staff who serve as navigators to 

help guide clients through the barriers 

of complex health care systems and 

provide support for consumers in such 

self-directed activities as developing 

plans and making choices. Early 

research indicates that provision of 

navigator services can improve health 

outcomes and use of medical services 

for individuals with mental illness 

(Griswold et al., 2010; Kelly et al., 

2013). In addition, having peers serve 

either as navigators or to deliver mental 

or general healthcare interventions can 

be effective for individuals with mental 

illness (Brekke et al., 2013; Chinman et 

al., 2014; Kelly et al, 2014; Pitt et al., 

2013). 

Research on the use of self-directed 

services and supports, and self-directed 

care, for individuals with mental illness 

is in preliminary stages. There is a need 

for better understanding of the optimal 

use of self-directed strategies in the 

integration of general health care and 

mental health care, as well as the 

optimal involvement of peer supports 

for people with serious mental illness. 

References: 

Alakeson, V., (2008). Let patients control the 

purse strings. British Medical Journal, 

336, 807–809. 

Banham, L., & Gilbody, S. (2010). Smoking 

cessation in severe mental illness: What 

works? Addiction, 105(7), 1176–1189. 

Barczyk, A.N., & Lincove, J.A. (2010). Cash 

and counseling: A model for selfdirected care programs to empower 

individuals with serious mental 

illnesses. Social Work in Mental Health, 

8(3), 209–224. 

Barry, C.L., & Huskamp, H.A. (2011). Moving 

beyond parity—mental health and 

addiction care under the ACA. New 

England Journal of Medicine, 365(11), 

973–975. 

Brekke, J.S., Siantz, E., Pahwa, R., Kelly, E., 

Tallen, L., & Fulginiti, A. (2013). 

Reducing Health Disparities for People 

with Serious Mental Illness. Best 

Practices in Mental Health, 9(1), 62–82. 

Centers for Medicaid and Medicare Services. 

(no date). Self directed services. 

Retrieved from: http:// 

www.medicaid.gov/Medicaid-CHIPProgram-Information/By-Topics/ 

Delivery-Systems/Self-DirectedServices.html. 

Chinman, M., George, P., Dougherty, R.H., 

Daniels, A.S., Ghose, S.S., Swift, A., & 

Delphin-Rittmon, M.E. (2014). Peer 

support services for individuals with 

serious mental illnesses: assessing the 

evidence. Psychiatric Services, 65(4), 

429–441. 

Cook, J. (2006). Employment barriers for 

persons with psychiatric disabilities: 

Update of a report for the President’s 

Commission. Psychiatric Services, 

57(10), 1391–1405. 

Cook, J.A., & Jonikas, J.A. (2002). SelfDetermination Among Mental Health 

Consumers/Survivors Using Lessons 

From the Past to Guide the Future. 

Journal of Disability Policy Studies, 

13(2), 88–96. 

Cook, J.A., Razzano, L.A., Burke-Miller, J.K., 

Blyler, C.R., Leff, H.S., Mueser, 

K.T.,Gold, P.B., Goldberg, R.W., Shafer, 

M.S., Onken, S.J., McFarlane, W.R., 

Donegan, K., Carey, M.A., Kauffmann, C., 

& Grey, D.D. (2007). Effects of cooccurring disorders on employment 

outcomes in a multisite randomized 

study of supported employment for 

people with severe mental illness. 

Journal of Rehabilitation Research and 

Development, 44(6), 837. 

Cook, J., Russell, C., Grey, D., & Jonikas, J. 

(2008). Economic grand rounds: A selfdirected care model for mental health 

recovery. Psychiatric Services, 59(6), 

600–602. 

Croft, B., & Parish, S.L. (2013). Care 

integration in the patient protection and 

affordable care act: Implications for 

behavioral health. Administration and 

Policy in Mental Health and Mental 

Health Services Research, 40(4), 258– 

263. 

Drake, R.E., Bond, G. R., & Becker, D. R. 

(2012). Individual placement and 

support: An evidence-based approach to 

supported employment. Oxford 

University Press. 

Druss, B.G., Zhao, L., von Esenwein, S.A., 

Bona, J.R., Fricks, L., Jenkins-Tucker, S., 

Sterling, E., DiClemente, R., & Lorig, K. 

(2010). The Health and Recovery Peer 

(HARP) Program: a peer-led intervention 

to improve medical self-management for 

persons with serious mental illness. 

Schizophrenia Research, 118(1), 264– 


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270. 

Frey, W.D., Azrin, S.T., Goldman, H.H., 

Kalasunas, S., Salkever, D.S., Miller, 

A.L., Bond, G.R., & Drake, R.E. (2008). 

The mental health treatment study. 

Psychiatric Rehabilitation Journal, 31(4), 

306. 

Griswold, K.S., Homish, G.G., Pastore, P.A., 

& Leonard, K.E. (2010). A randomized 

trial: Are care navigators effective in 

connecting patients to primary care after 

psychiatric crisis? Community Mental 

Health Journal, 46(4), 398–402. 

Kelly, E.L., Fenwick, K.M., Barr, N., Cohen, 

H., & Brekke, J.S. (2014). A Systematic 

Review of Self-Management Health Care 

Models for Individuals With Serious 

Mental Illnesses. Psychiatric Services, 

65(11), 1300–1310. 

Kelly, E., Fulginiti, A., Pahwa, R., Tallen, L., 

Duan, L., & Brekke, J.S. (2013). A pilot 

test of a peer navigator intervention for 

improving the health of individuals with 

serious mental illness. Community 

Mental Health Journal, 50(4), 435–446. 

Lerner, D., Adler, D., Hermann, R.C., Chang, 

H., Ludman, E.J., Greenhill, A., Perch, K., 

McPeck, W.C., & Rogers, W.H. (2012). 

Impact of a work-focused intervention on 

the productivity and symptoms of 

employees with depression. Journal of 

Occupational and Environmental 

Medicine, 54(2), 128. 

Mechanic, D. (2014). Seizing opportunities 

under the Affordable Care Act for 

transforming the mental and behavioral 

health system. Health Affairs, 31(2), 

376–382. 

Michon, H.W., Van Weeghel, J., Kroon, H., & 

Schene, A.H. (2011). Illness selfmanagement assessment in psychiatric 

vocational rehabilitation. Psychiatric 

Rehabilitation Journal, 35(1), 21. 

National Council on Disability (2008). 

Inclusive livable communities for people 

with psychiatric disabilities. 

Washington, DC: National Council on 

Disability. Retrieved from www.ncd.gov/ 

publications/2008/03172008. 

O’Brien, D., Ford, L., & Malloy, J. M. (2005). 

Person centered funding: Using vouchers 

and personal budgets to support recovery 

and employment for people with 

psychiatric disabilities. Journal of 

Vocational Rehabilitation, 23, 71–79. 

Pitt, V., Lowe, D., Hill, S., Prictor, M., 

Hetrick, S.E., Ryan, R., & Berends, L. 

(2013). Consumer-providers of care for 

adult clients of statutory mental health 

services. Cochrane Database Systematic 

Reviews, 3. 

Powers L.E., & Sowers, J. (2006). A crossdisability analysis of person-directed, 

long-term services. Journal of Disability 

Policy Studies, 17, 66–76. 

Robert Wood Johnson Foundation (2006). 

Choosing independence: An overview of 

the cash and counseling model of selfdirected personal assistance services. 

Princeton NJ: Robert Wood Johnson 

Foundation. 

Roe, D., Hasson-Ohayon, I., Salyers, M.P., & 

Kravetz, S. (2009). A one year follow-up 

of illness management and recovery: 

Participants’ accounts of its impact and 

uniqueness. Psychiatric Rehabilitation 

Journal, 32(4), 285–291. 

Salzer, M., Kaplan, K., & Atay, J. (2006). State 

psychiatric hospital census after the 

1999 Olmstead decision: Evidence of 

decelerating deinstitutionalization. 

Psychiatric Services, 57(10), 1501–1504. 

U.S. Department of Health and Human 

Services, Substance Abuse and Mental 

Health Services Administration (2012a). 

Results from the 2012 National Survey 

on Drug Use and Health: Mental Health 

Findings. Retrieved from: http:// 

www.samhsa.gov/data/sites/default/ 

files/2k12MH_Findings/ 

2k12MH_Findings/ 

NSDUHmhfr2012.htm#sec2-2. 

U.S. Department of Health and Human 

Services, Substance Abuse and Mental 

Health Services Administration (2012b). 

SAMHSA’s Working Definition of 

Recovery. Retrieved from: http:// 

store.samhsa.gov/shin/content//PEP12- 

RECDEF/PEP12-RECDEF.pdf. 

Webber, M., Treacy, S., Carr, S., Clark, M., & 

Parker, G. (2014). The effectiveness of 

personal budgets for people with mental 

health problems: A systematic review. 

Journal of Mental Health, 23(3), 146–155. 

Woltmann, E., Grogan-Kaylor, A., Perron, B., 

Georges, H., Kilbourne, A.M., & Bauer, 

M.S. (2012). Comparative effectiveness of 

collaborative chronic care models for 

mental health conditions across primary, 

specialty, and behavioral health care 

settings: Systematic review and metaanalysis. American Journal of Psychiatry, 

169(8), 790–804. 

Workforce Innovation and Opportunity Act 

of 2014. Public Law 113–128. 

Definitions 

The research that is proposed under 

this priority must be focused on one or 

more stages of research. If the RRTC is 

to conduct research that can be 

categorized under more than one 

research stage, or research that 

progresses from one stage to another, 

those research stages must be clearly 

specified. For purposes of this priority, 

the stages of research are from the notice 

of final priorities and definitions 

published in the Federal Register on 

June 7, 2013 (78 FR 34261). 

(a) Exploration and Discovery means 

the stage of research that generates 

hypotheses or theories by conducting 

new and refined analyses of data, 

producing observational findings, and 

creating other sources of research-based 

information. This research stage may 

include identifying or describing the 

barriers to and facilitators of improved 

outcomes of individuals with 

disabilities, as well as identifying or 

describing existing practices, programs, 

or policies that are associated with 

important aspects of the lives of 

individuals with disabilities. Results 

achieved under this stage of research 

may inform the development of 

interventions or lead to evaluations of 

interventions or policies. The results of 

the exploration and discovery stage of 

research may also be used to inform 

decisions or priorities. 

(b) Intervention Development means 

the stage of research that focuses on 

generating and testing interventions that 

have the potential to improve outcomes 

for individuals with disabilities. 

Intervention development involves 

determining the active components of 

possible interventions, developing 

measures that would be required to 

illustrate outcomes, specifying target 

populations, conducting field tests, and 

assessing the feasibility of conducting a 

well-designed interventions study. 

Results from this stage of research may 

be used to inform the design of a study 

to test the efficacy of an intervention. 

(c) Intervention Efficacy means the 

stage of research during which a project 

evaluates and tests whether an 

intervention is feasible, practical, and 

has the potential to yield positive 

outcomes for individuals with 

disabilities. Efficacy research may assess 

the strength of the relationships 

between an intervention and outcomes, 

and may identify factors or individual 

characteristics that affect the 

relationship between the intervention 

and outcomes. Efficacy research can 

inform decisions about whether there is 

sufficient evidence to support ‘‘scalingup’’ an intervention to other sites and 

contexts. This stage of research can 

include assessing the training needed 

for wide-scale implementation of the 

intervention, and approaches to 

evaluation of the intervention in real 

world applications. 

(d) Scale-Up Evaluation means the 

stage of research during which a project 

analyzes whether an intervention is 

effective in producing improved 

outcomes for individuals with 

disabilities when implemented in a realworld setting. During this stage of 

research, a project tests the outcomes of 

an evidence-based intervention in 

different settings. It examines the 

challenges to successful replication of 

the intervention, and the circumstances 

and activities that contribute to 

successful adoption of the intervention 

in real-world settings. This stage of 

research may also include well-designed 

studies of an intervention that has been 

widely adopted in practice, but that 

lacks a sufficient evidence-base to 

demonstrate its effectiveness. 

Proposed Priority 

The Administrator of the 

Administration for Community Living 

proposes a priority for the 

Rehabilitation Research and Training 

Center (RRTC) Program administered by 


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the National Institute on Disability, 

Independent Living, and Rehabilitation 

Research (NIDILRR). Specifically, this 

notice proposes a priority on SelfDirected Care to Promote Recovery, 

Health, and Wellness for Individuals 

with Serious Mental Illness. This RRTC 

will be jointly funded by NIDILRR and 

the Substance Abuse and Mental Health 

Services Administration. The RRTC will 

conduct research to develop, adapt, and 

enhance self-directed models of general 

medical, mental health, and nonmedical 

services that are designed to improve 

health, recovery, and employment 

outcomes for individuals with serious 

mental illness. The RRTC must conduct 

research, knowledge translation, 

training, dissemination, and technical 

assistance within a framework of 

consumer-directed services and selfmanagement. Under this priority, the 

RRTC must contribute to the following 

outcomes: 

(1) Increased knowledge that can be 

used to enhance the health and wellbeing of individuals with serious mental 

illness and co-occurring conditions. The 

RRTC must contribute to this outcome 

by: 

(a) Conducting research to develop a 

better understanding of the barriers to 

and facilitators of implementing models 

that integrate general medical and 

mental health care for individuals with 

SMI. These models must incorporate 

self-management and self-direction 

strategies. This research must 

specifically examine models that 

incorporate peer-provided services and 

supports along with research-based 

service integration strategies such as 

health navigation and care coordination. 

(b) Conducting research to identify or 

develop and then test interventions that 

use individual budgets or flexible funds 

to increase consumer choice. The RRTC 

must design this research to determine 

the extent to which the consumerchoice intervention improves health 

outcomes and promotes recovery among 

individuals living with SMI. In carrying 

out this activity, the grantee must 

investigate the applicability of strategies 

that have proven successful with the 

general population or other 

subpopulations to determine if they are 

effective with individuals with SMI and 

co-occurring conditions. 

(2) Improved employment outcomes 

among individuals with SMI. The RRTC 

must contribute to this outcome by: 

(a) Conducting research to develop a 

better understanding of the barriers to 

and facilitators of implementing 

vocational service and support models 

that incorporate self management and 

self-direction features. These features 

must include self-directed financing and 

flexible funding of services that support 

mental health treatment and recovery, 

general health, and employment. These 

services may include services and 

supports not traditionally supplied by 

mental health or general medical 

systems. 

(3) Increased incorporation of 

research findings related to SMI, selfdirected care, health management, and 

employment into practice or policy. 

(a) Developing, evaluating, or 

implementing strategies to increase 

utilization of research findings related 

to SMI, co-occurring conditions, health 

management, and employment. 

(b) Conducting training, technical 

assistance, and dissemination activities 

to increase utilization of research 

findings related to self-directed care of 

individuals living with SMI to promote 

and co-occurring conditions, health 

management, and employment. 

Final Priority 

We will announce the final priority in 

a notice in the Federal Register. We will 

determine the final priority after 

considering responses to this notice and 

other information available to the 

Department. This notice does not 

preclude us from proposing additional 

priorities, requirements, definitions, or 

selection criteria, subject to meeting 

applicable rulemaking requirements. 

Note: This notice does not solicit 

applications. In any year in which we choose 

to use this priority, we invite applications 

through a notice in the Federal Register or 

in a Funding Opportunity Announcement 

posted at www.grants.gov. 

Executive Orders 12866 and 13563 

Regulatory Impact Analysis 

Under Executive Order 12866, the 

Secretary must determine whether this 

regulatory action is ‘‘significant’’ and, 

therefore, subject to the requirements of 

the Executive Order and subject to 

review by the Office of Management and 

Budget (OMB). Section 3(f) of Executive 

Order 12866 defines a ‘‘significant 

regulatory action’’ as an action likely to 

result in a rule that may— 

(1) Have an annual effect on the 

economy of $100 million or more, or 

adversely affect a sector of the economy, 

productivity, competition, jobs, the 

environment, public health or safety, or 

State, local, or tribal governments or 

communities in a material way (also 

referred to as an ‘‘economically 

significant’’ rule); 

(2) Create serious inconsistency or 

otherwise interfere with an action taken 

or planned by another agency; 

(3) Materially alter the budgetary 

impacts of entitlement grants, user fees, 

or loan programs or the rights and 

obligations of recipients thereof; or 

(4) Raise novel legal or policy issues 

arising out of legal mandates, the 

President’s priorities, or the principles 

stated in the Executive Order. 

This proposed regulatory action is not 

a significant regulatory action subject to 

review by OMB under section 3(f) of 

Executive Order 12866. 

We have also reviewed this regulatory 

action under Executive Order 13563, 

which supplements and explicitly 

reaffirms the principles, structures, and 

definitions governing regulatory review 

established in Executive Order 12866. 

To the extent permitted by law, 

Executive Order 13563 requires that an 

agency— 

(1) Propose or adopt regulations only 

upon a reasoned determination that 

their benefits justify their costs 

(recognizing that some benefits and 

costs are difficult to quantify); 

(2) Tailor its regulations to impose the 

least burden on society, consistent with 

obtaining regulatory objectives and 

taking into account—among other things 

and to the extent practicable—the costs 

of cumulative regulations; 

(3) In choosing among alternative 

regulatory approaches, select those 

approaches that maximize net benefits 

(including potential economic, 

environmental, public health and safety, 

and other advantages; distributive 

impacts; and equity); 

(4) To the extent feasible, specify 

performance objectives, rather than the 

behavior or manner of compliance a 

regulated entity must adopt; and 

(5) Identify and assess available 

alternatives to direct regulation, 

including economic incentives—such as 

user fees or marketable permits—to 

encourage the desired behavior, or 

provide information that enables the 

public to make choices. 

Executive Order 13563 also requires 

an agency ‘‘to use the best available 

techniques to quantify anticipated 

present and future benefits and costs as 

accurately as possible.’’ The Office of 

Information and Regulatory Affairs of 

OMB has emphasized that these 

techniques may include ‘‘identifying 

changing future compliance costs that 

might result from technological 

innovation or anticipated behavioral 

changes.’’ 

We are issuing this proposed priority 

only upon a reasoned determination 

that its benefits would justify its costs. 

In choosing among alternative 

regulatory approaches, we selected 

those approaches that would maximize 

net benefits. Based on the analysis that 

follows, the Department believes that 


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Federal Register / Vol. 80, No. 37 / Wednesday, February 25, 2015 / Notices 10111 

this proposed priority is consistent with 

the principles in Executive Order 13563. 

We also have determined that this 

regulatory action would not unduly 

interfere with State, local, and tribal 

governments in the exercise of their 

governmental functions. 

In accordance with both Executive 

Orders, the Department has assessed the 

potential costs and benefits, both 

quantitative and qualitative, of this 

regulatory action. The potential costs 

are those resulting from statutory 

requirements and those we have 

determined as necessary for 

administering the Department’s 

programs and activities. 

The benefits of the Disability and 

Rehabilitation Research Projects and 

Centers Program have been well 

established over the years. Projects 

similar to one envisioned by the 

proposed priority have been completed 

successfully, and the proposed priority 

would generate new knowledge through 

research. The new RRTC would 

generate, disseminate, and promote the 

use of new information that would 

improve recovery, health, and wellness 

outcomes for individuals with serious 

mental illness (SMI) and co-occurring 

conditions. 

Intergovernmental Review: This 

program is not subject to Executive 

Order 12372. 

Electronic Access to This Document: 

The official version of this document is 

the document published in the Federal 

Register. Free Internet access to the 

official edition of the Federal Register 

and the Code of Federal Regulations is 

available via the Federal Digital System 

at: www.gpo.gov/fdsys. At this site you 

can view this document, as well as all 

other documents of this Department 

published in the Federal Register, in 

text or Adobe Portable Document 

Format (PDF). To use PDF you must 

have Adobe Acrobat Reader, which is 

available free at the site. 

You may also access documents of the 

Department published in the Federal 

Register by using the article search 

feature at: www.federalregister.gov. 

Specifically, through the advanced 

search feature at this site, you can limit 

your search to documents published by 

the Department. 

Dated: February 19, 2015. 

Kathy Greenlee, 

Administrator. 

[FR Doc. 2015–03880 Filed 2–24–15; 8:45 am] 

BILLING CODE 4151–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Community Living 

[CFDA Number: 84.133B–3] 

Proposed priority—National Institute 

on Disability, Independent Living, and 

Rehabilitation Research— 

Rehabilitation Research and Training 

Centers 

AGENCY: Administration for Community 

Living, Department of Health and 

Human Services. 

ACTION: Notice of proposed priority. 

SUMMARY: The Administrator of the 

Administration for Community Living 

proposes a priority for the 

Rehabilitation Research and Training 

Center (RRTC) Program administered by 

the National Institute on Disability, 

Independent Living, and Rehabilitation 

Research (NIDILRR). Specifically, this 

notice proposes a priority for an RRTC 

on Employment Policy and 

Measurement. We take this action to 

focus research attention on an area of 

national need. We intend this priority to 

contribute to improved employment 

outcomes for individuals with 

disabilities. 

DATES: We must receive your comments 

on or before March 27, 2015. 

ADDRESSES: Submit your comments 

through the Federal eRulemaking Portal 

or via postal mail or commercial 

delivery. We will not accept comments 

submitted by fax or by email or those 

submitted after the comment period. To 

ensure that we do not receive duplicate 

copies, please submit your comments 

only once. In addition, please include 

the Docket ID at the top of your 

comments. 

• Federal eRulemaking Portal: Go to 

www.regulations.gov to submit your 

comments electronically. Information 

on using Regulations.gov, including 

instructions for accessing agency 

documents, submitting comments, and 

viewing the docket, is available on the 

site under ‘‘Are you new to the site?’’ 

• Postal Mail or Commercial Delivery: 

If you mail or deliver your comments 

about these proposed regulations, 

address them to Patricia Barrett, U.S. 

Department of Health and Human 

Services, 400 Maryland Avenue SW., 

Room 5142, Potomac Center Plaza 

(PCP), Washington, DC 20202–2700. 

Privacy Note: The Department’s 

policy is to make all comments received 

from members of the public available for 

public viewing in their entirety on the 

Federal eRulemaking Portal at 

www.regulations.gov. Therefore, 

commenters should be careful to 

include in their comments only 

information that they wish to make 

publicly available. 

FOR FURTHER INFORMATION CONTACT: 

Patricia Barrett. Telephone: (202) 245– 

6211 or by email: 

patricia.barrett@ed.gov. 

If you use a telecommunications 

device for the deaf (TDD) or a text 

telephone (TTY), call the Federal Relay 

Service (FRS), toll free, at 1–800–877– 

8339. 

SUPPLEMENTARY INFORMATION: This 

notice of proposed priority is in concert 

with NIDRR’s currently approved LongRange Plan (Plan). The Plan, which was 

published in the Federal Register on 

April 4, 2013 (78 FR 20299), can be 

accessed on the Internet at the following 

site: www.ed.gov/about/offices/list/ 

osers/nidrr/policy.html. 

The Plan identifies a need for research 

and training regarding employment of 

individuals with disabilities. To address 

this need, NIDILRR seeks to: (1) Improve 

the quality and utility of disability and 

rehabilitation research; (2) foster an 

exchange of research findings, expertise, 

and other information to advance 

knowledge and understanding of the 

needs of individuals with disabilities 

and their family members, including 

those from among traditionally 

underserved populations; (3) determine 

effective practices, programs, and 

policies to improve community living 

and participation, employment, and 

health and function outcomes for 

individuals with disabilities; (4) identify 

research gaps and areas for promising 

research investments; (5) identify and 

promote effective mechanisms for 

integrating research and practice; and 

(6) disseminate research findings to all 

major stakeholder groups, including 

individuals with disabilities and their 

family members in formats that are 

appropriate and meaningful to them. 

This notice proposes one priority that 

NIDILRR intends to use for one or more 

competitions in fiscal year (FY) 2015 

and possibly later years. NIDILRR is 

under no obligation to make an award 

under this priority. The decision to 

make an award will be based on the 

quality of applications received and 

available funding. NIDILRR may publish 

additional priorities, as needed. 

Invitation to Comment: We invite you 

to submit comments regarding this 

proposed priority. To ensure that your 

comments have maximum effect in 

developing the final priority, we urge 

you to identify clearly the specific topic 

within the priority that each comment 

addresses. 


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