Federal Register / Vol. 76, No. 1 / Monday, January 3, 2011 / Notices 147 

Dated: December 28, 2010. 

Mirtha Beadle, 

Deputy Director, Office of Minority Health, 

Office of the Assistant Secretary for Health, 

Office of the Secretary, U.S. Department of 

Health and Human Services. 

[FR Doc. 2010–33084 Filed 12–30–10; 8:45 am] 

BILLING CODE 4150–29–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Disease Control and 

Prevention 

[60Day–11–11BM] 

Proposed Data Collections Submitted 

for Public Comment and 

Recommendations 

In compliance with the requirement 

of Section 3506(c)(2)(A) of the 

Paperwork Reduction Act of 1995 for 

opportunity for public comment on 

proposed data collection projects, the 

Centers for Disease Control and 

Prevention (CDC) will publish periodic 

summaries of proposed projects. To 

request more information on the 

proposed projects or to obtain a copy of 

the data collection plans and 

instruments, call 404–639–5960 and 

send comments to Carol E. Walker, 

Acting CDC Reports Clearance Officer, 

1600 Clifton Road, MS–D74, Atlanta, 

GA 30333 or send an e-mail to 

omb@cdc.gov. 

Comments are invited on: (a) Whether 

the proposed collection of information 

is necessary for the proper performance 

of the functions of the agency, including 

whether the information shall have 

practical utility; (b) the accuracy of the 

agency’s estimate of the burden of the 

proposed collection of information; (c) 

ways to enhance the quality, utility, and 

clarity of the information to be 

collected; and (d) ways to minimize the 

burden of the collection of information 

on respondents, including through the 

use of automated collection techniques 

or other forms of information 

technology. Written comments should 

be received within 60 days of this 

notice. 

Proposed Project 

Healthcare System Surge Capacity at 

the Community Level—New—National 

Center for Emerging and Zoonotic 

Infectious Diseases, (NCEZID), Centers 

for Disease Control and Prevention, 

(CDC). 

Background and Brief Description 

The Healthcare Preparedness Activity, 

Division of Healthcare Quality 

Promotion (DHQP) at the Centers for 

Disease Control and Prevention (CDC) 

works with other Federal agencies, State 

governments, medical societies and 

other public and private organizations 

to promote collaboration amongst 

healthcare partners, and to integrate 

healthcare preparedness into Federal, 

State and local public health 

preparedness planning. The goal of the 

Activity is to help local communities’ 

healthcare delivery and public health 

sectors effectively and efficiently 

prepare for and respond to urgent and 

emergent threats. 

Surge is defined as a marked increase 

in demand for resources such as 

personnel, space and material. Health 

care providers manage both routine 

surge (predictable fluctuations in 

demand associated with the weekly 

calendar, for example) as well as 

unusual surge (larger fluctuations in 

demand caused by rarer events such as 

pandemic influenza). Except in 

extraordinary cases, providers are 

expected to manage surge while 

adhering to their existing standards for 

quality and patient safety. Currently, 

health care organizations are expected 

to prepare for and respond to surges in 

demand ranging from a severe 

catastrophe (for example, a nuclear 

detonation) to more common, less 

severe events (for example, a worsethan-usual influenza season). The 

Centers for Disease Control and 

Prevention (CDC) and Federal agencies 

have dedicated considerable funding 

and technical assistance towards 

developing and coordinating 

community-level responses to surges in 

demand, but it remains a difficult task. 

While there is extensive research on 

managing collaborations during times of 

extraordinary pressure where response 

to surge takes precedence over other 

activities, less is known about 

developing and maintaining integrated 

collaborations during periods where the 

system must respond to unusual surge 

but also continue the routine provision 

of health care. In particular, studies 

have not explored how these 

collaborations can build on sustainable 

relationships between a broad range of 

stakeholders (including primary care 

providers) in communities with 

different market structures and different 

degrees of investment in public health. 

This study aims to generate 

information about the role of 

community-based collaborations in 

disaster preparedness that the CDC can 

use to develop its programs guiding and 

supporting these collaborations. This 

project will explore barriers and 

facilitators to coordination on surge 

response in ten communities, eight of 

which have been studied longitudinally 

since the mid-1990s as part of the 

Center for Studying Health System 

Change’s (HSC’s) Community Tracking 

Study (CTS). Interviews of local 

healthcare stakeholders will be 

conducted at 10 sites. 

Interviews will be conducted at a total 

of 63 organizations over the two years 

of this project. Within each of the ten 

communities studied, two emergency 

practitioner respondents (one from a 

safety-net hospital and one from a nonsafety-net hospital), two primary care 

providers (one from a large practice and 

one from a small practice) and two local 

preparedness experts (one from the 

County or local public health agency, 

and one coordinator or collaboration 

leader) will be interviewed. In three 

sites (Phoenix, Greenville and Seattle) 

an additional respondent will be 

identified from an outlying rural area to 

offer the perspective of providers in 

those communities. There is no cost to 

respondents except their time. 

ESTIMATED ANNUALIZED BURDEN HOURS

Respondent category Number of 

respondents 

Number of responses per 

respondent 

Average burden response 

(in hours) 

Total burden 

(in hours) 

Emergency Department: Private, non-safety net ............................................ 10 1 1 10 

Emergency Department: Public/safety net ...................................................... 10 1 1 10 

Primary Care: Larger practice ......................................................................... 10 1 1 10 

Primary Care: Solo/2 physician practice ......................................................... 10 1 1 10 

Preparedness: Public/Department of Health ................................................... 10 1 1 10 

Preparedness: Health care preparedness coordinator/collaboration leader ... 10 1 1 10 

Rural (Greenville, Phoenix, Seattle only: Clinician-leader at rural site (ED or 

PC) ............................................................................................................... 3 1 1 3 


jlentini on DSKJ8SOYB1PROD with NOTICES
148 Federal Register / Vol. 76, No. 1 / Monday, January 3, 2011 / Notices 

ESTIMATED ANNUALIZED BURDEN HOURS—Continued 

Respondent category Number of 

respondents 

Number of responses per 

respondent 

Average burden response 

(in hours) 

Total burden 

(in hours) 

Total .......................................................................................................... ........................ ........................ ........................ 63 

Dated: December 27, 2010. 

Carol E. Walker, 

Acting Reports Clearance Officer, Centers for 

Disease Control and Prevention. 

[FR Doc. 2010–33128 Filed 12–30–10; 8:45 am] 

BILLING CODE P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–2321–N] 

RIN 0938–AQ44 

Medicaid Program; Final FY 2009 and 

Preliminary FY 2011 Disproportionate 

Share Hospital Allotments, and Final 

FY 2009 and Preliminary FY 2011 

Institutions for Mental Diseases 

Disproportionate Share Hospital Limits 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice announces the 

final Federal share disproportionate 

share hospital (DSH) allotments for 

Federal FY (FY) 2009 and the 

preliminary Federal share DSH 

allotments for FY 2011. This notice also 

announces the final FY 2009 and the 

preliminary FY 2011 limitations on 

aggregate DSH payments that States may 

make to institutions for mental disease 

and other mental health facilities. In 

addition, this notice includes 

background information describing the 

methodology for determining the 

amounts of States’ FY DSH allotments. 

DATES: Effective Date: This notice is 

effective March 4, 2011. The final 

allotments and limitations set forth in 

this notice are effective for the fiscal 

years specified. 

FOR FURTHER INFORMATION CONTACT: 

Richard Strauss, (410) 786–2019. 

SUPPLEMENTARY INFORMATION: 

I. Background 

A. Disproportionate Share Hospital 

Allotments for Federal FY 2003 

Under section 1923(f)(3) of the Social 

Security Act (the Act), States’ Federal 

fiscal year (FY) 2003 disproportionate 

share hospital (DSH) allotments were 

calculated by increasing the amounts of 

the FY 2002 allotments for each State 

(as specified in the chart, entitled ‘‘DSH 

Allotment (in millions of dollars)’’, 

contained in section 1923(f)(2) of the 

Act) by the percentage change in the 

Consumer Price Index for all Urban 

Consumers (CPI–U) for the prior fiscal 

year. The allotment, determined in this 

way, is subject to the limitation that an 

increase to a State’s DSH allotment for 

a FY cannot result in the DSH allotment 

exceeding the greater of the State’s DSH 

allotment for the previous FY or 12 

percent of the State’s total medical 

assistance expenditures for the 

allotment year (this is referred to as the 

12 percent limit). 

Most States’ actual FY 2002 

allotments were determined in 

accordance with the provisions of 

section 1923(f)(4) of the Act which 

allowed for a special DSH calculation 

rule for FY 2001 and FY 2002. However, 

as indicated previously, the calculation 

of States’ FY 2003 allotments was not 

based on the actual FY 2002 DSH 

allotments; rather, section 1923(f)(3) of 

the Act requires that the States’ FY 2003 

allotments be determined using the 

amount of the States’ FY 2002 

allotments specified in the chart in 

section 1923(f)(2) of the Act. The 

exception to this is the calculation of 

the FY 2003 DSH allotments for certain 

‘‘Low-DSH States’’ (defined in section 

1923(f)(5) of the Act). Under the LowDSH State provision, there is a special 

calculation methodology for the LowDSH States only. Under this 

methodology, the FY 2003 allotments 

were determined by increasing States’ 

actual FY 2002 DSH allotments, rather 

than their FY 2002 allotments specified 

in the chart in section 1923(f)(2) of the 

Act, by the percentage change in the 

CPI–U for the previous fiscal year. 

B. DSH Allotments for FY 2004 

Section 1001(a) of the Medicare 

Prescription Drug, Improvement, and 

Modernization Act of 2003 (MMA) (Pub. 

L. 108–173, enacted on December 8, 

2003) amended section 1923(f)(3) of the 

Act to provide for a ‘‘Special, Temporary 

Increase In Allotments On A One-Time, 

Non-Cumulative Basis.’’ Under this 

provision, States’ FY 2004 DSH 

allotments were determined by 

increasing their FY 2003 allotments by 

16 percent, and the FY DSH allotment 

amounts so determined were not subject 

to the 12 percent limit. 

C. DSH Allotments for Non-Low DSH 

States for FY 2005, and FYs Thereafter 

Under the methodology contained in 

section 1923(f)(3)(C) of the Act, as 

amended by section 1001(a)(2) of the 

MMA, the non-Low-DSH States’ DSH 

allotments for FY 2005 and subsequent 

FYs continue at the same level as the 

States’ DSH allotments for FY 2004 until 

a ‘‘fiscal year specified’’ occurs. The 

fiscal year specified is the first FY for 

which the Secretary estimates that a 

State’s DSH allotment equals (or no 

longer exceeds) the DSH allotment as 

would have been determined under the 

statute in effect before the enactment of 

the MMA. We determine whether the 

fiscal year specified has occurred under 

a special parallel process. Specifically, 

under this parallel process, a ‘‘parallel’’ 

DSH allotment is determined for FYs 

after 2003 by increasing the State’s DSH 

allotment for the previous FY by the 

percentage change in the CPI–U for the 

prior FY, subject to the 12 percent limit. 

This is the methodology as would 

otherwise have been applied under 

section 1923(f)(3)(A) of the Act, 

notwithstanding the application of the 

provisions of MMA. The fiscal year 

specified, is the FY in which the 

parallel DSH allotment calculated under 

this special parallel process equals or 

exceeds the FY 2004 DSH allotment, as 

determined under the MMA provisions. 

Once the fiscal year specified occurs for 

a State, that State’s FY DSH allotment 

will be calculated by increasing the 

State’s previous actual FY DSH 

allotment (which would be equal to the 

FY 2004 DSH allotment) by the 

percentage change in the CPI–U for the 

previous FY, subject to the 12 percent 

limit. The following example illustrates 

how the FY DSH allotment would be 

calculated for FYs after FY 2004. 

Example—In this example, we are 

determining the parallel FY 2009 DSH 

allotment. A State’s actual FY 2003 DSH 

allotment is $100 million. Under the MMA, 

this State’s actual FY 2004 DSH allotment 

would be $116 million ($100 million 

increased by 16 percent). The State’s DSH 

allotment for FY 2005 and subsequent FYs 

would continue at the $116 million FY 2004 

DSH allotment for FYs following FY 2004 

until the fiscal year specified occurs. Under 

the separate parallel process, we determine 


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