Request for Information: Administration for Children and Families Development of Interoperability Standards for Human Service Programs, 85540-85545 [2024-24924]
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Federal Register / Vol. 89, No. 208 / Monday, October 28, 2024 / Notices
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2024.
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ADDRESSES:
FOR FURTHER INFORMATION CONTACT:
William Parham at (410) 786–4669.
Under the
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SUPPLEMENTARY INFORMATION:
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comply with this requirement, CMS is
publishing this notice that summarizes
the following proposed collection(s) of
information for public comment:
1. Type of Information Collection
Request: Revision with change of a
currently approved collection; Title of
Information Collection: Part C Medicare
Advantage Reporting Requirements;
Use: The Centers for Medicare and
Medicaid Services (CMS) established
reporting requirements for Medicare
Advantage Organizations (MAOs) under
the authority described in 42 CFR
422.516(a). Each MAO must have an
effective procedure to develop, compile,
evaluate, and report to CMS, to its
enrollees, and to the general public at
the times and in the manner that CMS
requires. At the same time, each MAO
must, in accordance with 42 CFR
422.516(a), safeguard the confidentiality
of the provider-patient relationship.
Health plans can use this information
to measure and benchmark their
performance. CMS receives inquiries
from the industry and other interested
stakeholders about the beneficiary use
of available benefits, including
supplemental benefits, grievance and
appeals rates, cost, and other factors
pertaining to use of government funds,
as well the performance of MA plans.
Form Number: CMS–10261 (OMB
control number: 0938–1054); Frequency:
Yearly; Affected Public: Business or
other for-profits; Number of
Respondents: 783; Total Annual
Responses: 7,830; Total Annual Hours:
225,575. (For policy questions regarding
this collection contact Lucia Patrone at
410–786–8621 or Lucia.Patrone@
cms.hhs.gov).
William N. Parham, III,
Director, Division of Information Collections
and Regulatory Impacts, Office of Strategic
Operations and Regulatory Affairs.
[FR Doc. 2024–25015 Filed 10–25–24; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Administration for Children and
Families
Request for Information:
Administration for Children and
Families Development of
Interoperability Standards for Human
Service Programs
Office of the Chief Technology
Officer, Administration of Children and
Families, Department of Health and
Human Services.
ACTION: Request for information (RFI).
AGENCY:
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The Administration for
Children and Families (ACF), in the
U.S. Department of Health and Human
Services (HHS), invites public
comments to inform the use or adoption
of interoperability standards for human
services programs. ACF and state, local,
and tribal governments all provide a
number of health and human services
programs for children, youth, families,
communities, and individuals. ACF
seeks public comment on the most
effective approaches, technical
standards, and technological tools that
currently or could promote
interoperability between health and
human services programs. ACF
collaborates with the Assistant Secretary
for Technology Policy/Office of the
National Coordinator for Health
Information Technology (ASTP/ONC) as
a critical steward and advisor for human
services interoperability with
responsibility for leading the
development and harmonization of
interoperability standards between
health and human services in line with
the HHS Data Strategy. The potential of
interoperability across the full spectrum
of health and human services is
immense—it can enable efficient
delivery of government services,
enhance access to critical non-profit
programs, and most importantly,
improve overall individual and
community outcomes. ACF has
authority under the Title IV of the
Social Security Act to designate use of
interoperable data standards for several
of its programs (e.g., Temporary
Assistance for Needy Families (TANF),
child support, child welfare, and foster
care). The purpose of this RFI is to
understand how ACF, in collaboration
with ASTP/ONC, can better support
interoperability between human
services within and across states and
local community resources, between
states, and ACF.
DATES: Comments are due within 60
days of publication.
ADDRESSES: Submit responses to
DataRx@acf.hhs.gov, a federal mailbox
allowing the public to submit comments
on documents agencies have published
in the Federal Register and are open for
comment. Simply type ‘‘ACF-2024Interoperability-RFI’’ in the Comment or
Submission search box, click Go, and
follow the instructions for submitting
comments.
Comments submitted in response to
this notice are subject to the Freedom of
Information Act and may be made
available to the public. For this reason,
please do not include any information
of a confidential nature, such as
sensitive personal information or
SUMMARY:
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proprietary information. If you submit
your email address, it will be
automatically captured and included as
part of the comment placed in the
public docket. Please note that
responses to this public comment
request containing any routine notice
about the confidentiality of the
communication will be treated as public
comments that may be made available to
the public, notwithstanding the
inclusion of the routine notice.
SUPPLEMENTARY INFORMATION:
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1. Background
The Administration for Children and
Families (ACF) requests comments to
inform the use of interoperable data
standards across human services
programs. This will improve the quality
of service delivery and increase
efficiency in collaborations between
agencies administering ACF programs
and other government and nongovernment agencies that serve the same
populations.
1.1 Regulation Development Process
The data exchange standardization
requirements under the Social Security
Act Title IV programs of child welfare
and foster care (Titles IV–B and IV–E),
child support (Title IV–D), and
Temporary Assistance for Needy
Families (TANF, Title IV–A) result from
Public Laws 112–34,1 112–96,2 113–
183,3 and 115–123.4 These laws require
the designation of interoperable
standards for data that must be
exchanged: (1) between states and ACF;
and/or (2) between states under
specified programs.
ACF’s Office of the Chief Technology
Officer (OCTO) will lead the drafting of
any regulations with respect to the
programs described above with subject
matter expertise from ACF program
offices including, but not limited to, the
Children’s Bureau (CB), Family and
Youth Services Bureau (FYSB), Office of
Early Childhood Development (ECD),
Office of Child Care (OCC), Office of
Head Start (OHS), Office of Child
Support Services (OCSS), Office of
Community Services (OCS), Office of
Family Assistance (OFA), and Office of
Family Violence and Prevention
Services (OFVPS).
Additionally, OCTO will coordinate
and consult on the input received in
response to this RFI both with the
ASTP/ONC and with other agencies
executing programs and policies
involving human services interoperable
data standards, such as the Centers for
Medicare & Medicaid Services (CMS),
Administration for Community Living
(ACL), and the Health Resources and
Services Administration (HRSA).
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ASTP/ONC enable standards on
behalf of HHS under section 3004 of the
Public Health Service Act (PHSA) in
45 CFR part 170 Subpart B. As lead for
the development and harmonization of
interoperability standards between
health and human services, ASTP/ONC
may enable standards for human
services which will be available for use
by any HHS program, including ACF.
Adopting standards in one location for
HHS use enables alignment across HHS
programs to further interoperability,
including alignment described under
Sections 13111 and 13112 of the Health
Information Technology for Economic
and Clinical Health Act (‘‘HITECH Act’’)
(Pub. L. 111–5, Title XIII, secs. 13111
and 13112).
1.2 For the Purposes of This Notice
Interoperability refers to the ability of
different information systems, devices,
or applications to connect, in a
coordinated way, within and beyond
organizational boundaries to access,
exchange, and use data in a cooperative
way between stakeholders, with the aim
of optimizing the health and wellbeing
of individuals and populations (adapted
from HIMSS, 2019).5 The definition of
interoperability in section 4003 of the
21st Century Cures Act calls for all
electronically accessible information to
be accessed, exchanged, and used
without special effort on the user’s part
(Pub. L. 114–255).
Standards, for the purposes of this
RFI, refer to any documented,
consistent, and repeatable method for
exchanging data through technical or
non-technical means. There are
technical standards for electronic data
exchange, such as through data
exchange standards, including Health
Level Seven (HL7) Fast Healthcare
Interoperability Resources (FHIR®).
There are also standards of practice in
the context of business processes, such
as protocols for encryption, hashing, or
establishment of accessible websites.
These standards of practice are often
codified in policies, interagency
agreements, memoranda of
understanding, service-level
agreements, etc.
Human Services Interoperability
refers to the ability of health and human
service systems to exchange data for
service planning, coordination, delivery,
monitoring, and evaluation in an
automated, standards-based, and
integrated manner that improves
outcomes for children, families, and
communities. Human services refer to
programs that may not exclusively be
provided or funded by HHS but may
include those funded through other
federal agencies. Human services
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include a wide variety of programs and
services to enhance the quality of life,
promote well-being, and address the
needs of individuals and communities.
1.3 Purpose of Interoperable Data
Standardization for Interoperability
The purpose of designating
interoperable data standards is to ensure
all parts of the human services delivery
ecosystem can effectively and efficiently
exchange information between and
among programs for seamless service
delivery. Effective and efficient
information exchange can help
appropriately reach people and deliver
the right benefits, supporting
coordinated case management, benefits
enrollment, and new service delivery
models. Interoperability promotes many
objectives, from the availability of
higher quality, more recent data that can
be used to appropriately reach people
and deliver the right benefits to
coordinated case management, benefits
enrollment, and new service delivery
models.
Using timely and quality data, for
example, a child welfare caseworker
might be able to retrieve a family’s
current address from child support data
to locate the family for an in-person
visit or locate the non-custodial parent
for possible placement of the children.
Interoperable data standards between a
public child welfare agency with care
and custody of a child and a foster care
placing agency could ensure both
agencies have the most current
information on the child in care.
Interoperability can also help identify if
household composition has changed, or
a recipient has moved out of state, and
changes to benefits levels are needed.
For example, if a parent was reunited
with their children exiting foster care,
data sharing across information systems
would allow the TANF agency to update
the benefit eligibility for the family.
Widespread adherence to data standards
can enable better interoperability and
reduce the burden of connecting
disparate systems containing the
information described in this example.
Interoperable data standards can also
help to facilitate initiatives. For
example, a Medicaid applicant works
with a health insurance navigator
during the annual Marketplace
enrollment period and participates in a
Social Determinants of Health (SDOH)
questionnaire with the navigator, who
recognizes that the applicant is
experiencing challenges in securing
adequate food and necessary clothing.
The navigator could pre-fill an
enrollment application for SNAP
benefits and provide information to
complete the enrollment. Also, the
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navigator can provide the Medicaid
applicant with the local food bank’s
name, location, phone number, and a
resource for the community clothing
closet. Further, with the Medicaid
applicant’s consent, the navigator can
send an electronic message or alert to
the local non-profits identified in a
statewide network of non-profit
community resources, allowing
receiving organizations to reach out to
the applicant to determine if they need
additional support to get connected
with services. Common standards can
help simplify the complex interactions
between different systems described in
this scenario and ensure scalability as
new entities seek to participate in the
exchange.
ACF believes that designating
nationally recognized interoperable data
standards in the programs described
above will make it easier to share data
across multiple organizations. While
likely more effective and cost-effective
in the long run, ACF also recognizes
that this approach may initially involve
financial and time costs related to
updating proprietary systems to use
open standards. Therefore, as part of
any future ACF programmatic and
policy development, and in
coordination with ASTP/ONC, ACF
seeks to strike the appropriate balance
between the benefits of interoperability
and standardization and ease of
implementation.
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2. Legal Authority
Federal statutes require ACF to
designate interoperable data standards
to promote data exchange in state
human services programs at the state
level and with the federal government.
Most recently, the Family First
Prevention Services Act (FFPSA),
enacted as part of Public Law (Pub. L.)
115–123, authorized optional Title IV–
E funding for time-limited prevention
services for mental health, substance
abuse, and in-home parent skill-based
programs for children or youth who are
candidates for foster care, pregnant or
parenting youth in foster care, and the
parents or kin caregivers of those
children and youth. This law amended
Title IV–B of the Social Security Act to
require that ACF must ‘‘designate data
exchange standards to govern . . . (1)
necessary categories of information that
State agencies operating programs under
State plans approved under this part are
required under applicable Federal law
to exchange with another State agency
electronically; and (2) Federal reporting
and data exchange required under
applicable Federal law’’ (42 U.S.C.
629m(a)).
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The statute further provides that ACF
shall incorporate, to the extent practical,
interoperable standards developed and
maintained by intergovernmental
partnerships and federal agencies with
authority over contracting and financial
assistance. The data exchange reporting
standards shall incorporate a widely
accepted, nonproprietary, searchable,
computer-readable format; be consistent
with and implement applicable
accounting principles; be implemented
in a manner that is cost-effective and
improves program efficiency and
effectiveness; and be capable of being
continually upgraded as necessary (42
U.S.C. 629m(b)).
Additionally, ACF coordinates with
the ASTP/ONC in a manner consistent
with Sections 13111 and 13112 of the
HITECH Act to ensure alignment across
HHS and non-HHS agencies around
health IT standards ASTP/ONC adopts
on behalf of HHS under section 3004 of
the PHSA in 45 CFR part 170 Subpart
B. ACF coordinates with ASTP/ONC
pursuant to the provisions of the
HITECH Act above when adopting,
implementing, or upgrading health IT
systems used for the direct exchange of
individually identifiable health
information between agencies and nonFederal entities.
The extent of data elements that need
to be shared to enable improved service
delivery and program management often
exceeds the minimum legal
requirements. As described throughout
ACF’s Confidentiality Toolkit 6 in the
Applicable Federal Legislation sections,
data sharing beyond the minimum
regulatory requirements (as referenced
throughout this RFI) is permissible and
encouraged when practical use cases
exist.
3. Current Interoperability Standards
and Initiatives
3.1 FHIR and Gravity Project
HL7® Fast Healthcare Interoperability
Resources (FHIR®) is a rapidly maturing
interoperability standard based on
modern internet technology approaches.
FHIR goes beyond document-level
interoperability to data element-level
exchange. It uses standardized
application programming interface (API)
standards to facilitate interoperable data
standards, enabling more efficient
application development across
multiple device types. There is a
growing open-source community
developing around FHIR
implementation.7
Today, several stakeholder efforts are
underway to extend the use of FHIR to
support the interoperability of human
services information. For instance, the
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Gravity Project 8 is a stakeholder-led
initiative to identify and harmonize
social risk factor data for interoperable
electronic health information exchange.
The HL7 Gravity Accelerator 9
established codes for data elements such
as housing instability, food insecurity,
transportation insecurity, etc. It creates
a common terminology for exchanging
content related to non-medical factors
influencing health and human services
outcomes. Another HL7 group is the
Health and Social Services (HSS) Work
Group, supported by ACF, which is
focused on facilitating human services
data content further. A project
description of Enhancing the FHIR for
Social Services and Social Determinants
(EFSS) and a list of use cases can be
found in Appendices 1 and 2.
3.2 United States Core Data for
Interoperability (USCDI/USCDI+)
In the 21st Century Cures Act:
Interoperability, Information Blocking,
and the ONC Health IT Certification
Program final rule (85 FR 25642) 10
published in May 2020, ASTP/ONC
adopted the United States Core Data for
Interoperability (USCDI) 11 standard,
which describes a standardized set of
health data and constituent data
elements for nationwide, interoperable
health information exchange (85 FR
25669). USCDI is implemented in FHIR
by mapping data elements and value
sets to FHIR resources and
implementation guides through the US
Core Implementation Guide.12 ASTP/
ONC published Version 3 of the USCDI
in July 2022 13 and subsequently
adopted Version 3 as the new baseline
for the ASTP/ONC Certification Program
in the Health Data, Technology, and
Interoperability: Certification Program
Updates, Algorithm Transparency, and
Information Sharing (HTI–1) Final Rule
(89 FR 1210). Version 3 included new
data elements for social determinants of
health (SDOH), which includes SDOH
Problems/Health Concerns, SDOH
Interventions, SDOH Goals, and SDOH
Assessments. USCDI Version 4,
published in July 2023,14 added 20 data
elements to help address and mitigate
health and healthcare inequities and
disparities. Additional priorities for
USCD v4 were to address underserved
communities’ needs, behavioral health
integration with primary care and other
physical care, and public health
interoperability needs of reporting,
investigation, and emergency response.
Further, ASTP/ONC oversees the
USCDI+ 15 initiative to support
identifying and establishing domain, or
program-specific, datasets that build on
the existing USCDI. Specifically,
USCDI+ is a service that ASTP/ONC
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provides to federal and industry
partners to establish, harmonize, and
advance the use of interoperable
datasets that extend beyond the core
data in the USCDI to meet specific
programmatic and/or use case
requirements. This approach allows
ASTP/ONC to assure that new datasets
build from the same core USCDI
foundation, and allows for alignment of
similar data needs across agency
programs and corresponding data users
and/or participants at the state and local
levels.
3.3 Human Services Interoperability
Innovations (HSII) Demonstration
Program
ACF has focused on programmatic
investments to advance human services
interoperability. ACF’s Human Services
Interoperability Innovations (HSII)
demonstration program 16 was intended
to expand data-sharing efforts by state
and local governments, tribes, and
territories to improve human services
program delivery and to identify novel
data-sharing approaches that can be
replicated in other jurisdictions. These
investments enabled ACF to fund
entities to focus on addressing
longstanding barriers to interoperability
through cooperative agreements for the
HL7 Care Plan for Maternal Opioid
Misuse and the implementation of FHIR
operating systems necessary to support
Centers for Medicare and Medicaid
Innovation (CMMI) Integrated Care for
Kids model grantees in both New Jersey
and Connecticut.
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3.4 HL7 Human and Social Services
(HSS) Workgroup
ACF led the creation of the HL7
Human and Social Services (HSS)
Workgroup.17 The HSS Workgroup’s
mission is to provide a space to design
and validate HL7 interoperable human
services data standards. The group is
also developing a common format for
social services provider directory
information. This project maps the
definitions from Open Referral to the
FHIR standard using an FHIR Facade
before the Human Services Data API
(HSDA).
4. Proposed Direction for Developing
Interoperable Data Standards
The health sector has increasingly
looked to FHIR as a core standard,
catalyzed by the industry’s embrace of
FHIR and codified through the
incorporation of ASTP/ONC-certified
health IT systems featuring FHIR APIs
into CMS program requirements for use
of certified electronic health record
technology (CEHRT) (for instance,
Medicare Promoting Interoperability
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Program and the Promoting
Interoperability performance category of
the Merit-Based Incentive Payment
System (MIPS)),18 and ASTP/ONC’s
efforts to incorporate FHIR as part of the
technical requirements for the Trusted
Exchange Framework Common
Agreement (TEFCA).19 Given the need
for human services data to be
interoperable with health data to
support integrated case management at
the person level and in light of the
opportunity to significantly leverage
health sector infrastructure such as
Qualified Health Information Networks
(QHINs) and existing data exchange
pathways using FHIR, ACF is
considering the HL7 FHIR standard as
the foundation of data interoperability
for ACF-covered domains.
5. Request for Information
ACF seeks a more interoperable
human services data ecosystem with
available and shareable data between
care providers, programs, and the
government to drive improved outcomes
for children and families. To deliver
that goal, more consistent use of
interoperable standards and practices is
needed at all levels. ACF recognizes that
organizations may be limited in major
IT system transitions without significant
new funding. However, without
government-backed standards, pilots,
and processes, the current and future IT
systems will maintain and even
accelerate their current degree of
fragmentation. Therefore, ACF is
seeking input on how to support a drive
toward interoperability across the field
in economical, efficient, effective, and
reasonable ways.
ACF also seeks feedback on proposed
initial domain focus areas for standards
development and pilots. These focus
areas may encompass areas where HHS/
ASTP/ONC and ACF have formal
regulatory powers to set standards for
child welfare and foster care as well as
prevention, adoption and guardianship
(Title IV–B and IV–E), child support
(Title IV–D), and Temporary Assistance
for Needy Families (TANF, Title IV–A).
It also includes areas where ACF could
engage more actively with standards
development organizations, such as the
HL7 Human and Social Services (HSS)
Workgroup (currently focusing on food,
housing, and economic insecurity as its
priority use cases). We are interested in
receiving input affecting additional
programs.
ACF requests comments on the
following topics. Please comment or
respond to any questions that apply
from the perspective of your agency,
organization, program, or setting;
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commenters are not required to respond
to every question:
Input on specific topics
1. Practical enablers of/or barriers to
interoperability:
1.1 Provide examples of the key
enablers and/or inhibitors to using
interoperable human services data
standards (including data content and
data exchange) in your program or
agency.
1.2 How is the ability to exchange
human services data impacted by state
or federal law, policies, or other
governing frameworks (including CMS
Interoperability rules)?
1.3 What is the highest priority
legal, policy, or governance issues to be
addressed when moving to an
interoperable ACF environment? (e.g.,
minor consent, guardianship, Family
Education Rights and Privacy Act
(FERPA), privacy, security, sensitive
data, parental controls, etc.)
1.4 Describe any mitigation
strategies or policy levers that have
effectively moved interoperable human
services data exchange forward in your
organization, state, or program.
2. Impact of lack of human services
interoperable data standardization:
Provide examples of existing and
planned human services interoperable
data efforts and to what degree, if any,
does a lack of standardization negatively
impact them.
2.1 What interoperable data
standards are being used today in ACFfunded programs?
2.2 Describe any impediments
experienced in current systems when
accessing, analyzing, or sending data to
the federal level.
2.3 What are the benefits of moving
to a common interoperable data
standard like Fast Healthcare
Interoperability Resources (FHIR)?
3. Care coordination: ACF seeks
comments on current care coordination
activities and data standards to support
the interoperable data exchange for
service delivery, operations, and
reporting.
3.1 How do you currently use
interoperable data to support care
coordination across human services,
both between human services programs
and between human services and health
services? For example, are you able to
collect medical data for children who
have medical issues?
3.2 Describe use cases that benefit
from interoperable data standards for
advancing service coordination
activities among state and federal
programs (e.g., clinical, administrative,
operations). Tell us about systems
currently used that are API-enabled.
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3.3 What are the most important use
cases where interoperable data
standards or exchange protocols must be
piloted/validated?
3.4 What federal support would be
necessary or helpful to catalyze those
efforts?
4. Interoperable data standards
needed for operations and reporting:
ACF recognizes that not all systems
operate using interoperable data
standards, and as a result, not all
applications are capable of data
exchange. Since 2021, ACF has
sponsored an HL7 Human and Social
Services (HSS) workgroup to develop
data standards using FHIR
specifications for Human and Social
Services.
4.1 What ACF domains or programs
would benefit from using an
interoperable data standard for business
operation and reporting?
4.2 To what extent is the HL7 or the
HL7 FHIR standard used in ACF
programs today?
4.3 Will your organization
experience specific benefits or
drawbacks if an interoperable data
standard like FHIR is widely used in
ACF programs?
4.4 Should any domain or program
be exempt from using a standard like
FHIR?
5. Standards in practice: In cases
where human services data systems
currently use interoperable data
standards, describe how they do or do
not incorporate the following:
5.1 Interoperable standards
developed and maintained by an
international voluntary consensus
standards body such as HL7.
5.2 Interoperable standards
developed and maintained by
intergovernmental partnerships such as
the National Information Exchange
Model (NIEM).
5.3 Interoperable standards
developed and maintained by specific
federal agencies with authority over
contracting and financial assistance.
6. Intra- and inter-state human
services data sharing: Describe the types
of human services agencies in your state
that electronically exchange with other
states, state agencies, or community
organizations in healthcare or human
services within your state.
6.1 How are they aligned, or not,
with a specific industry standard(s), e.g.,
FHIR, to ensure ease of access and use
of interoperable data?
6.2 What types of systems and nonproprietary, open-data standards are
used to facilitate interoperability across
programs?
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6.3 Are there tools in use for
normalizing and/or harmonizing data to
standards?
6.4 Tell us about any significant data
quality and matching issues to be
addressed to make the data exchange
meaningful.
6.5 What additional infrastructure
would need to be developed to ensure
that data is interoperable and actively
exchanged?
7. Funding: Describe current funding
mechanisms that support or hinder
interoperable data systems’ design,
development, and implementation.
7.1 What types of funding have you
leveraged to design, develop, and
implement interoperable data systems
(e.g., Advance Planning Documents and
grants)?
7.2 What incentives or requirements
would be needed to drive key use cases
of data exchange once systems are
interoperable (e.g., data quality and/or
identity management)?
7.3 What barriers or challenges have
you encountered with these funding
mechanisms?
8. Technical Assistance: What
technical assistance have you leveraged
in designing, developing, and
implementing interoperable data
systems?
8.1 What technical assistance (such
as subject matter expertise in data
standards and coding/software
development) would be necessary to
move to an interoperable standard like
FHIR?
8.2 What top actions should the
federal government take to provide
technical assistance to encourage
human services interoperability?
9. United States Core Data for
Interoperability (USCDI/USCDI+):
Provide input to inform how ACF may
identify, create, and standardize human
services data elements leveraging the
ASTP/ONC USCDI+ initiative, HL7
FHIR, and relevant HHS policy levers,
including applicable regulations, to
improve interoperability for human
services programs. 9.1 How could an
initiative such as USCDI+ be leveraged
to harmonize human services data
needed for care coordination, program
evaluations, and reporting
requirements?
9.2 What is the highest priority use
case(s) that need further development in
USCDI+ and FHIR to address ACF’s
stakeholders’ needs?
9.3 What data elements are a high
priority to enable comprehensive case
management, including whole-person
care, referrals, and research?
9.4 What technical and policy
approaches effectively link human
services data to health IT codes and
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Sfmt 4703
value sets to help improve
interoperability, and use across multiple
systems and domains?
10. General questions—Provide input
on the current state of data that your
organization receives and/or exchanges.
10.1 What information do you
exchange, if any, and from whom?
10.2 What information to you
currently collect and from whom?
10.3 What information do you need
to exchange, that you have trouble
exchanging and with whom? How does
that challenge impact your work,
community, etc.?
11. Other considerations: ACF
welcomes comments on other aspects of
recognizing and establishing
interoperable data standards for human
services programs you wish to provide.
Kevin M. Duvall,
Chief Technology Officer, Administration of
Children and Families.
Endnotes
1 Public Law 112–34—Child and Family
Service Improvement and Innovation Act.
(2011). Retrieved from https://
www.govinfo.gov/app/details/PLAW112publ34/summary.
2 Public Law 112–96—Middle Class Tax
Relief and Job Creation Act. (2012). Retrieved
from https://www.govinfo.gov/app/details/
PLAW-112publ96/summary.
3 Public Law 113–183—Preventing Sex
Trafficking and Strengthening Families Act.
(2014). Retrieved from https://
www.govinfo.gov/app/details/PLAW113publ183/summary.
4 Public Law 115–123—Bipartisan Budget
Act of 2018. (2018). Retrieved from https://
www.govinfo.gov/app/details/PLAW115publ123/summary.
5 Health Information Management Systems
Society: Interoperability Definition. (2021).
Retrieved from HIMSS writes new definition
of interoperability—Digital-health.
6 Administration of Children and Families
(ACF): Confidentiality Toolkit. (2021).
Retrieved from https://www.acf.hhs.gov/
opre/report/confidentiality-toolkit.
7 Redox. Popular Open Source FHIR
Libraries. (2021). Retrieved from https://
www.redoxengine.com/blog/popular-opensource-fhir-libraries/.
8 Health Level Seven (HL7) Confluence.
(2023). The Gravity Project. Consensusdriven standards on social determinants of
health. Retrieved from https://
confluence.hl7.org/display/GRAV/
The+Gravity+Project.
9 HealthITbuzz. (2022). FAST Continues
FHIR Scalability Work as a New HL7 FHIR
Accelerator. Retrieved from https://
www.healthit.gov/buzz-blog/health-it/fastcontinues-fhir-scalability-work-as-a-new-hl7fhir-accelerator.
10 National Archives Federal Register.
(2020). 21st Century Cures Act:
Interoperability, Information Blocking, and
the ONC Health IT Certification Program.
Retrieved from https://
www.federalregister.gov/documents/2020/05/
E:\FR\FM\28OCN1.SGM
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Federal Register / Vol. 89, No. 208 / Monday, October 28, 2024 / Notices
01/2020-07419/21st-century-cures-actinteroperability-information-blocking-andthe-onc-health-it-certification.
11 Office of the National Coordinator for
Health IT. (2023). United States Core Data for
Interoperability (USCDI). Retrieved from
https://www.healthit.gov/isa/united-statescore-data-interoperability-uscdi.
12 Office of the National Coordinator for
Health IT. (2023) United States Core (US
Core) Fast Healthcare Interoperability
Resources (FHIR) Retrieved from https://
hl7.org/fhir/us/core/history.html.
13 Office of the National Coordinator for
Health IT. (2023) United States Core (US
Core) Fast Healthcare Interoperability
Resources (FHIR) Retrieved from https://
hl7.org/fhir/us/core/history.html.
14 Office of the National Coordinator for
Health IT. (2023). United States Core Data for
Interoperability. Retrieved from https://
www.healthit.gov/isa/sites/isa/files/2023-10/
USCDI-Version-4-October-2023-ErrataFinal.pdf.
15 Office of the National Coordinator for
Health IT. (2023). United States Core Data for
Interoperability Plus (USCDI+). Retrieved
from https://www.healthit.gov/topic/
interoperability/uscdi-plus.
16 Office of Planning, Research and
Evaluation an Office of the Administration of
Children & Families. (2023). Human Services
Interoperability Innovations (HSII). Retrieved
from https://www.acf.hhs.gov/opre/project/
human-services-interoperability-innovationshsii-2020-2021.
17 Health Level Seven (HL7) Confluence.
(2023). Human and Social Services Home.
Retrieved from https://confluence.hl7.org/
display/HSS/
Human+and+Social+Services+Home.
18 Centers for Medicare & Medicaid
Services. (2020). CMS Interoperability and
Patient Access Final Rule (CMS–9115–F).
Retrieved from https://www.cms.gov/
interoperability/policies-and-regulations/
cms-interoperability-and-patient-accessfinal-rule-cms-9115-f.
19 The Sequoia Project. (2022). FHIR
Roadmap v1.0. Retrieved from https://
rce.sequoiaproject.org/wp-content/uploads/
2022/01/FHIR-Roadmap-v1.0_updated.pdf.
[FR Doc. 2024–24924 Filed 10–25–24; 8:45 am]
BILLING CODE 4184–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
lotter on DSK11XQN23PROD with NOTICES1
Health Resources and Services
Administration
Agency Information Collection
Activities: Proposed Collection: Public
Comment Request; Information
Collection Request Title: Behavioral
Health Integration Evidence Based
Telehealth Network Program Outcome
Measures
Health Resources and Services
Administration (HRSA), Department of
Health and Human Services.
AGENCY:
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ACTION:
Notice.
In compliance with the
requirement for opportunity for public
comment on proposed data collection
projects of the Paperwork Reduction Act
of 1995, HRSA announces plans to
submit an Information Collection
Request (ICR), described below, to the
Office of Management and Budget
(OMB). Prior to submitting the ICR to
OMB, HRSA seeks comments from the
public regarding the burden estimate,
below, or any other aspect of the ICR.
DATES: Comments on this ICR should be
received no later than December 27,
2024.
ADDRESSES: Submit your comments to
paperwork@hrsa.gov or mail the HRSA
Information Collection Clearance
Officer, Room 14NWH04, 5600 Fishers
Lane, Rockville, Maryland, 20857.
FOR FURTHER INFORMATION CONTACT: To
request more information on the
proposed project or to obtain a copy of
the data collection plans and draft
instruments, email paperwork@hrsa.gov
or call Joella Roland, the HRSA
Information Collection Clearance
Officer, at (301) 443–3983.
SUPPLEMENTARY INFORMATION: When
submitting comments or requesting
information, please include the ICR title
for reference.
Information Collection Request Title:
Behavioral Health Integration Evidence
Based Telehealth Network Program
Outcome Measures, OMB No. 0906–
xxxx—New.
Abstract: This clearance request is for
OMB approval of a new information
collection, the Behavioral Health
Integration Evidence Based Telehealth
Network Program (BHI EB-TNP)
Outcome Measures. Under the BHI EBTNP, HRSA administers grants in
accordance with section 330I(d)(1) of
the Public Health Service Act (42 U.S.C.
254c–14(d)(1)). The purpose of this
program is to integrate behavioral health
services into primary care settings using
telehealth technology through telehealth
networks and evaluate the effectiveness
of such integration. This program
supports evidence-based projects that
utilize telehealth technologies through
telehealth networks in rural and
underserved areas to (1) improve access
to integrated behavioral health services
in primary care settings; and (2) expand
and improve the quality of health
information available to health care
providers by evaluating the
effectiveness of integrating
telebehavioral health services into
primary care settings and establishing
SUMMARY:
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85545
an evidence-based model that can assist
health care providers. HRSA created a
set of outcome measures to evaluate the
effectiveness of grantees’ services
programs and monitor their progress
using performance reporting data. The
measures address behavioral health and
substance use disorder priorities,
originating and distant sites, specialties
and services by site, volume of services
by site and specialty, patient travel
miles saved, and other uses of the
telehealth network.
Need and Proposed Use of the
Information: HRSA’s goals for the
program are to improve access to
needed services, reduce rural
practitioner isolation, improve health
system productivity and efficiency, and
improve patient outcomes. HRSA
worked with program grantees to
develop outcome measures to evaluate
and monitor the progress of the grantees
in each of these categories, with specific
indicators to be reported annually
through a performance monitoring data
collection platform/website. Measures
capture awardee-level and aggregate
data that illustrate the impact and scope
of program funding along with assessing
these efforts. The measures are intended
to inform HRSA’s progress toward
meeting program goals, specifically
improving access to telebehavioral
health services that support primary
care providers.
Likely Respondents: BHI EB-TNP
grantees.
Burden Statement: Burden in this
context means the time expended by
persons to generate, maintain, retain,
disclose, or provide the information
requested. This includes the time
needed to review instructions; to
develop, acquire, install, and utilize
technology and systems for the purpose
of collecting, validating, and verifying
information, processing and
maintaining information, and disclosing
and providing information; to train
personnel and to be able to respond to
a collection of information; to search
data sources; to complete and review
the collection of information; and to
transmit or otherwise disclose the
information. The total annual burden
hours estimated for this ICR are
summarized in the table below.
E:\FR\FM\28OCN1.SGM
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]]>Agencies
[Federal Register Volume 89, Number 208 (Monday, October 28, 2024)]
[Notices]
[Pages 85540-85545]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-24924]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Administration for Children and Families
Request for Information: Administration for Children and Families
Development of Interoperability Standards for Human Service Programs
AGENCY: Office of the Chief Technology Officer, Administration of
Children and Families, Department of Health and Human Services.
ACTION: Request for information (RFI).
-----------------------------------------------------------------------
SUMMARY: The Administration for Children and Families (ACF), in the
U.S. Department of Health and Human Services (HHS), invites public
comments to inform the use or adoption of interoperability standards
for human services programs. ACF and state, local, and tribal
governments all provide a number of health and human services programs
for children, youth, families, communities, and individuals. ACF seeks
public comment on the most effective approaches, technical standards,
and technological tools that currently or could promote
interoperability between health and human services programs. ACF
collaborates with the Assistant Secretary for Technology Policy/Office
of the National Coordinator for Health Information Technology (ASTP/
ONC) as a critical steward and advisor for human services
interoperability with responsibility for leading the development and
harmonization of interoperability standards between health and human
services in line with the HHS Data Strategy. The potential of
interoperability across the full spectrum of health and human services
is immense--it can enable efficient delivery of government services,
enhance access to critical non-profit programs, and most importantly,
improve overall individual and community outcomes. ACF has authority
under the Title IV of the Social Security Act to designate use of
interoperable data standards for several of its programs (e.g.,
Temporary Assistance for Needy Families (TANF), child support, child
welfare, and foster care). The purpose of this RFI is to understand how
ACF, in collaboration with ASTP/ONC, can better support
interoperability between human services within and across states and
local community resources, between states, and ACF.
DATES: Comments are due within 60 days of publication.
ADDRESSES: Submit responses to [email protected], a federal mailbox
allowing the public to submit comments on documents agencies have
published in the Federal Register and are open for comment. Simply type
``ACF-2024-Interoperability-RFI'' in the Comment or Submission search
box, click Go, and follow the instructions for submitting comments.
Comments submitted in response to this notice are subject to the
Freedom of Information Act and may be made available to the public. For
this reason, please do not include any information of a confidential
nature, such as sensitive personal information or
[[Page 85541]]
proprietary information. If you submit your email address, it will be
automatically captured and included as part of the comment placed in
the public docket. Please note that responses to this public comment
request containing any routine notice about the confidentiality of the
communication will be treated as public comments that may be made
available to the public, notwithstanding the inclusion of the routine
notice.
SUPPLEMENTARY INFORMATION:
1. Background
The Administration for Children and Families (ACF) requests
comments to inform the use of interoperable data standards across human
services programs. This will improve the quality of service delivery
and increase efficiency in collaborations between agencies
administering ACF programs and other government and non-government
agencies that serve the same populations.
1.1 Regulation Development Process
The data exchange standardization requirements under the Social
Security Act Title IV programs of child welfare and foster care (Titles
IV-B and IV-E), child support (Title IV-D), and Temporary Assistance
for Needy Families (TANF, Title IV-A) result from Public Laws 112-
34,\1\ 112-96,\2\ 113-183,\3\ and 115-123.\4\ These laws require the
designation of interoperable standards for data that must be exchanged:
(1) between states and ACF; and/or (2) between states under specified
programs.
ACF's Office of the Chief Technology Officer (OCTO) will lead the
drafting of any regulations with respect to the programs described
above with subject matter expertise from ACF program offices including,
but not limited to, the Children's Bureau (CB), Family and Youth
Services Bureau (FYSB), Office of Early Childhood Development (ECD),
Office of Child Care (OCC), Office of Head Start (OHS), Office of Child
Support Services (OCSS), Office of Community Services (OCS), Office of
Family Assistance (OFA), and Office of Family Violence and Prevention
Services (OFVPS).
Additionally, OCTO will coordinate and consult on the input
received in response to this RFI both with the ASTP/ONC and with other
agencies executing programs and policies involving human services
interoperable data standards, such as the Centers for Medicare &
Medicaid Services (CMS), Administration for Community Living (ACL), and
the Health Resources and Services Administration (HRSA).
ASTP/ONC enable standards on behalf of HHS under section 3004 of
the Public Health Service Act (PHSA) in 45 CFR part 170 Subpart B. As
lead for the development and harmonization of interoperability
standards between health and human services, ASTP/ONC may enable
standards for human services which will be available for use by any HHS
program, including ACF. Adopting standards in one location for HHS use
enables alignment across HHS programs to further interoperability,
including alignment described under Sections 13111 and 13112 of the
Health Information Technology for Economic and Clinical Health Act
(``HITECH Act'') (Pub. L. 111-5, Title XIII, secs. 13111 and 13112).
1.2 For the Purposes of This Notice
Interoperability refers to the ability of different information
systems, devices, or applications to connect, in a coordinated way,
within and beyond organizational boundaries to access, exchange, and
use data in a cooperative way between stakeholders, with the aim of
optimizing the health and wellbeing of individuals and populations
(adapted from HIMSS, 2019).\5\ The definition of interoperability in
section 4003 of the 21st Century Cures Act calls for all electronically
accessible information to be accessed, exchanged, and used without
special effort on the user's part (Pub. L. 114-255).
Standards, for the purposes of this RFI, refer to any documented,
consistent, and repeatable method for exchanging data through technical
or non-technical means. There are technical standards for electronic
data exchange, such as through data exchange standards, including
Health Level Seven (HL7) Fast Healthcare Interoperability Resources
(FHIR[supreg]). There are also standards of practice in the context of
business processes, such as protocols for encryption, hashing, or
establishment of accessible websites. These standards of practice are
often codified in policies, interagency agreements, memoranda of
understanding, service-level agreements, etc.
Human Services Interoperability refers to the ability of health and
human service systems to exchange data for service planning,
coordination, delivery, monitoring, and evaluation in an automated,
standards-based, and integrated manner that improves outcomes for
children, families, and communities. Human services refer to programs
that may not exclusively be provided or funded by HHS but may include
those funded through other federal agencies. Human services include a
wide variety of programs and services to enhance the quality of life,
promote well-being, and address the needs of individuals and
communities.
1.3 Purpose of Interoperable Data Standardization for Interoperability
The purpose of designating interoperable data standards is to
ensure all parts of the human services delivery ecosystem can
effectively and efficiently exchange information between and among
programs for seamless service delivery. Effective and efficient
information exchange can help appropriately reach people and deliver
the right benefits, supporting coordinated case management, benefits
enrollment, and new service delivery models. Interoperability promotes
many objectives, from the availability of higher quality, more recent
data that can be used to appropriately reach people and deliver the
right benefits to coordinated case management, benefits enrollment, and
new service delivery models.
Using timely and quality data, for example, a child welfare
caseworker might be able to retrieve a family's current address from
child support data to locate the family for an in-person visit or
locate the non-custodial parent for possible placement of the children.
Interoperable data standards between a public child welfare agency with
care and custody of a child and a foster care placing agency could
ensure both agencies have the most current information on the child in
care. Interoperability can also help identify if household composition
has changed, or a recipient has moved out of state, and changes to
benefits levels are needed. For example, if a parent was reunited with
their children exiting foster care, data sharing across information
systems would allow the TANF agency to update the benefit eligibility
for the family. Widespread adherence to data standards can enable
better interoperability and reduce the burden of connecting disparate
systems containing the information described in this example.
Interoperable data standards can also help to facilitate
initiatives. For example, a Medicaid applicant works with a health
insurance navigator during the annual Marketplace enrollment period and
participates in a Social Determinants of Health (SDOH) questionnaire
with the navigator, who recognizes that the applicant is experiencing
challenges in securing adequate food and necessary clothing. The
navigator could pre-fill an enrollment application for SNAP benefits
and provide information to complete the enrollment. Also, the
[[Page 85542]]
navigator can provide the Medicaid applicant with the local food bank's
name, location, phone number, and a resource for the community clothing
closet. Further, with the Medicaid applicant's consent, the navigator
can send an electronic message or alert to the local non-profits
identified in a statewide network of non-profit community resources,
allowing receiving organizations to reach out to the applicant to
determine if they need additional support to get connected with
services. Common standards can help simplify the complex interactions
between different systems described in this scenario and ensure
scalability as new entities seek to participate in the exchange.
ACF believes that designating nationally recognized interoperable
data standards in the programs described above will make it easier to
share data across multiple organizations. While likely more effective
and cost-effective in the long run, ACF also recognizes that this
approach may initially involve financial and time costs related to
updating proprietary systems to use open standards. Therefore, as part
of any future ACF programmatic and policy development, and in
coordination with ASTP/ONC, ACF seeks to strike the appropriate balance
between the benefits of interoperability and standardization and ease
of implementation.
2. Legal Authority
Federal statutes require ACF to designate interoperable data
standards to promote data exchange in state human services programs at
the state level and with the federal government. Most recently, the
Family First Prevention Services Act (FFPSA), enacted as part of Public
Law (Pub. L.) 115-123, authorized optional Title IV-E funding for time-
limited prevention services for mental health, substance abuse, and in-
home parent skill-based programs for children or youth who are
candidates for foster care, pregnant or parenting youth in foster care,
and the parents or kin caregivers of those children and youth. This law
amended Title IV-B of the Social Security Act to require that ACF must
``designate data exchange standards to govern . . . (1) necessary
categories of information that State agencies operating programs under
State plans approved under this part are required under applicable
Federal law to exchange with another State agency electronically; and
(2) Federal reporting and data exchange required under applicable
Federal law'' (42 U.S.C. 629m(a)).
The statute further provides that ACF shall incorporate, to the
extent practical, interoperable standards developed and maintained by
intergovernmental partnerships and federal agencies with authority over
contracting and financial assistance. The data exchange reporting
standards shall incorporate a widely accepted, nonproprietary,
searchable, computer-readable format; be consistent with and implement
applicable accounting principles; be implemented in a manner that is
cost-effective and improves program efficiency and effectiveness; and
be capable of being continually upgraded as necessary (42 U.S.C.
629m(b)).
Additionally, ACF coordinates with the ASTP/ONC in a manner
consistent with Sections 13111 and 13112 of the HITECH Act to ensure
alignment across HHS and non-HHS agencies around health IT standards
ASTP/ONC adopts on behalf of HHS under section 3004 of the PHSA in 45
CFR part 170 Subpart B. ACF coordinates with ASTP/ONC pursuant to the
provisions of the HITECH Act above when adopting, implementing, or
upgrading health IT systems used for the direct exchange of
individually identifiable health information between agencies and non-
Federal entities.
The extent of data elements that need to be shared to enable
improved service delivery and program management often exceeds the
minimum legal requirements. As described throughout ACF's
Confidentiality Toolkit \6\ in the Applicable Federal Legislation
sections, data sharing beyond the minimum regulatory requirements (as
referenced throughout this RFI) is permissible and encouraged when
practical use cases exist.
3. Current Interoperability Standards and Initiatives
3.1 FHIR and Gravity Project
HL7[supreg] Fast Healthcare Interoperability Resources
(FHIR[supreg]) is a rapidly maturing interoperability standard based on
modern internet technology approaches. FHIR goes beyond document-level
interoperability to data element-level exchange. It uses standardized
application programming interface (API) standards to facilitate
interoperable data standards, enabling more efficient application
development across multiple device types. There is a growing open-
source community developing around FHIR implementation.\7\
Today, several stakeholder efforts are underway to extend the use
of FHIR to support the interoperability of human services information.
For instance, the Gravity Project \8\ is a stakeholder-led initiative
to identify and harmonize social risk factor data for interoperable
electronic health information exchange. The HL7 Gravity Accelerator \9\
established codes for data elements such as housing instability, food
insecurity, transportation insecurity, etc. It creates a common
terminology for exchanging content related to non-medical factors
influencing health and human services outcomes. Another HL7 group is
the Health and Social Services (HSS) Work Group, supported by ACF,
which is focused on facilitating human services data content further. A
project description of Enhancing the FHIR for Social Services and
Social Determinants (EFSS) and a list of use cases can be found in
Appendices 1 and 2.
3.2 United States Core Data for Interoperability (USCDI/USCDI+)
In the 21st Century Cures Act: Interoperability, Information
Blocking, and the ONC Health IT Certification Program final rule (85 FR
25642) \10\ published in May 2020, ASTP/ONC adopted the United States
Core Data for Interoperability (USCDI) \11\ standard, which describes a
standardized set of health data and constituent data elements for
nationwide, interoperable health information exchange (85 FR 25669).
USCDI is implemented in FHIR by mapping data elements and value sets to
FHIR resources and implementation guides through the US Core
Implementation Guide.\12\ ASTP/ONC published Version 3 of the USCDI in
July 2022 \13\ and subsequently adopted Version 3 as the new baseline
for the ASTP/ONC Certification Program in the Health Data, Technology,
and Interoperability: Certification Program Updates, Algorithm
Transparency, and Information Sharing (HTI-1) Final Rule (89 FR 1210).
Version 3 included new data elements for social determinants of health
(SDOH), which includes SDOH Problems/Health Concerns, SDOH
Interventions, SDOH Goals, and SDOH Assessments. USCDI Version 4,
published in July 2023,\14\ added 20 data elements to help address and
mitigate health and healthcare inequities and disparities. Additional
priorities for USCD v4 were to address underserved communities' needs,
behavioral health integration with primary care and other physical
care, and public health interoperability needs of reporting,
investigation, and emergency response.
Further, ASTP/ONC oversees the USCDI+ \15\ initiative to support
identifying and establishing domain, or program-specific, datasets that
build on the existing USCDI. Specifically, USCDI+ is a service that
ASTP/ONC
[[Page 85543]]
provides to federal and industry partners to establish, harmonize, and
advance the use of interoperable datasets that extend beyond the core
data in the USCDI to meet specific programmatic and/or use case
requirements. This approach allows ASTP/ONC to assure that new datasets
build from the same core USCDI foundation, and allows for alignment of
similar data needs across agency programs and corresponding data users
and/or participants at the state and local levels.
3.3 Human Services Interoperability Innovations (HSII) Demonstration
Program
ACF has focused on programmatic investments to advance human
services interoperability. ACF's Human Services Interoperability
Innovations (HSII) demonstration program \16\ was intended to expand
data-sharing efforts by state and local governments, tribes, and
territories to improve human services program delivery and to identify
novel data-sharing approaches that can be replicated in other
jurisdictions. These investments enabled ACF to fund entities to focus
on addressing longstanding barriers to interoperability through
cooperative agreements for the HL7 Care Plan for Maternal Opioid Misuse
and the implementation of FHIR operating systems necessary to support
Centers for Medicare and Medicaid Innovation (CMMI) Integrated Care for
Kids model grantees in both New Jersey and Connecticut.
3.4 HL7 Human and Social Services (HSS) Workgroup
ACF led the creation of the HL7 Human and Social Services (HSS)
Workgroup.\17\ The HSS Workgroup's mission is to provide a space to
design and validate HL7 interoperable human services data standards.
The group is also developing a common format for social services
provider directory information. This project maps the definitions from
Open Referral to the FHIR standard using an FHIR Facade before the
Human Services Data API (HSDA).
4. Proposed Direction for Developing Interoperable Data Standards
The health sector has increasingly looked to FHIR as a core
standard, catalyzed by the industry's embrace of FHIR and codified
through the incorporation of ASTP/ONC-certified health IT systems
featuring FHIR APIs into CMS program requirements for use of certified
electronic health record technology (CEHRT) (for instance, Medicare
Promoting Interoperability Program and the Promoting Interoperability
performance category of the Merit-Based Incentive Payment System
(MIPS)),\18\ and ASTP/ONC's efforts to incorporate FHIR as part of the
technical requirements for the Trusted Exchange Framework Common
Agreement (TEFCA).\19\ Given the need for human services data to be
interoperable with health data to support integrated case management at
the person level and in light of the opportunity to significantly
leverage health sector infrastructure such as Qualified Health
Information Networks (QHINs) and existing data exchange pathways using
FHIR, ACF is considering the HL7 FHIR standard as the foundation of
data interoperability for ACF-covered domains.
5. Request for Information
ACF seeks a more interoperable human services data ecosystem with
available and shareable data between care providers, programs, and the
government to drive improved outcomes for children and families. To
deliver that goal, more consistent use of interoperable standards and
practices is needed at all levels. ACF recognizes that organizations
may be limited in major IT system transitions without significant new
funding. However, without government-backed standards, pilots, and
processes, the current and future IT systems will maintain and even
accelerate their current degree of fragmentation. Therefore, ACF is
seeking input on how to support a drive toward interoperability across
the field in economical, efficient, effective, and reasonable ways.
ACF also seeks feedback on proposed initial domain focus areas for
standards development and pilots. These focus areas may encompass areas
where HHS/ASTP/ONC and ACF have formal regulatory powers to set
standards for child welfare and foster care as well as prevention,
adoption and guardianship (Title IV-B and IV-E), child support (Title
IV-D), and Temporary Assistance for Needy Families (TANF, Title IV-A).
It also includes areas where ACF could engage more actively with
standards development organizations, such as the HL7 Human and Social
Services (HSS) Workgroup (currently focusing on food, housing, and
economic insecurity as its priority use cases). We are interested in
receiving input affecting additional programs.
ACF requests comments on the following topics. Please comment or
respond to any questions that apply from the perspective of your
agency, organization, program, or setting; commenters are not required
to respond to every question:
Input on specific topics
1. Practical enablers of/or barriers to interoperability:
1.1 Provide examples of the key enablers and/or inhibitors to using
interoperable human services data standards (including data content and
data exchange) in your program or agency.
1.2 How is the ability to exchange human services data impacted by
state or federal law, policies, or other governing frameworks
(including CMS Interoperability rules)?
1.3 What is the highest priority legal, policy, or governance
issues to be addressed when moving to an interoperable ACF environment?
(e.g., minor consent, guardianship, Family Education Rights and Privacy
Act (FERPA), privacy, security, sensitive data, parental controls,
etc.)
1.4 Describe any mitigation strategies or policy levers that have
effectively moved interoperable human services data exchange forward in
your organization, state, or program.
2. Impact of lack of human services interoperable data
standardization: Provide examples of existing and planned human
services interoperable data efforts and to what degree, if any, does a
lack of standardization negatively impact them.
2.1 What interoperable data standards are being used today in ACF-
funded programs?
2.2 Describe any impediments experienced in current systems when
accessing, analyzing, or sending data to the federal level.
2.3 What are the benefits of moving to a common interoperable data
standard like Fast Healthcare Interoperability Resources (FHIR)?
3. Care coordination: ACF seeks comments on current care
coordination activities and data standards to support the interoperable
data exchange for service delivery, operations, and reporting.
3.1 How do you currently use interoperable data to support care
coordination across human services, both between human services
programs and between human services and health services? For example,
are you able to collect medical data for children who have medical
issues?
3.2 Describe use cases that benefit from interoperable data
standards for advancing service coordination activities among state and
federal programs (e.g., clinical, administrative, operations). Tell us
about systems currently used that are API-enabled.
[[Page 85544]]
3.3 What are the most important use cases where interoperable data
standards or exchange protocols must be piloted/validated?
3.4 What federal support would be necessary or helpful to catalyze
those efforts?
4. Interoperable data standards needed for operations and
reporting: ACF recognizes that not all systems operate using
interoperable data standards, and as a result, not all applications are
capable of data exchange. Since 2021, ACF has sponsored an HL7 Human
and Social Services (HSS) workgroup to develop data standards using
FHIR specifications for Human and Social Services.
4.1 What ACF domains or programs would benefit from using an
interoperable data standard for business operation and reporting?
4.2 To what extent is the HL7 or the HL7 FHIR standard used in ACF
programs today?
4.3 Will your organization experience specific benefits or
drawbacks if an interoperable data standard like FHIR is widely used in
ACF programs?
4.4 Should any domain or program be exempt from using a standard
like FHIR?
5. Standards in practice: In cases where human services data
systems currently use interoperable data standards, describe how they
do or do not incorporate the following:
5.1 Interoperable standards developed and maintained by an
international voluntary consensus standards body such as HL7.
5.2 Interoperable standards developed and maintained by
intergovernmental partnerships such as the National Information
Exchange Model (NIEM).
5.3 Interoperable standards developed and maintained by specific
federal agencies with authority over contracting and financial
assistance.
6. Intra- and inter-state human services data sharing: Describe the
types of human services agencies in your state that electronically
exchange with other states, state agencies, or community organizations
in healthcare or human services within your state.
6.1 How are they aligned, or not, with a specific industry
standard(s), e.g., FHIR, to ensure ease of access and use of
interoperable data?
6.2 What types of systems and non-proprietary, open-data standards
are used to facilitate interoperability across programs?
6.3 Are there tools in use for normalizing and/or harmonizing data
to standards?
6.4 Tell us about any significant data quality and matching issues
to be addressed to make the data exchange meaningful.
6.5 What additional infrastructure would need to be developed to
ensure that data is interoperable and actively exchanged?
7. Funding: Describe current funding mechanisms that support or
hinder interoperable data systems' design, development, and
implementation.
7.1 What types of funding have you leveraged to design, develop,
and implement interoperable data systems (e.g., Advance Planning
Documents and grants)?
7.2 What incentives or requirements would be needed to drive key
use cases of data exchange once systems are interoperable (e.g., data
quality and/or identity management)?
7.3 What barriers or challenges have you encountered with these
funding mechanisms?
8. Technical Assistance: What technical assistance have you
leveraged in designing, developing, and implementing interoperable data
systems?
8.1 What technical assistance (such as subject matter expertise in
data standards and coding/software development) would be necessary to
move to an interoperable standard like FHIR?
8.2 What top actions should the federal government take to provide
technical assistance to encourage human services interoperability?
9. United States Core Data for Interoperability (USCDI/USCDI+):
Provide input to inform how ACF may identify, create, and standardize
human services data elements leveraging the ASTP/ONC USCDI+ initiative,
HL7 FHIR, and relevant HHS policy levers, including applicable
regulations, to improve interoperability for human services programs.
9.1 How could an initiative such as USCDI+ be leveraged to harmonize
human services data needed for care coordination, program evaluations,
and reporting requirements?
9.2 What is the highest priority use case(s) that need further
development in USCDI+ and FHIR to address ACF's stakeholders' needs?
9.3 What data elements are a high priority to enable comprehensive
case management, including whole-person care, referrals, and research?
9.4 What technical and policy approaches effectively link human
services data to health IT codes and value sets to help improve
interoperability, and use across multiple systems and domains?
10. General questions--Provide input on the current state of data
that your organization receives and/or exchanges.
10.1 What information do you exchange, if any, and from whom?
10.2 What information to you currently collect and from whom?
10.3 What information do you need to exchange, that you have
trouble exchanging and with whom? How does that challenge impact your
work, community, etc.?
11. Other considerations: ACF welcomes comments on other aspects of
recognizing and establishing interoperable data standards for human
services programs you wish to provide.
Kevin M. Duvall,
Chief Technology Officer, Administration of Children and Families.
Endnotes
\1\ Public Law 112-34--Child and Family Service Improvement and
Innovation Act. (2011). Retrieved from https://www.govinfo.gov/app/details/PLAW-112publ34/summary.
\2\ Public Law 112-96--Middle Class Tax Relief and Job Creation
Act. (2012). Retrieved from https://www.govinfo.gov/app/details/PLAW-112publ96/summary.
\3\ Public Law 113-183--Preventing Sex Trafficking and
Strengthening Families Act. (2014). Retrieved from https://www.govinfo.gov/app/details/PLAW-113publ183/summary.
\4\ Public Law 115-123--Bipartisan Budget Act of 2018. (2018).
Retrieved from https://www.govinfo.gov/app/details/PLAW-115publ123/summary.
\5\ Health Information Management Systems Society:
Interoperability Definition. (2021). Retrieved from HIMSS writes new
definition of interoperability--Digital-health.
\6\ Administration of Children and Families (ACF):
Confidentiality Toolkit. (2021). Retrieved from https://www.acf.hhs.gov/opre/report/confidentiality-toolkit.
\7\ Redox. Popular Open Source FHIR Libraries. (2021). Retrieved
from https://www.redoxengine.com/blog/popular-open-source-fhir-libraries/.
\8\ Health Level Seven (HL7) Confluence. (2023). The Gravity
Project. Consensus-driven standards on social determinants of
health. Retrieved from https://confluence.hl7.org/display/GRAV/The+Gravity+Project.
\9\ HealthITbuzz. (2022). FAST Continues FHIR Scalability Work
as a New HL7 FHIR Accelerator. Retrieved from https://www.healthit.gov/buzz-blog/health-it/fast-continues-fhir-scalability-work-as-a-new-hl7-fhir-accelerator.
\10\ National Archives Federal Register. (2020). 21st Century
Cures Act: Interoperability, Information Blocking, and the ONC
Health IT Certification Program. Retrieved from https://
www.federalregister.gov/documents/2020/05/
[[Page 85545]]
01/2020-07419/21st-century-cures-act-interoperability-information-
blocking-and-the-onc-health-it-certification.
\11\ Office of the National Coordinator for Health IT. (2023).
United States Core Data for Interoperability (USCDI). Retrieved from
https://www.healthit.gov/isa/united-states-core-data-interoperability-uscdi.
\12\ Office of the National Coordinator for Health IT. (2023)
United States Core (US Core) Fast Healthcare Interoperability
Resources (FHIR) Retrieved from https://hl7.org/fhir/us/core/history.html.
\13\ Office of the National Coordinator for Health IT. (2023)
United States Core (US Core) Fast Healthcare Interoperability
Resources (FHIR) Retrieved from https://hl7.org/fhir/us/core/history.html.
\14\ Office of the National Coordinator for Health IT. (2023).
United States Core Data for Interoperability. Retrieved from https://www.healthit.gov/isa/sites/isa/files/2023-10/USCDI-Version-4-October-2023-Errata-Final.pdf.
\15\ Office of the National Coordinator for Health IT. (2023).
United States Core Data for Interoperability Plus (USCDI+).
Retrieved from https://www.healthit.gov/topic/interoperability/uscdi-plus.
\16\ Office of Planning, Research and Evaluation an Office of
the Administration of Children & Families. (2023). Human Services
Interoperability Innovations (HSII). Retrieved from https://www.acf.hhs.gov/opre/project/human-services-interoperability-innovations-hsii-2020-2021.
\17\ Health Level Seven (HL7) Confluence. (2023). Human and
Social Services Home. Retrieved from https://confluence.hl7.org/display/HSS/Human+and+Social+Services+Home.
\18\ Centers for Medicare & Medicaid Services. (2020). CMS
Interoperability and Patient Access Final Rule (CMS-9115-F).
Retrieved from https://www.cms.gov/interoperability/policies-and-regulations/cms-interoperability-and-patient-access-final-rule-cms-9115-f.
\19\ The Sequoia Project. (2022). FHIR Roadmap v1.0. Retrieved
from https://rce.sequoiaproject.org/wp-content/uploads/2022/01/FHIR-Roadmap-v1.0_updated.pdf.
[FR Doc. 2024-24924 Filed 10-25-24; 8:45 am]
BILLING CODE 4184-01-P
