Federal Register / Vol. 75, No. 232 / Friday, December 3, 2010 / Notices 75469 

FEDERAL MARITIME COMMISSION 

Sunshine Act Meeting 

TIME AND DATE: December 8, 2010–10 

a.m. 

PLACE: 800 North Capitol Street, NW., 

First Floor Hearing Room, Washington, 

DC. 

STATUS: Part of the meeting will be in 

Open Session and the remainder of the 

meeting will be in Closed Session. 

MATTERS TO BE CONSIDERED: 

Open Session 

1. Staff Update on Cruise West. 

2. Initiative to Modernize Commission 

Rules of Practice and Procedure. 

Closed Session 

1. Fact Finding No. 27: Complaints or 

Inquiries from Individual Shippers of 

Household Goods or Private 

Automobiles—Discussion of the Fact 

Finding Officer’s Interim Report. 

2. Fact Finding Investigation No. 26: 

Vessel Capacity and Equipment 

Availability in the United States 

Export and Import Liner Trades— 

Discussion of the Fact Finding 

Officer’s Final Report. 

3. Petition No. P1–01: Petition of Hainan 

P O Shipping Co., Ltd., for an 

Exemption from the First Sentence of 

Section 9(c) of the Shipping Act. 

4. Staff Briefing and Discussion 

Regarding Passenger Vessel Financial 

Responsibility. 

CONTACT PERSON FOR MORE INFORMATION: 

Karen V. Gregory, Secretary, (202) 523– 

5725. 

[FR Doc. 2010–30438 Filed 12–1–10; 11:15 am] 

BILLING CODE 6730–01–P 

FEDERAL RESERVE SYSTEM 

Change in Bank Control Notices; 

Acquisitions of Shares of a Bank or 

Bank Holding Company 

The notificants listed below have 

applied under the Change in Bank 

Control Act (12 U.S.C. 1817(j)) and 

225.41 of the Board’s Regulation Y (12 

CFR 225.41) to acquire shares of a bank 

or bank holding company. The factors 

that are considered in acting on the 

notices are set forth in paragraph 7 of 

the Act (12 U.S.C. 1817(j)(7)). 

The notices are available for 

immediate inspection at the Federal 

Reserve Bank indicated. The notices 

also will be available for inspection at 

the offices of the Board of Governors. 

Interested persons may express their 

views in writing to the Reserve Bank 

indicated for that notice or to the offices 

of the Board of Governors. Comments 

must be received not later than 

December 20, 2010. 

A. Federal Reserve Bank of San 

Francisco 

(Kenneth Binning, Vice President, 

Applications and Enforcement) 101 

Market Street, San Francisco, California 

94105–1579: 

1. BOTC Holdings LLC, Lightyear Fund II, 

L.P.; Lightyear Co-Invest Partnership II, L.P.; 

Lightyear Fund II GP, L.P.; Lightyear Fund II 

GP Holdings, LLC; Marron & Associates, LLC; 

Chestnut Venture Holdings, LLC; Donald B. 

Marron; Lightyear Capital LLC and Lightyear 

Capital II, LLC, all of New York, New York; 

to acquire voting shares of Cascade Bancorp, 

and thereby indirectly acquire voting shares 

of The Bank of the Cascades, both of Bend, 

Oregon. 

Board of Governors of the Federal Reserve 

System, November 30, 2010. 

Robert deV. Frierson, 

Deputy Secretary of the Board. 

[FR Doc. 2010–30361 Filed 12–2–10; 8:45 am] 

BILLING CODE 6210–01–P 

FEDERAL RESERVE SYSTEM 

Formations of, Acquisitions by, and 

Mergers of Bank Holding Companies 

The companies listed in this notice 

have applied to the Board for approval, 

pursuant to the Bank Holding Company 

Act of 1956 (12 U.S.C. 1841 et seq.) 

(BHC Act), Regulation Y (12 CFR part 

225), and all other applicable statutes 

and regulations to become a bank 

holding company and/or to acquire the 

assets or the ownership of, control of, or 

the power to vote shares of a bank or 

bank holding company and all of the 

banks and nonbanking companies 

owned by the bank holding company, 

including the companies listed below. 

The applications listed below, as well 

as other related filings required by the 

Board, are available for immediate 

inspection at the Federal Reserve Bank 

indicated. The application also will be 

available for inspection at the offices of 

the Board of Governors. Interested 

persons may express their views in 

writing on the standards enumerated in 

the BHC Act (12 U.S.C. 1842(c)). If the 

proposal also involves the acquisition of 

a nonbanking company, the review also 

includes whether the acquisition of the 

nonbanking company complies with the 

standards in section 4 of the BHC Act 

(12 U.S.C. 1843). Unless otherwise 

noted, nonbanking activities will be 

conducted throughout the United States. 

Unless otherwise noted, comments 

regarding each of these applications 

must be received at the Reserve Bank 

indicated or the offices of the Board of 

Governors not later than December 30, 

2010. 

A. Federal Reserve Bank of Richmond 

(A. Linwood Gill, III, Vice President) 

701 East Byrd Street, Richmond, 

Virginia 23261–4528: 

1. Old Line Bancshares, Inc., Bowie, 

Maryland; to acquire 100 percent of the 

voting shares of Maryland Bankcorp, 

Inc., and thereby indirectly acquire 

voting shares of Maryland Bank & Trust 

Company, National Association, both of 

Lexington Park, Maryland. 

Board of Governors of the Federal Reserve 

System, November 30, 2010. 

Robert deV. Frierson, 

Deputy Secretary of the Board. 

[FR Doc. 2010–30362 Filed 12–2–10; 8:45 am] 

BILLING CODE 6210–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Agency for Healthcare Research and 

Quality 

Priority Setting for the Children’s 

Health Insurance Program 

Reauthorization Act (CHIPRA) 

Pediatric Quality Measures Program 

AGENCY: Agency for Healthcare Research 

and Quality, HHS. 

ACTION: Request for public comments. 

SUMMARY: Section 401(a) of the 

Children’s Health Insurance Program 

Reauthorization Act of 2009 (Pub. L. 

111–3) amended title Xl of the Social 

Security Act by inserting after section 

1139 the new section 1139A, ‘‘Child 

Health Quality Measures.’’: Subsection 

1139A(b), ‘‘Advancing and Improving 

Pediatric Quality Measures,’’ directs the 

Secretary to establish a pediatric quality 

measures program to: improve and 

strengthen the initial core child health 

care quality measures established by the 

Secretary under section 1139A(a); 

expand on existing pediatric quality 

measures used by public and private 

health care purchasers and advance the 

development of new quality measures; 

and increase the portfolio of evidencebased, consensus pediatric quality 

measures available to public and private 

purchasers of children’s healthcare 

services, providers, and consumers. 

Section 1139A(b)(3) requires the 

Secretary to consult with a broad range 

of stakeholders to set these priorities. To 

meet the requirement for extensive 

stakeholder consultation, we are seeking 

general public comment on these draft 

priorities, and asking the public to 

identify additional priorities as needed. 

DATES: Comments on this notice must be 

received by January 14, 2010. The 

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75470 Federal Register / Vol. 75, No. 232 / Friday, December 3, 2010 / Notices 

public comment period will close on 

January 14, 2010 at 5 p.m. EST. Any 

comments received after the close of the 

comment period will not be considered. 

ADDRESSES: You may submit comments 

by any of the following methods: 

1. Electronic Mail—CHIPRAquality

measures@AHRQ.hhs.gov. 

2. Mail—Agency for Healthcare 

Research and Quality, Attention: Office 

of Extramural Research, Education, and 

Priority Populations-Public Comment, 

CHIPRA PQMP Priorities, 540 Gaither 

Rd., Rockville, MD 20850. 

Comments cannot be sent by facsimile 

transmission, because of staff and 

resource limitations. Please note that all 

submissions may be posted without 

change to http://www.AHRQ.gov/chipra, 

including any personal information 

provided. 

FOR FURTHER INFORMATION CONTACT:

Denise Dougherty, PhD, Senior 

Advisor, Child Health and Quality 

Improvement, Office of Extramural 

Research, Education, and Priority 

Populations, Agency for Healthcare 

Research and Quality, 540 Gaither Rd., 

Rockville, MD. 301–427–1868. 

Denise.dougherty@ahrq.hhs.gov. 

For information regarding this Notice, 

please contact: CHIPRAquality

measures@AHRQ.hhs.gov. 

SUPPLEMENTARY INFORMATION: On 

February 4, 2009, the Congress enacted 

the Children’s Health Insurance 

Program Reauthorization Act (CHIPRA) 

of 2009 (Pub. L. 111–3)., Section 401(a) 

of the legislation amended title XI of the 

Social Security Act (the Act) to establish 

section 1139A (42 U.S.C. 1320b-9a). 

Subsection 1139A(b)(E) requires the 

Secretary to consult with a wide 

spectrum of national stakeholders to 

identify gaps in existing pediatric 

quality measures and establish priorities 

for development and advancement of 

such measures. The Secretary delegated 

CHIPRA implementation to the Centers 

for Medicare & Medicaid Services 

(CMS). A ‘‘Memorandum of 

Understanding ‘‘was entered into with 

the Agency for Healthcare Research and 

Quality (AHRQ), by which AHRQ 

would conduct several activities in Title 

IV. These included the identification of 

an initial, recommended core set of 

children’s healthcare quality measures 

for voluntary use by Medicaid and CHIP 

programs and establishment of the 

Pediatric Quality Measures Program 

(PQMP), both in collaboration with 

CMS. 

Pediatric Quality Measures Program 

(PQMP). The PQMP was required to be 

established by January 1, 2011, and 

authorized to award grants and 

contracts. The PQMP will consist of 7– 

9 cooperative agreement awards to 

successful applicants to HS11–001 

(http://grants.nih.gov/grants/guide/rfafiles/RFA–HS–11–001.html), and a 

contract award to a CHIPRA 

Coordinating and Technical Assistance 

Center (http://www.ahrg.gov/chipra/

#CTAC), both supervised by AHRQ and 

CMS. As required by CHIPRA, 

successful applicants will work on 

priorities for measurement methods and 

topics set by HHS and informed by the 

input of multiple stakeholders. 

Multi-stakeholder consultation. 

Section 1139A(b)(3) requires a 

consultation process for establishing 

priorities for the pediatric quality 

measures program that requires 

consultation with multiple stakeholders, 

as follows: 

‘‘ * * * the Secretary shall consult with: 

‘‘(A) States; 

(B) pediatricians, children’s hospitals, and 

other primary and specialized pediatric 

health care professionals (including members 

of the allied health professions) who 

specialize in the care and treatment of 

children, particularly children with special 

physical, mental and developmental health 

care needs; 

(C) dental professionals, including 

pediatric dental professionals; 

(D) health care providers that furnish 

primary health care to children and families 

who live in urban and rural medically 

underserved communities or who are 

members of distinct population sub-groups at 

heightened risk for poor health outcomes; 

(E) national organizations representing 

children, including children with disabilities 

and children with chronic conditions; 

(F) national organizations representing 

consumers and purchasers of children’s 

health care; 

(G) national organizations and individuals 

with expertise in pediatric health quality 

measurement; and 

(H) voluntary consensus standards setting 

organizations and other organizations 

involved in the advancement of evidencebased measures of health care.’’ 

Measure topics: Section 

1139A(b)(2)(E) requires that the 

improved core measure sets include (but 

not necessarily be limited to) the 

following topics and types of healthcare 

quality measures: 

‘‘(A) The duration of children’s health 

insurance coverage over a 12-month time 

period. 

‘‘(B) The availability and effectiveness of a 

full range of— 

‘‘(i) preventive services, treatments, and 

services for acute conditions, including 

services to promote healthy birth, prevent 

and treat premature birth, and detect the 

presence or risk of physical or mental 

conditions that could adversely affect growth 

and development; and 

‘‘(ii) treatments to correct or ameliorate the 

effects of physical and mental conditions, 

including chronic conditions, in infants, 

young children, school-age children, and 

adolescents. 

‘‘(C) The availability of care in a range of 

ambulatory and inpatient health care settings 

in which such care is furnished. 

‘‘(D) The types of measures that, taken 

together, can be used to estimate the overall 

national quality of health care for children, 

including children with special needs, and to 

perform comparative analyses of pediatric 

health care quality and racial, ethnic, and 

socioeconomic disparities in child health and 

health care for children. 

CHIPRA Section 1139A(b)(2)) requires 

that the measures developed under the 

pediatric quality measures program 

shall, at a minimum, be: 

‘‘(A) evidence-based and, where 

appropriate, risk adjusted; 

‘‘(B) designed to identify and eliminate 

racial and ethnic disparities in child health 

and the provision of health care; 

‘‘(C) designed to ensure that the data 

required for such measures is collected and 

reported in a standard format that permits 

comparison of quality and data at a State, 

plan, and provider level; 

‘‘(D) periodically updated; and 

‘‘(E) responsive to the child health needs, 

services, and domains of health care quality 

described in clauses (i), (ii), and (iii) of 

subsection (a)(6)(A). 

Definition of healthcare quality 

measure. For purposes of this notice, a 

healthcare quality measure is defined as 

a mechanism that enables a user to 

quantify the quality of a selected aspect 

of care by comparing it to a criterion 

(adapted from http:// 

www.qualitymeasures.AHRQ.gov/ 

resources/measure use.aspx). 

Definition of healthcare quality. An 

Institute of Medicine Committee on a 

Future Vision for the National 

Healthcare Quality and Disparities 

Reports has recently updated the IOM 

recommended framework for assessing 

and improving quality so that 6 

components of quality care are 

identified (safety, timeliness, 

effectiveness, patient/familycenteredness, access, efficiency), as well 

as 2 crosscutting dimensions (equity 

and value), three types of care 

(preventive care, acute treatment, and 

chronic condition management), and 

two additional elements (care 

coordination, health systems 

infrastructure capabilities). (http:// 

iom.edu/Reports/2010/FutureDirections-for-the-National-HealthcareQuality-and-Disparities-Reports.aspx). 

We adopt this framework for purposes 

of this public notice. 

Prior work to identify priorities for 

the POMP. The first phase of CHIPRA 

required a process for developing 

recommendations for an initial core set 

of quality measures for voluntary use by 

Medicaid and CHIP programs. As 

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Federal Register / Vol. 75, No. 232 / Friday, December 3, 2010 / Notices 75471 

discussed in the Federal Register Notice 

and background paper that 

accompanied the public posting of the 

initial, recommended core set (http:// 

www.ahrq.gov/chip/ 

chipraact.htm#Core), not all CHIPRA 

criteria were able to be met for the 

initial core set. Public comments on the 

initial, recommended core set, and an 

expert meeting on measure criteria for 

the CHIPRA PQMP (http:// 

www.AHRQ.gov/chipra/#Expert) 

provided additional insights into 

potential priorities for the PQMP. The 

combination of these efforts and events 

led to the identification of the following 

potential priorities for measure 

enhancement and development of new 

measures: 

1. Development or enhancement of 

methods to: 

a. Standardize measures across all 

payers, programs, and providers, public 

and private, as appropriate, to ensure 

that comparisons are valid. 

b. Assess disparities in quality by 

race, ethnicity, socioeconomic status, 

geographic region and residence, and 

special health care needs, for example 

by developing new measurement 

methods or enhancing existing 

measurement methods. 

c. Adjust for risk by enrollment 

duration. 

d. Stratify or adjust for risk by depth 

and breadth of coverage. 

e. Stratify or adjust for risk by medical 

conditions, including severity and 

acuity. 

f. Capitalize on current and coming 

investments in health information 

technology (e.g., patient and procedure 

registries, electronic health records, 

health information exchanges, 

interoperability), including meaningful 

use criteria under the American 

Recovery and Reinvestment Act 

(ARRA). 

g. Increase State programs’ and CMS’s 

ability to rely on non-Medicaid and 

CHIP data sources through improvement 

in public health sector measurement 

(e.g., birth certificate data; 

immunization surveys). 

h. Come to consensus on the meaning 

and application of ‘‘evidence-based’’ in 

the context of healthcare quality 

measurement for children. 

i. Incorporate patient and family 

perspectives into measurement to 

increase understandability. 

2. Development or enhancement of 

measures in key topic areas: 

a. Most integrated healthcare settings. 

b. Availability of services. 

c. Duration of enrollment as a 

standalone measure. 

d. Measures of the content (quality) of 

care now typically measured as broad 

utilization categories (e.g., prenatal, 

postpartum, newborn care (including 

breastfeeding support), well-child and 

adolescent well-care visits, screening 

services, and follow-up visits for 

chronic conditions and related 

medications). 

e. Specific care settings and 

conditions: 

i. Perinatal care (e.g., family planning 

clinics, obstetric and gynecological care, 

birth centers). 

ii. Quality of mental/behavioral health 

and substance abuse services, including 

prevention and treatment services, 

across all settings. 

iii. Quality of care in settings beyond 

traditional medical care settings (e.g., 

for screening, diagnostic services and 

therapies). 

iv. Inpatient settings (including 

specialty inpatient settings). 

v. Specialty care for child conditions 

and diseases. 

vi. Care transitions for patients 

transitioning within and across health 

care settings. 

vii. Additional measures related to 

family experiences of care (e.g., child or 

adolescent self-reports; perinatal 

experiences of care; inpatient 

experiences) 

viii. Health outcome measures (e.g., 

measures of patient and population 

health or other outcomes of 

healthcare).2

ix. Structural measures (e.g., measures 

of system design features that are 

causally linked to improved healthcare 

processes and outcomes). 

Those submitting comments are 

encouraged to include a summary of 

evidence for the readiness of a topic for 

quality measurement and the 

importance of a topic or method. 

Additional background information may 

be attached. Commenters may wish to 

address these issues using the following 

questions. Commenters may also wish 

to include in their comments a summary 

score based on a scale of 1–5, where 1 

is a high score, 3 is a medium score, and 

5 is a low score. 

Validity/Underlying Scientific 

Soundness: To what extent is there a 

demonstrated causal relationship 

between the element of quality to be 

measured (as a structure, process, or 

health outcome of healthcare delivery) 

and another element of the healthcare 

delivery system (e.g., structure and 

process; process and outcome). 

Commenters may wish to use as a guide 

to assessing underlying scientific 

soundness the method and criteria used 

by the AHRQ National Advisory 

Council Subcommittee on Children’s 

Healthcare Quality Measures for 

Medicaid and CHIP, where appropriate 

http://www.AHRQ.gov/chipra/

corebackground/

corebacktab.htm#note5). 

Importance: Importance has several 

dimensions: 

• To what extent is the topic 

important to children’s health 

outcomes, family functioning, or 

societal functioning, including but not 

necessarily limited to high monetary 

costs of poor quality healthcare to 

children, families, or Society? 

• To what extent is the topic 

important to reducing disparities in the 

quality of care for particular racial and 

ethnic groups of children, 

socioeconomic groups, geographically 

underserved groups, and children with 

special healthcare needs? 

• To what extent is the topic 

important as a sentinel measure that 

could have spillover effects to the rest 

of the children’s healthcare delivery 

system? 

• To what extent is the proposed 

methodology important for addressing 

current shortcoming of healthcare 

quality measurement? 

We strongly encourage comments to 

be as succinct as possible (250 words or 

less per topic, with additional 

supporting data allowed). 

3. Collection of Information 

Requirements 

This voluntary request does not 

impose information collection and 

recordkeeping requirements. 

Consequently, it need not be reviewed 

by the Office of Management and 

Budget under the authority of the 

Paperwork Reduction Act of 1995 (44 

U.S.C. 35). 

4. Regulatory Impact Analysis 

As this notice does not meet the 

significance criteria of Executive Order 

12866, it was not reviewed by the Office 

of Management and Budget. 

Dated: November 24, 2010. 

Carolyn M. Clancy, 

AHRQ Director. 

[FR Doc. 2010–30262 Filed 12–2–10; 8:45 am] 

BILLING CODE 4160–90–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Agency for Healthcare Research and 

Quality 

Patient Safety Organizations: 

Voluntary Delisting 

AGENCY: Agency for Healthcare Research 

and Quality, HHS. 

ACTION: Notice of Delisting. 

mstockstill on DSKH9S0YB1PROD with NOTICES