Request for Information on Potential Stay-at-Work/Return-to-Work Demonstration Projects, 45618-45623 [2017-20338]

Agencies

• DEPARTMENT OF LABOR

[Federal Register Volume 82, Number 188 (Friday, September 29, 2017)]
[Notices]
[Pages 45618-45623]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-20338]


-----------------------------------------------------------------------

DEPARTMENT OF LABOR

[Agency Docket Number: DOL-2017-0003]


Request for Information on Potential Stay-at-Work/Return-to-Work 
Demonstration Projects

AGENCY: Office of Disability Employment Policy, DOL.

ACTION: Request for information.

-----------------------------------------------------------------------

SUMMARY: Washington State's workers' compensation system runs several 
promising early intervention programs including the Centers of 
Occupational Health and Education (COHE) and the Early Return to Work 
and the Stay at Work programs, which provide early intervention and 
return-to-work services for individuals with work-related health 
conditions and their employers. The President's FY2018 budget proposed 
that the Office of Disability Employment Policy (ODEP) at the U.S. 
Department of Labor (DOL) and the Social Security Administration (SSA) 
jointly conduct a demonstration testing the effects of implementing key 
features of these programs in other states and/or for a broader 
population beyond workers' compensation. To do that, we anticipate 
funding two to three states to operate projects with key elements drawn 
from the Washington State programs mentioned above, with an increased 
emphasis on access to employment-related supports, or fund the 
expansion of existing programs to include increased access to 
employment-related supports. The ultimate policy goal is to increase 
employment and labor force participation of individuals who have or are 
developing work disabilities. This request for information (RFI) seeks 
public input on how the proposed demonstration projects can best be 
designed to promote labor force attachment, coordinate employment and 
health services, and support injured and ill workers in returning to 
and remaining at work. The input we receive will inform our 
deliberations about the possible design of a future demonstration 
project.

DATES: Comments must be received by October 30, 2017.

ADDRESSES: You may submit comments by any one of three methods--
Internet, fax, or mail. Do not submit the same comments multiple times 
or by more than one method. Regardless of which method you choose, 
please refer to Docket No. DOL-2017-0003in your comment pages so that 
we may associate your comments with the correct docket.
    Caution: In your comments, you should be careful to include only 
the information that you wish to make publicly available. We strongly 
urge you not to include in your comments any personal information, such 
as Social Security numbers or medical information.
    1. Internet: We strongly recommend that you submit your comments 
via the Internet. Please visit the Federal eRulemaking portal at https://www.regulations.gov. Use the ``Search'' function to find docket number 
DOL-2017-0003. The system will issue a tracking number to confirm your 
submission. You will not be able to view your comment immediately 
because we must post each comment manually. It may take up to a week 
for your comment to be viewable.
    2. Fax: Fax comments to (202) 693-7888.
    3. Mail: Mail your comments to the Office of Disability Employment 
Policy, U.S. Department of Labor, 200 Constitution Avenue NW., S-1303, 
Washington, DC 20210.
    Comments are available for public viewing on the Federal 
eRulemaking portal at https://www.regulations.gov or in person, during 
regular business

[[Page 45619]]

hours, by arranging with the contact person identified below.

FOR FURTHER INFORMATION CONTACT: Jennifer Sheehy, Deputy Assistant 
Secretary, Office of Disability Employment Policy, U.S. Department of 
Labor, 200 Constitution Avenue NW., S-1303, Washington, DC 20210, (202) 
693-7880, or visit https://www.dol.gov/dol/contact/contact-phonecallcenter.htm (TTY), for information about this notice.

SUPPLEMENTARY INFORMATION: 

Purpose

    Millions of American workers leave the workforce each year after 
experiencing an injury or illness.\1\ Hundreds of thousands of these 
workers go on to receive state or Federal disability benefits.\2\ Many 
injured or ill workers could remain in their jobs or the workforce if 
they received timely, effective supports.
---------------------------------------------------------------------------

    \1\ Bardos, Maura, Hannah Burak, and Yonatan Ben-Shalom. 
``Assessing the Costs and Benefits of Return-to-Work Programs.'' 
Final report submitted to the U.S. Department of Labor, Office of 
Disability Employment Policy. Washington, DC: Mathematica Policy 
Research, March 2015.
    \2\ Social Security Administration, ``Annual Statistical Report 
on the Social Security Disability Insurance Program, 2015.'' SSA 
Publication No. 13-11826. Washington, DC: Social Security 
Administration, October 2016.
---------------------------------------------------------------------------

    This request for information (RFI) offers interested parties--
including but not limited to states, community-based and other non-
profit organizations, philanthropic organizations, researchers, 
employers, health care providers with assorted training and 
specialties, private disability insurance providers, vocational 
rehabilitation specialists, and members of the public--the opportunity 
to provide information and recommendations to inform the development of 
a potential grant program aimed at reducing long-term disability and 
increasing labor force participation among workers who are injured or 
become ill while employed.

Background

    The President's 2018 budget supports a demonstration to test 
promising Stay-at-Work/Return-to-Work (SAW/RTW) strategies aimed at 
improving labor force participation, employment, and earnings outcomes 
for workers who are injured or become ill.
    The proposed demonstration program is modeled after promising 
programs in Washington State including the Centers for Occupational 
Health and Education (COHE) \3\ and the Early Return to Work \4\ (ERTW) 
and Stay at Work programs.\5\ Projects funded through the proposed 
demonstration project, however, would include additional connections to 
existing employment services and supports provided through the 
workforce development system.
---------------------------------------------------------------------------

    \3\ https://www.lni.wa.gov/ClaimsIns/Providers/ProjResearchComm/OHS/default.asp.
    \4\ https://www.lni.wa.gov/ClaimsIns/Insurance/Injury/LightDuty/Ertw/Default.asp.
    \5\ https://lni.wa.gov/Main/StayAtWork/.
---------------------------------------------------------------------------

    COHE, which is funded by Washington's workers' compensation system, 
provides early intervention and RTW services for individuals with work-
related health conditions. An evaluation of the COHE pilot in the early 
2000s produced promising results: COHE participants were less likely to 
be off work and on disability benefits one year after the claim, and 
combined medical and disability costs were reduced by $510 per claim 
for COHE participants. The magnitude of these reductions was greater 
for back sprain cases (a common occupational injury): the relative risk 
of being off work and on disability at one year was 37 percent lower 
for back sprain COHE patients, and disability costs for back sprains 
were reduced by $542 per case.\6\ Preliminary analysis indicated that 
at the eight-year mark, 26 percent fewer COHE claimants received Social 
Security Disability Insurance (SSDI) benefits.\7\
---------------------------------------------------------------------------

    \6\ Wickizer, T.M., Franklin, G., Fulton-Kehoe, D., Gluck, J., 
Mootz, R., Smith-Weller, T., and Plaeger-Brockway, R. (2011) 
``Improving Quality, Preventing Disability and Reducing Costs in 
Workers' Compensation Healthcare: A Population-based Intervention 
Study.'' Medical Care, Vol. 49, No. 12, pp. 1105-1111.
    \7\ Franklin, G.M., Wickizer, T.M., Coe, N.B, and Fulton-Kehoe, 
D. (2015) ``Workers' Compensation: Poor Quality Health Care and the 
Growing Disability Problem in the United States.'' American Journal 
of Industrial Medicine, 58: 245-251.
---------------------------------------------------------------------------

    The ERTW program and Stay at Work programs in Washington State 
provide related assistance. The ERTW program helps injured and ill 
workers RTW as soon as medically possible by providing access to a team 
of vocational services consultants, therapists, and nurse consultants 
to assist with developing and implementing medically appropriate RTW 
options. The Stay at Work program is a financial incentive program that 
reimburses employers for some of their costs when providing temporary, 
light-duty jobs for injured workers while they heal.
    This demonstration will draw from and test key features of the 
Washington COHE model and ERTW and Stay at Work programs, in other 
states and/or for a population beyond workers' compensation (i.e., for 
non-occupational injuries and illnesses). To do that, we anticipate 
funding states to operate one or more COHE-style programs, or fund the 
expansion of existing programs, with an increased emphasis on access to 
employment-related supports. The ultimate policy goal is to increase 
employment and labor force participation of individuals with work 
disabilities, and to identify and/or confirm effective strategies for 
doing so. For the purposes of this RFI, the term ``work disability'' is 
defined as an illness, injury, or medical condition that is anticipated 
to inhibit or prevent continued employment or labor force 
participation.
    This RFI offers interested parties the opportunity to provide 
recommendations on effective approaches for the design and 
implementation of the demonstration project. We expect that public 
input provided in response to this request will assist us in defining 
the scope and design of the demonstration project. For example, a 
demonstration project could test whether elements of the COHE workers' 
compensation model, which focus on immediate or early intervention, 
could be combined with re-employment services provided through the 
American Job Centers for the subset of participants who do not return 
to work within 90 days so that they could obtain additional employment 
services and supports to maintain a workforce attachment. The RFI 
specifically seeks public input on how the proposed demonstration 
projects can best be designed to promote labor force attachment, 
coordinate employment and health services, and support injured and ill 
workers in returning to and remaining at work.
    Background on the COHE model and Early Return to Work and Stay at 
Work programs:
    As the proposed demonstration is based on elements from Washington 
State's COHE, ERTW, and Stay at Work programs, the following background 
material is provided about these programs. There are six COHE centers 
across the state of Washington, including some housed in large medical 
systems and others that are community-based. Each of these centers \8\ 
recruits and trains health care providers in their area--often 
orthopedists or other doctors specializing in treating workers' 
compensation (WC) patients. COHE started as a small pilot in two 
regions and has grown to currently include about 3,500 health care 
providers who cover about 60 percent of all WC claims in the state. 
Injured workers retain health care provider choice. They

[[Page 45620]]

receive COHE services if they choose a COHE-affiliated provider for 
their care.
---------------------------------------------------------------------------

    \8\ Grantees will not be required to establish a ``center'' or 
new entity as part of the demonstration.
---------------------------------------------------------------------------

    Given that health care providers often see relatively few patients 
who are at risk of labor force separation due to their illness or 
injury, many may have limited knowledge and resources to address the 
employment-related needs of this population. Health care providers 
affiliated with COHE, however, receive training in occupational health 
best practices for these cases, including the following four best 
practices:
    1. Submitting a complete Report of Accident (ROA) in two business 
days or less;
    2. Developing an activity plan, which communicates the worker's 
ability to participate in work activities, activity restrictions, and 
the provider's treatment plans;
    3. Communicating directly with employers when injured workers are 
absent or expected to be absent from work; and
    4. Assessing the injured worker's barriers to return to work and 
developing a plan to overcome them.
    Health service coordinators are integral to the success of the COHE 
model. The program is based on the MacColl chronic care model.\9\ 
Successful health service coordinators are skilled in vocational 
rehabilitation and motivational interviewing and work directly with 
injured workers, employers, health care providers, and other 
stakeholders to coordinate care and RTW activities for injured workers. 
They also help stakeholders navigate the workers' compensation system 
by performing claim coordination functions, such as ensuring forms are 
received and complete and contacting stakeholders as needed for 
clarifications or follow-up. Health service coordinators frequently 
contact injured workers, employers, health care providers, state agency 
staff, and other stakeholders to help with the RTW process, and 
identify barriers to returning to work and resources to resolve them. 
The RTW activities they coordinate for the patient can include 
functional assessments, referrals to existing training and employment 
services, and setting appropriate RTW expectations. Health service 
coordinators also educate employers on the financial and other benefits 
of retaining injured workers and can refer employers to the ERTW and 
Stay at Work programs for resources and financial incentives to help 
them with job accommodation. The health service coordinators monitor 
all cases, but focus on those at risk for long-term disability, 
typically less than a quarter of all cases. The health service 
coordinator role is critical and depends heavily on the neutrality of 
health service coordinators in helping the health care and RTW system 
work effectively for patients, employers, health care providers, and 
the insurer. This neutrality allows health service coordinators to be 
trusted by the various stakeholders, allowing health service 
coordinators to maximize the likelihood of the best-case recovery and 
employment outcome.
---------------------------------------------------------------------------

    \9\ See https://www.improvingchroniccare.org/index.php?p=The_Chronic_Care_Model&s=2.
---------------------------------------------------------------------------

    As a program based in the medical system, COHE depends heavily on 
project champions among sponsoring health care organizations' 
leadership to create organizational buy-in and support. Additionally, 
each COHE participates in a Regional Business-Labor Advisory Board that 
ensures community support and solicits input from local business and 
labor interests.
    Key features of the COHE model of interest to the proposed 
demonstration include:
    1. Coordination of services, including enhanced stakeholder 
communication, RTW planning, and identification of potential delays and 
solutions to keep treatment and RTW plans on track;
    2. Physician training on occupational health best practices;
    3. Incentives for physicians to utilize the best practices for 
participating patients;
    4. A data management system allowing services coordinators real-
time access to all relevant information on each case to support 
effective triage, population monitoring, and case management.
    The ERTW program helps injured and ill workers RTW as soon as 
medically possible by providing access to a team of specialists 
including vocational services consultants, therapist consultants, and 
nurse consultants who assist health care providers and employers 
develop and implement medically appropriate RTW options. Resources 
available to employers include risk management specialists, safety 
consultants to provide on-site consultations, and job modification 
funds. By providing these resources, the ERTW program speeds the 
worker's recovery and reduces the financial impact of a workers' 
compensation claim on the worker, the employer, and the workers' 
compensation system.
    The Stay at Work program incentivizes employers to offer temporary 
light-duty work to injured employees while they heal, by reimbursing 
the employers for some of the costs of providing such jobs. Eligible 
employers can be reimbursed for 50 percent of the base wages they pay 
the injured worker and some of the cost of training, tools, or clothing 
the worker needs to do the light-duty or transitional work.
    The COHE model focuses services on the first 12 weeks after injury 
because this period is most critical in maximizing the likelihood of 
RTW. While the proposed demonstration builds upon the COHE model and 
the ERTW and Stay at Work programs, it differs from the original model 
by adding an extended focus on employment services and supports and a 
strong and purposeful involvement of the workforce development system.

Potential Project Scope

    DOL and SSA anticipate three acquisitions for this project: 
Implementation grants awarded via a cooperative agreement, a technical 
assistance contract to support grantees, and an evaluation contract. 
The agencies anticipate implementing the demonstration in two to three 
states representing diverse programmatic contexts and with the ability 
to provide meaningful analyses and policy recommendations. There would 
be a separate technical assistance (TA) contract to assist states with 
implementation and a separate integrated evaluation contract to 
evaluate all of the sites and address specific research goals. For the 
purposes of this RFI, the implementation grantees are referred to as 
the ``projects,'' the technical assistance contractor is referred to as 
the ``TA provider,'' and the evaluation contractor is referred to as 
the ``evaluator.''
    We anticipate designing this demonstration to solicit innovative 
projects that create systems changes by targeting individuals when they 
are in the early stages of developing a work disability, and assisting 
them in maintaining a connection to the labor force, preferably through 
their current or most recent employer. Projects will be encouraged to 
build upon existing programs or systems, such as state-based temporary 
disability insurance (TDI) programs, collaborative health care 
organizations, disability management insurance providers, or workers' 
compensation programs. We would also encourage projects to think 
broadly about new and effective ways to prevent the development of 
long-term work disability. The solicitation will leave flexibility for 
applicants to develop their own projects that adapt to the specific 
programmatic, demographic, and economic contexts of their state or 
region while also satisfying the project's requirements.

[[Page 45621]]

    Preliminary required design elements of the demonstration are 
described below. We encourage public input and comment on these 
elements in response to the questions in the following section.
    Overview: We anticipate funding implementation grants in two to 
three states to either operate one or more projects with key elements 
drawn from the COHE model and the ERTW and Stay at Work programs, with 
an added emphasis on access to employment-related services and 
supports, or the expansion of similar existing programs to include 
increased access to employment-related supports and services. The 
ultimate policy goal is to increase employment and labor force 
participation of individuals with work disabilities through timely and 
effective coordination of health care and employment-related services. 
Each grantee would be responsible for identifying, recruiting, and 
training health care providers within their geographic area, and 
incentivizing their use of occupational health best practices for 
eligible workers. In addition, each grantee would be responsible for 
providing and supporting return to work service coordinators who will 
coordinate and facilitate the RTW process for eligible workers. 
Grantees would also be responsible for providing a centralized data 
collection and reporting system for the efficient management of the 
care and RTW coordination system, and to support the evaluation of the 
program.
    We anticipate requiring funded projects to include the following 
treatment elements:
     Coordination of services, including enhanced stakeholder 
communication, RTW planning, and identification of potential delays and 
solutions to keep treatment and RTW plans on track;
     Health care provider training on occupational health best 
practices that COHE uses;
     Incentives for health care providers to utilize the 
specified best practices for participating patients;
     Possible incentives for employers to actively participate 
in worker retention and other RTW efforts through utilization of 
strategies such as temporary light-duty jobs, job modifications, and 
job-banking;
     Provision of, or facilitated access to, employment-related 
services and supports (such as needs assessments, skill assessments, 
accommodations, job coaching, job search assistance if not remaining 
with original employer) and training;
     Engaging key stakeholders (e.g., the business community, 
labor representatives) up front and on an ongoing basis; and
     A data management system that:
    [cir] (1) allows service coordinators real-time access to all 
relevant information on each case for purposes of triage, individual 
case management, and population health monitoring, including on 
disability time loss duration; and
    [cir] (2) supports the evaluation of the project.
    Eligible grant applicants: We anticipate requiring each project and 
application to have a state agency designated as the lead coordinating 
entity. The lead agency would be required or encouraged to form 
partnerships with other public or private organizations, such as DOL-
funded employment-service providers, state vocational rehabilitation 
agencies, private non-profit organizations, health care providers/
organizations, other public or private organizations, state and local 
Workforce Investment Boards, and county or municipal-level governments 
as appropriate.
    Population: Each project would be required to identify and clearly 
define its target population, including showing that the population has 
a substantial risk of developing a long-term work disability, and/or 
transitioning to Social Security Disability Insurance (SSDI) or 
Supplemental Security Income (SSI), such that the intervention could 
change their employment outcomes. Projects are encouraged to include 
workers with active state TDI or workers' compensation claims, or those 
using paid leave, as well as broader populations of workers 
experiencing the onset of a medical condition that could result in a 
work disability. The target population must be clearly identifiable 
using existing administrative records, easily completed screening 
forms, or an information management system, and there must be a clear 
mechanism that triggers the start of services.
    Participant Recruitment: Each grantee would propose a recruitment 
plan for outreach and enrollment of worker participants based on their 
target population and their project design. Grantees would be required 
to be able to recruit a sufficient number of worker participants to 
allow for a meaningful assessment of the impact of the intervention. 
Applicants would also be required to recruit and have signed MOUs or 
letters of intent with project partners, including partnering health 
care providers.
    Evaluation Design: We anticipate carrying out an impact and 
implementation study to understand how the programs are implemented, 
service components, who is being served, the extent to which those 
served experience improved outcomes (including labor market outcomes, 
receipt of SSDI/SSI), and a cost-benefit analysis. The impact study 
would include a process evaluation and participation analysis in order 
to assess the implementation and fidelity of the program and general 
interest and take-up rates across the project sites. The evaluation 
design would be finalized once the evaluator is secured and would take 
into account the specifics of the funded projects. All projects would 
be required to fully cooperate with and participate in the evaluation.
    Data collection: Projects would be required to provide for 
centralized data collection to capture care management, RTW 
coordination information, and measures and outcomes of interest to the 
evaluation. The evaluation contractor would be provided access to this 
data. A data management system would be required to allow the service 
coordinators and others in the intervention to have real-time access to 
all relevant information on each case in order to effectively triage, 
monitor, and intervene as needed on a timely basis. Projects would be 
encouraged to use or adapt existing centralized data systems.
    Evaluation: We anticipate evaluating projects on two primary 
research questions:
     Does the intervention improve employment outcomes compared 
to the control group?
     Does the intervention reduce application to Social 
Security Disability Insurance (SSDI) or Supplemental Security Income 
(SSI)?
    Below are additional research questions of interest, which may not 
all be answered by the initial evaluation of the proposed 
demonstration:
     Does the intervention increase labor force participation 
of participating workers?
     Does the intervention increase labor force attachment of 
participating workers?
     Does the intervention reduce labor force exit of 
participating workers?
     Does the intervention maintain or result in increased 
wages of participating workers?
     Does the intervention improve the ability of participating 
workers to maintain hours of work?
     Does the intervention reduce medical, time lost, or 
litigation costs?
     What are optimal and efficient methods to identify target 
populations at risk of exiting the labor force that will benefits from 
the intervention?
     What is the best timing to engage a worker effectively 
while also minimizing cost?

[[Page 45622]]

     What recruitment methods are most effective to engage a 
target population?
     Does the intervention decrease SSDI or SSI allowance 
rates?
     What elements of the intervention are most influential in 
determining success (i.e., improved employment outcomes and reduced 
need for SSDI or SSI benefits)?
     What environmental factors are necessary for successful 
implementation of the intervention?
     What are the cost effective and efficient interventions 
that reduce workers exit from the labor force?
     What are the effective and efficient strategies to 
incentivize employers to actively retain workers with injuries and 
health conditions?
     What are effective and efficient strategies to create buy-
in from health care providers that work is an important health care 
outcome?

Request for Information

    This request for information (RFI) seeks public input on how the 
proposed demonstration projects can best be designed to promote labor 
force attachment, coordinate employment and health services, and 
support injured and ill workers in returning to and remaining at work. 
Through this notice, we are soliciting feedback from interested parties 
on the scope and design of a potential demonstration project related to 
providing coordinated occupational health and employment services to 
individuals who become injured or ill while employed in order to enable 
them to remain in the labor force, thereby improving their employment 
and earnings outcomes and maximizing their self-sufficiency. Responses 
to this request will inform decisions about the development, design, 
and evaluation of the potential demonstration project.
    This notice is for internal planning purposes only and should not 
be construed as a solicitation or as an obligation on the part of the 
Department of Labor or any participating Federal agencies. We ask 
respondents to address the following questions, where possible, in the 
context of the discussion in this document. You do not need to address 
every question and should focus on those that relate to your expertise 
or perspectives. To the extent possible, please clearly indicate which 
question(s) you address in your response. We ask that each respondent 
include the name and address of his or her institution or affiliation, 
if any, and the name, title, mailing and email addresses, and telephone 
number of a contact person for his or her institution or affiliation, 
if any.

Questions

I. Intervention Elements

    1. Are there potential issues with the treatment elements listed 
under ``required treatment elements'' on pages 6-7? Should any not be 
required? What other elements might be useful, and what is the evidence 
base for them? What additional optional services and supports could 
grantees choose to include in the model? What is the existing evidence 
documenting the effectiveness of these additional optional services and 
supports?
    2. What should be the required and optional roles and 
responsibilities of the RTW service coordinator in implementing the 
treatment elements?
    3. Where should the role of a RTW service coordinator be housed in 
order to most effectively accomplish its goals, including an ability to 
maintain neutrality? For example, should service coordinators be 
employed by health care provider networks, by the public workforce 
system, by private disability insurance providers, by employers, or by 
another entity?
    4. Should there be educational and/or experience requirements for 
the RTW service coordinators, such as vocational counseling or public 
health backgrounds? How should these educational and experience 
requirements parallel and differ from those of health navigators, 
community health workers, and vocational rehabilitation counselors?
    5. What specific employment-related interventions should be 
required or allowed? What evidence supports these interventions as 
effective in early intervention for these populations? When referrals 
to existing employment-related service providers occur, will these 
providers have sufficient capacity and funding to provide services in a 
timely manner to referred individuals?
    6. The COHE model focuses interventions primarily in the first 12 
weeks after injury/illness (with occasional exceptions allowing up to 
26 weeks). For a demonstration such as this requiring increased 
involvement of the workforce development system, what is the optimal 
timing and length of intervention? Why, or what is the evidence base?
    7. Employment services (such as needs assessments, skill 
assessments, accommodations, job coaching, job search assistance if not 
remaining with original employer) and the public workforce system are 
important elements of the proposed demonstration program. What is the 
optimal time to provide employment services? For example, should 
employment services be provided during the same time window as the 
health care services/coordination, or afterwards? How can the RTW 
service coordinators best facilitate the effective use of employment 
services?
    8. What role should employer incentives play in this intervention? 
Are there particular employer incentives that we should consider in 
projects where workers' compensation insurance premiums play a limited 
role? Are there effective non-financial ways to engage and incentivize 
employers to support and implement SAW/RTW programs within their 
workplaces?
    9. What is an appropriate health care provider payment or fee 
structure to incentivize the specific occupational health best 
practices and to encourage a focus on employment as a health outcome? 
Are there models other than fee-for-service that would be appropriate 
and feasible, such as basing payments on process and/or outcome 
metrics? How would these models operate in the context of managed-care 
organizations?
    10. How can health systems and health care providers be better 
incentivized to consider employment a valid health outcome? What is the 
recent relevant evidence documenting the effectiveness of incentive 
models (including financial or other incentives) that include 
employment as an outcome?

II. Target Population and Sites

    11. What is an appropriate age range of participants to target for 
this demonstration project? For example, should the demonstration 
projects target prime-age workers (25-54)? Why or why not?
    12. What populations of RTW participants--such as those listed 
below--should be allowed, encouraged, or required in the demonstration? 
Why should the populations you recommend be included? Are there 
populations of RTW participants that you would not recommend?
    [ssquf] Individuals with active state-based TDI claims?
    [ssquf] Workers accessing FMLA benefits (except for pregnancy and 
caring for others)?
    [ssquf] Individuals with active WC claims?
    [ssquf] Others (not participating in WC or TDI) experiencing the 
onset of a medical condition that could affect their connection to the 
workforce?
    13. How should the target population described above be 
specifically defined and cleanly identified? We are particularly 
interested in how to define an appropriate population that is not 
limited to individuals with state-based

[[Page 45623]]

TDI claims or WC. What are the most appropriate eligibility criteria 
(such as time off work, type of condition, type of employment) to 
identify such individuals? What kinds of ``triggers'' would work for 
the population as a mechanism for enrollment into the project?
    14. Are there specific functional risk assessment instruments that 
you recommend using for this project? What are the benefits and 
limitations of those instruments? How might they be used to identify 
the target population here or form the basis for an RTW plan?
    15. Are there aspects of your state's TDI, paid leave, FMLA, WC, or 
other state programs that would pose particular advantages or 
challenges for identifying workers who might benefit from an 
intervention like the one discussed above? Are there aspects of these 
programs that would pose particular advantages or challenges for 
collecting data on treatments, services, and outcomes for a project 
like this?
    16. Should the target population be limited to individuals with 
certain types of medical conditions, such as musculoskeletal conditions 
and chronic health conditions? Why or why not?
    17. How should project service areas be defined? For example, 
should demonstrations be carried out state-wide, in specific counties, 
regions, or local communities? Would these service areas have a large 
enough target population for evaluation purposes?
    18. What types of entities would be the most beneficial to consider 
partnering with to provide the COHE-style services, and why? Examples 
could include large health-care systems, collections of small health 
care provider offices, private self-insured employers with in-house 
disability management, vocational rehabilitation providers, accountable 
or managed care organizations, federally qualified community health 
centers, community based organizations, and urgent care centers.

III. Eligible Applicants

    19. What types of state government entities are the most logical or 
well-positioned to serve as the primary applicant and fiscal agent? 
What is the best way to organize the structure of a demonstration like 
the one described above in your state? What structure would best enable 
effective leadership, responsibility, and accountability for the 
project? Would a single agency be the natural lead for the project?
    20. Similar state functions may be housed in different agencies, 
depending on the state. Should key functions be required, rather than 
specific agencies? If so, what functions should be required?
    21. Should groups of states be allowed to jointly apply? Why or why 
not?
    22. Could a non-state (i.e., county or local government) or non-
governmental (i.e., non-profit or private organization) entity serve as 
the primary applicant and fiscal agent? If so, what characteristics 
should be required of such entities? Would this be preferable to a 
state governmental agency serving in this role? Why or why not?
    23. The COHE model in Washington operates within a monopolistic WC 
system, which allows for centralized participant controls, service 
management, and data collection. Would states with other WC models, 
such as privately managed and competitive WC markets, be able to 
feasibly implement a similar model, particularly with regard to data 
collection? If so, how? Would states with short-term or temporary 
disability insurance programs or states with mandatory paid sick leave 
be able to do so, and how? In other words, should grant applicants be 
limited to states with specific characteristics, and why or why not?
    24. What partners, public or private, should be required or 
encouraged as part of the demonstration project? What other entities 
might be beneficial as collaborators? In what ways could they assist?

IV. Evaluation and Design Issues

    25. Are there research questions, not specified above, that could 
be answered through the evaluation which would improve understanding of 
ways to better serve and increase employment and labor force 
participation of individuals with work disabilities?
    26. What entity would be most successful in recruiting participants 
who have a qualifying injury or health condition (that makes them at 
risk for leaving the labor force)? Examples could include an insurance 
company, state TDI or WC insurance providers, an employer, or a health 
care provider.
    27. Do health systems and/or health care providers utilize risk 
predictors to target specific types of services? If so, which 
predictors are used, and for which services? Are any employment- or 
SAW/RTW-related?
    28. If a cluster-randomized design is used for an experimental 
impact evaluation, how could the unit of randomization be defined and 
operationalized within various types of grantee sites? Are there other 
evaluation designs (randomized or not) that would be more feasible 
(e.g. quasi-experimental design)? If so, how could a potential 
comparison group be identified? If other randomized designs are 
recommended, what are potential units for random assignment and points 
at which assignment would occur?

Rights to Materials Submitted

    By submitting material in response to this notice, you agree to 
grant us a worldwide, royalty-free, perpetual, irrevocable, 
nonexclusive license to use the material, and to post it publicly. 
Further, you agree that you own, have a valid license, or are otherwise 
authorized to provide the material to us. You should not provide any 
material you consider confidential or proprietary in response to this 
notice. We will not provide any compensation for material submitted in 
response to this notice.

Jennifer Sheehy,
Deputy Assistant Secretary for Disability Employment Policy.
[FR Doc. 2017-20338 Filed 9-28-17; 8:45 am]
 BILLING CODE P