70166 Federal Register / Vol. 75, No. 221 / Wednesday, November 17, 2010 / Proposed Rules 

create incentives for health care 

providers to enhance health care quality 

and lower costs. One important delivery 

system reform is the Medicare Shared 

Savings Program under section 3022 of 

the Affordable Care Act, which 

promotes the formation and operation of 

accountable care organizations (ACOs). 

Under this provision, ‘‘groups of 

providers * * * meeting the criteria 

specified by the Secretary may work 

together to manage and coordinate care 

for Medicare * * * beneficiaries 

through an [ACO].’’ An ACO may 

receive payments for shared savings if 

the ACO meets certain quality 

performance standards and cost savings 

requirements established by the 

Secretary. We are developing 

rulemaking for the establishment of the 

Shared Savings Program under section 

3022 of the Affordable Care Act. In 

addition, section 3021 of the Affordable 

Care Act establishes a Center for 

Medicare and Medicaid Innovation 

(CMMI) within CMS, which is 

authorized to test innovative payment 

and service delivery models to reduce 

program expenditures while preserving 

or enhancing the quality of care. We are 

considering testing innovative payment 

and delivery system models that 

complement the Shared Savings 

Program in the CMMI. In both of these 

efforts, we are seeking to advance ACO 

structures that are organized in ways 

that are patient-centered and foster 

participation of physicians and other 

clinicians who are in solo or small 

practices. 

We have already conducted 

substantial outreach and had 

discussions with and received feedback 

from a wide array of physician groups, 

as well as groups representing other 

clinicians, hospitals, employers, 

consumers, and other interested parties, 

about how ACO programs can best be 

structured. In particular, CMS, along 

with the Office of the Inspector General 

(OIG) of the Department of Health and 

Human Services (DHHS) and the 

Federal Trade Commission hosted a 

public workshop on October 5, 2010, to 

discuss the application and enforcement 

of the antitrust laws, physician selfreferral prohibition, Federal antikickback statute, and civil monetary 

penalty law to the variety of possible 

ACO structures under the Shared 

Savings Program and other innovative 

payment models that CMMI is 

authorized to test under section 3021 of 

the Affordable Care Act. Prior to the 

public workshop, the three agencies 

solicited written comments and 

statements from industry stakeholders 

regarding a variety of issues, including 

the planned legal structures and 

business models of ACOs. 

II. Solicitation of Comments 

As we develop our initial rulemaking 

for the Shared Savings Program and 

begin the development of potential 

models in the CMMI, we are seeking 

additional information, particularly 

from the physician community, on the 

following questions: 

• What policies or standards should 

we consider adopting to ensure that 

groups of solo and small practice 

providers have the opportunity to 

actively participate in the Medicare 

Shared Savings Program and the ACO 

models tested by CMMI? 

• Many small practices may have 

limited access to capital or other 

resources to fund efforts from which 

‘‘shared savings’’ could be generated. 

What payment models, financing 

mechanisms or other systems might we 

consider, either for the Shared Savings 

Program or as models under CMMI to 

address this issue? In addition to 

payment models, what other 

mechanisms could be created to provide 

access to capital? 

• The process of attributing 

beneficiaries to an ACO is important to 

ensure that expenditures, as well as any 

savings achieved by the ACO, are 

appropriately calculated and that 

quality performance is accurately 

measured. Having a seamless attribution 

process will also help ACOs focus their 

efforts to deliver better care and 

promote better health. Some argue it is 

necessary to attribute beneficiaries 

before the start of a performance period, 

so the ACO can target care coordination 

strategies to those beneficiaries whose 

cost and quality information will be 

used to assess the ACO’s performance; 

others argue the attribution should 

occur at the end of the performance 

period to ensure the ACO is held 

accountable for care provided to 

beneficiaries who are aligned to it based 

upon services they receive from the 

ACO during the performance period. 

How should we balance these two 

points of view in developing the patient 

attribution models for the Medicare 

Shared Savings Program and ACO 

models tested by CMMI? 

• How should we assess beneficiary 

and caregiver experience of care as part 

of our assessment of ACO performance? 

• The Affordable Care Act requires us 

to develop patient-centeredness criteria 

for assessment of ACOs participating in 

the Medicare Shared Savings Program. 

What aspects of patient-centeredness are 

particularly important for us to consider 

and how should we evaluate them? 

• In order for an ACO to share in 

savings under the Medicare Shared 

Savings Program, it must meet a quality 

performance standard determined by 

the Secretary. What quality measures 

should the Secretary use to determine 

performance in the Shared Savings 

Program? 

• What additional payment models 

should CMS consider in addition to the 

model laid out in Section 1899(d), either 

under the authority provided in 1899(i) 

or the authority under the CMMI? What 

are the relative advantages and 

disadvantages of any such alternative 

payment models? 

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare—Hospital 

Insurance; and Program No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program) 

Dated: November 10, 2010. 

Donald M. Berwick, 

Administrator, Centers for Medicare & 

Medicaid Services. 

[FR Doc. 2010–28996 Filed 11–12–10; 4:15 pm] 

BILLING CODE 4120–01–P 

FEDERAL COMMUNICATIONS 

COMMISSION 

47 CFR Parts 1 and 17 

[WT Docket No. 08–61; WT Docket No. 03– 

187; DA 10–2178] 

Federal Communications Commission 

Announces Public Meetings and 

Invites Comment on the Environmental 

Effects of Its Antenna Structure 

Registration Program 

AGENCY: Federal Communications 

Commission. 

ACTION: Proposed rule. 

SUMMARY: In this document, the Federal 

Communications Commission 

announces public meetings regarding 

the pending Programmatic 

Environmental Assessment (PEA) of its 

Antenna Structure Registration (ASR) 

program and invites comment on the 

environmental effects of its antenna 

structure registration program. 

DATES: Interested parties may file 

comments on or before January 14, 

2011. 

ADDRESSES: You may submit comments, 

identified by DA 10–2178, WT Docket 

No. 08–61 and WT Docket No. 03–187, 

by any of the following methods: 

› Federal eRulemaking Portal: 

http://www.regulations.gov. Follow the 

instructions for submitting comments. 

› Federal Communications 

Commission’s Web site: http:// 

www.fcc.gov/cgb/ecfs/ or through a link 


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Federal Register / Vol. 75, No. 221 / Wednesday, November 17, 2010 / Proposed Rules 70167 

on the PEA Web site, http:// 

wireless.fcc.gov/antenna/index.htm?

job=programmatic_environmental

_assessment. Follow the instructions for 

submitting comments. 

› Mail: Filings can be sent by hand 

or messenger delivery, by commercial 

overnight courier, or by first-class or 

overnight U.S. Postal Service mail 

(although the Commission continues to 

experience delays in receiving U.S. 

Postal Service mail). All filings must be 

addressed to the Commission’s 

Secretary, Office of the Secretary, 

Federal Communications Commission. 

› People With Disabilities: Contact 

the FCC to request reasonable 

accommodations (accessible format 

documents, sign language interpreters, 

CART, etc.) by e-mail: FCC504@fcc.gov 

or phone: 202–418–0530 or TTY: 202– 

418–0432. 

For detailed instructions for submitting 

comments and additional information 

on the rulemaking process, see the 

SUPPLEMENTARY INFORMATION section of 

this document. 

FOR FURTHER INFORMATION CONTACT: 

Aaron Goldschmidt, Wireless 

Telecommunications Bureau, (202) 418– 

7146, e-mail 

aaron.goldschmidt@fcc.gov. 

SUPPLEMENTARY INFORMATION: This is a 

summary of the Federal 

Communications Commission’s public 

notice released on November 12, 2010. 

The full text of the public notice is 

available for public inspection and 

copying during business hours in the 

FCC Reference Information Center, 

Portals II, 445 12th Street, SW., Room 

CY–A257, Washington, DC 20554. It 

may also be purchased from the 

Commission’s duplicating contractor at 

Portals II, 445 12th Street, SW., Room 

CY–B402, Washington, DC 20554; the 

contractor’s Web site, http:// 

www.bcpiweb.com; or by calling (800) 

378–3160, facsimile (202) 488–5563, or 

e-mail FCC@BCPIWEB.com. Copies of 

the public notice also may be obtained 

via the Commission’s Electronic 

Comment Filing System (ECFS) by 

entering the docket number, WT Docket 

No. 07–250. Additionally, the complete 

public notice is available on the Federal 

Communications Commission’s Web 

site at http://www.fcc.gov. 

To comply with its obligations under 

the National Environmental Policy Act 

(NEPA), the Federal Communications 

Commission is conducting a 

Programmatic Environmental 

Assessment (PEA) of its Antenna 

Structure Registration (ASR) program. 

The purpose of the PEA is to evaluate 

the potential environmental effects of 

the Commission’s ASR program. The 

Commission is undertaking the PEA in 

response to the determination of the 

Court of Appeals for the District of 

Columbia Circuit in American Bird 

Conservancy v. FCC, (516 F.3d 1027 

(D.C. Cir. 2008) that registered towers 

may have a significant environmental 

effect on migratory birds. In the course 

of the PEA, the Commission will 

consider alternatives to address 

potential environmental effects, and 

will determine whether a more 

extensive analysis, in the form of a 

programmatic Environmental Impact 

Statement, may be required under 

NEPA. 

Under the ASR program, owners of 

antenna structures that are taller than 

200 feet above ground level or that may 

interfere with the flight path of a nearby 

airport must register those structures 

with the FCC. The antenna structure 

owner must obtain painting and lighting 

specifications from the Federal Aviation 

Administration and include those 

specifications in its registration prior to 

construction. The ASR program allows 

the FCC to fulfill its statutory 

responsibility to require painting and 

lighting of antenna structures that may 

pose a hazard to air navigation. 

The FCC has established a Web site, 

http://wireless.fcc.gov/antenna/ 

index.htm?job=programmatic_

environmental_assessment, which 

contains information and downloadable 

documents. The Web site also allows 

individuals to contact the Commission, 

and will be updated at key milestones 

throughout the study. 

The FCC will hold three scoping 

meetings for the public to provide input 

to the PEA process. The meetings will 

be open to the public; however, 

admittance will be limited to the seating 

available. Each scoping meeting will be 

comprised of an Information Session, a 

Presentation and a Formal Comment 

Period. Comment forms will be 

available, and may either be completed 

at the meeting, submitted through the 

PEA Web site, or mailed. Formal verbal 

comments will also be transcribed for 

public record by a stenographer at the 

meetings. PEA informational materials 

will be available at the meetings. 

Information gathered at the meetings 

will be used to prepare the PEA. The 

meetings are scheduled as follows: 

• On December 6, 2010, from 1:30 

p.m. until 4:30 p.m. Eastern Time, at the 

Federal Communications Commission’s 

Meeting Room, 445 12th Street, SW., 

Washington, DC. Audio/video coverage 

of this meeting will be broadcast live 

with open captioning over the Internet 

from the FCC’s Web page at http:// 

www.fcc.gov/live. The FCC’s webcast is 

free to the public. Those who watch the 

live video stream of the event may email 

event-related questions to 

livequestions@fcc.gov. Depending on the 

volume of questions and time 

constraints, FCC representatives will 

respond to as many questions as 

possible during the workshop. 

• On December 13, 2010, from 6 p.m. 

until 8:30 p.m. Pacific Time, at the 

Council Chambers, City of Chula Vista 

Civic Center, 276 Fourth Avenue, Chula 

Vista, California. 

• On December 15, 2010, from 6 p.m. 

until 8:30 p.m. Eastern Time, at the John 

F. Germany Public Library, 900 North 

Ashley Drive, Tampa, Florida. 

Individuals requiring special 

assistance during a meeting should 

submit a request through the PEA Web 

site no later than two business days 

prior to the applicable meeting. 

In addition to the scoping meetings, 

the Commission seeks written 

comments to assist it in preparing the 

PEA. Interested parties may file 

comments on or before January 14, 

2011. Comments may be filed: (1) 

Electronically, (2) in person at one of 

the scoping meetings, or (3) through the 

use of paper copies. 

• Electronic Filers: Comments may be 

filed electronically using the Internet by 

accessing the Commission’s Electronic 

Comment Filing System (‘‘ECFS’’): 

http://www.fcc.gov/cgb/ecfs/, through a 

link on the PEA Web site, http:// 

wireless.fcc.gov/antenna/index.htm?

job=programmatic_

environmental_assessment, or via the 

Federal eRulemaking Portal: http:// 

www.regulations.gov. 

• Paper Filers: Parties who choose to 

file by paper must file an original and 

four copies of each filing. If more than 

one docket or rulemaking number 

appears in the caption of this 

proceeding, filers must submit two 

additional copies for each additional 

docket or rulemaking number. 

Filings can be sent by hand or 

messenger delivery, by commercial 

overnight courier, or by first-class or 

overnight U.S. Postal Service mail. All 

filings must be addressed to the 

Commission’s Secretary, Office of the 

Secretary, Federal Communications 

Commission. 

Æ All hand-delivered or messengerdelivered paper filings for the 

Commission’s Secretary must be 

delivered to FCC Headquarters at 445 

12th St., SW., Room TW–A325, 

Washington, DC 20554. All hand 

deliveries must be held together with 

rubber bands or fasteners. Any 

envelopes must be disposed of before 

entering the building. The filing hours 

are 8 a.m. to 7 p.m. 


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70168 Federal Register / Vol. 75, No. 221 / Wednesday, November 17, 2010 / Proposed Rules 

Æ Commercial overnight mail (other 

than U.S. Postal Service Express Mail 

and Priority Mail) must be sent to 9300 

East Hampton Drive, Capitol Heights, 

MD 20743. 

Æ U.S. Postal Service first-class, 

Express, and Priority mail must be 

addressed to 445 12th Street, SW., 

Washington, DC 20554. 

Comments and ex parte submissions 

will be available for public inspection 

during regular business hours in the 

FCC Reference Center, Federal 

Communications Commission, 445 12th 

Street, SW., CY–A257, Washington, DC 

20554. These documents will also be 

available via ECFS. Documents will be 

available electronically in ASCII, 

Microsoft Word, and/or Adobe Acrobat. 

To request information in accessible 

formats (computer diskettes, large print, 

audio recording, and Braille), send an email to fcc504@fcc.gov or call the FCC’s 

Consumer and Governmental Affairs 

Bureau at (202) 418–0530 (voice), (202) 

418–0432 (TTY). This document can 

also be downloaded in Word and 

Portable Document Format (PDF) at: 

http://www.fcc.gov. 

For more news and information about 

the Federal Communications 

Commission please visit: http:// 

www.fcc.gov. 

Federal Communications Commission. 

Jane E. Jackson, 

Associate Chief, Wireless 

Telecommunications Bureau. 

[FR Doc. 2010–29005 Filed 11–16–10; 8:45 am] 

BILLING CODE 6712–01–P 

FEDERAL COMMUNICATIONS 

COMMISSION 

47 CFR Part 79 

[CG Docket 05–231, ET Docket No. 99–254; 

DA 10–2050] 

Consumer and Governmental Affairs 

Bureau Seeks To Refresh the Record 

on Notices of Proposed Rulemaking 

Regarding Closed Captioning Rules 

AGENCY: Federal Communications 

Commission. 

ACTION: Proposed rule. 

SUMMARY: In this document, the 

Commission, via the Consumer and 

Governmental Affairs Bureau (Bureau), 

seeks to refresh the record on issues 

pertaining to closed captioning that 

were raised in Notices of Proposed 

Rulemaking (NPRMs) released by the 

Commission in 2005 and 2008. Given 

the time that has elapsed and various 

technological developments that have 

occurred in the field of closed 

captioning since these NPRMs were 

released, the Bureau believes that a 

refreshed record will better educate the 

Commission regarding the issues raised 

for comment in the pending 

proceedings. 

DATES: Comments are due on or before 

November 24, 2010. Reply comments 

are due on or before December 9, 2010. 

ADDRESSES: Interested parties may 

submit comments identified by [CG 

Docket No. 05–231 and ET Docket No. 

99–254], and by any of the following 

methods: 

• Electronic Filers: Comments may be 

filed electronically using the Internet by 

accessing the Commission’s Electronic 

Comment Filing System (ECFS): http:// 

www.fcc.gov/cgb/ecfs, or the Federal 

eRulemaking Portal: http:// 

www.regulations.gov. Filers should 

follow the instructions provided on the 

website for submitting comments, and 

transmit one electronic copy of the 

filing to each docket number referenced 

in the caption, which in this case is CG 

Docket No. 05–231 and ET Docket No. 

99–254. For ECFS Filers, in completing 

the transmittal screen, filers should 

include their full name, U.S. Postal 

Service mailing address, and the 

applicable docket number. 

• Paper Filers: Parties who choose to 

file by paper must file an original and 

four copies of each filing. Because two 

docket numbers appear in the caption of 

this Notice, filers must submit two 

additional copies for the additional 

docket number. In addition, parties 

must send one copy to the 

Commission’s duplicating contractor, 

Best Copy and Printing, Inc., 445 12th 

Street, SW., Washington, DC 20554. 

Filings can be sent by hand or 

messenger delivery, by commercial 

overnight courier, or by first-class or 

overnight U.S. Postal Service mail. All 

filings must be addressed to the 

Commission’s Secretary, Office of the 

Secretary, Federal Communications 

Commission. 

• All hand-delivered or messengerdelivered paper filings for the 

Commission’s Secretary must be 

delivered to FCC Headquarters at 445 

12th Street, SW., Room TW–A325, 

Washington, DC 20554. All hand 

deliveries must be held together with 

rubber bands or fasteners. Any 

envelopes must be disposed of before 

entering the building. The filing hours 

are 8 a.m. to 7 p.m. 

• Commercial overnight mail (other 

than U.S. Postal Service Express Mail 

and Priority Mail) must be sent to 9300 

East Hampton Drive, Capitol Heights, 

MD 20743. U.S. Postal Service firstclass, Express, and Priority mail must be 

addressed to 445 12th Street, SW., 

Washington, DC 20554. 

FOR FURTHER INFORMATION CONTACT: 

Amelia Brown, Consumer and 

Governmental Affairs Bureau, Disability 

Rights Office, at (202) 418–2799 (voice), 

(202) 418–7804 (TTY), or e-mail: 

Amelia.Brown@fcc.gov. 

SUPPLEMENTARY INFORMATION: This is a 

summary of the Commission’s 

document DA 10–2050, released 

October 25, 2010 in CG Docket No. 05– 

231 and ET Docket No. 99–254. The full 

text of DA 10–2050 and any 

subsequently filed documents in this 

matter will be available for public 

inspection and copying via ECFS (insert 

[CG Docket No. 05–231 or ET Docket 

No. 99–254] into the Proceeding block) 

and during regular business hours at the 

FCC Reference Information Center, 

Portals II, 445 12th Street, SW., Room 

CY–A257, Washington, DC 20554. They 

may also be purchased from the 

Commission’s duplicating contractor, 

Best Copy and Printing, Inc. Portals II, 

445 12th Street, SW., Room CY–B402, 

Washington, DC 20554; telephone (800) 

378–3160, or via its Web site, http:// 

www.bcpiweb.com. DA 10–2050 can 

also be downloaded in Word or Portable 

Document Format (PDF) at: http:// 

www.fcc.gov/cgb/dro/caption.html. 

To request materials in accessible 

formats for people with disabilities 

(Braille, large print, electronic files, 

audio format), send an e-mail to 

fcc504@fcc.gov or call the Consumer 

and Governmental Affairs Bureau at 

(202) 418–0530 (voice), (202) 418–0432 

(TTY). Pursuant to 47 CFR 1.1206, these 

proceedings will be conducted as 

permit-but-disclose proceedings in 

which ex parte communications are 

subject to disclosure. 

Synopsis 

In DA 10–2050, the Bureau seeks to 

refresh the record on issues pertaining 

to closed captioning that were raised in 

NPRMs released by the Commission on 

July 21, 2005, and November 7, 2008. 

See Closed Captioning of Video 

Programming, Telecommunications for 

the Deaf, Inc., Petition for Rulemaking, 

CG Docket No. 05–231, Notice of 

Proposed Rulemaking, published at 70 

FR 56150, September 26, 2005; and 

Closed Captioning of Video 

Programming, Closed Captioning 

Requirements for Digital Television 

Receivers, CG Docket No. 05–231, ET 

Docket No. 99–254, Declaratory Ruling, 

Order and Notice of Proposed 

Rulemaking, published at 74 FR 1594, 

January 13, 2009 and 74 FR 1654, 

January 13, 2009 (2008 Closed 

Captioning Declaratory Ruling, Order 


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