### 70558 Federal Register / Vol. 78, No. 228 / Tuesday, November 26, 2013 / Notices

27 FDIC, ‘‘FDIC Model Safe Accounts Pilot Final Report,’’ (April 2012). template of important elements for such lending. 27 The FDIC encourages banks to continue to offer these products, in a manner consistent with safety and soundness and other supervisory considerations, and encourages other banks to consider offering suchproducts. Properly managed smalldollar loan products offered with
reasonable terms and at a reasonable cost do not pose the same level of supervisory risk as deposit advance products. The FDIC encourages banks to develop new or innovative programs toeffectively meet the need for smalldollar credit that do not exhibit the risks associated with deposit advance products and payday loans.

Dated at Washington, DC, this 21st day of November, 2013. Federal Deposit Insurance Corporation.

Robert E. Feldman,
Executive Secretary.

[FR Doc. 2013–28306 Filed 11–25–13; 8:45 am]

**BILLING CODE 6714–01–P**

**FEDERAL DEPOSIT INSURANCE**
**CORPORATION**

**FDIC Systemic Resolution Advisory Committee; Notice of Meeting** 

**AGENCY :**  Federal Deposit Insurance Corporation.

**ACTION :**  Notice of open meeting.

**SUMMARY :**  In accordance with the Federal Advisory Committee Act, 5 U.S.C. App. 2, notice is hereby given of a meeting of the FDIC Systemic Resolution Advisory Committee (the ‘‘SR Advisory Committee’’), which will be held in Washington, DC. The SR Advisory Committee will provide
advice and recommendations on a broad range of issues regarding the resolution of systemically important financial companies pursuant to Title II of the
Dodd-Frank Wall Street Reform and Consumer Protection Act, Public Law 111–203 (July 21, 2010), 12 U.S.C. 5301 et seq. (the ‘‘Dodd-Frank Act’’).

**DATES :**  Wednesday, December 11, 2013, from 8:45 a.m. to 3:45 p.m.

**ADDRESSES :**  The meeting will be held in
the FDIC Board Room on the sixth floor of the FDIC Building located at 550 17th Street NW., Washington, DC.

**FOR FURTHER INFORMATION CONTACT :**  Requests for further information concerning the meeting may be directed to Mr. Robert E. Feldman, Committee Management Officer of the FDIC, at (202) 898–7043.

**SUPPLEMENTARY INFORMATION :**  Agenda: The agenda will include a discussion of a range of issues related to the resolution of systemically important financial companies pursuant to Title II of the Dodd-Frank Act. The agenda may be subject to change. Any changes to the agenda will be announced at the beginning of the meeting.
Type of Meeting: The meeting will be open to the public, limited only by thespace available, on a first-come, firstserved basis. For security reasons, members of the public will be subject to security screening procedures and must present valid photo identification to enter the building. The FDIC will provide attendees with auxiliary aids (e.g., sign language interpretation) required for this meeting. Those attendees needing such assistance should call (703) 562–6067 (Voice or TTY) at least two days before the meeting to make necessary arrangements. Written statements may be filed with the SR Advisory Committee before or after the meeting. This SR Advisory Committee meeting

will be Webcast live via the Internet at http://www.vodium.com/ MediapodLibrary/ index.asp?library=pn100472

_ fdic

_ SRAC. This service is free and available to anyone with the following systems requirements: http://www.vodium.com/ home/sysreq.html. Adobe Flash Player is required to view these presentations. The latest version of Adobe Flash Player

can be downloaded at: http://
www.adobe.com/shockwave/download/ download.cgi?P1

_ Version=ShockwaveFlash. Installation questions or troubleshooting help can be found at the same link. For optimal viewing, a high speed Internet

connection is recommended. The SR Advisory Committee meeting videos are

made available on-demand approximately two weeks after the

event.

Dated: November 21, 2013.
Federal Deposit Insurance Corporation.

Robert E. Feldman,
Executive Secretary, Federal Deposit Insurance Corporation.

[FR Doc. 2013–28304 Filed 11–25–13; 8:45 am]

**BILLING CODE 6714–01–P DEPARTMENT OF HEALTH AND** 
**HUMAN SERVICES**

**Agency for Healthcare Research and Quality** 

**Review of Proposed Changes with ICD–10–CM/PCS; Conversion of**  **Quality Indicators** TM **(QIs)**

**AGENCY :**  Agency for Healthcare Research and Quality (AHRQ), HHS.

**ACTION :**  Notice of request for public

comments.

**SUMMARY :**  The Agency for Healthcare Research and Quality (AHRQ) seeks comments on the proposed conversion of the AHRQ Quality Indicators TM to ‘‘International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System’’ (ICD–10–CM and ICD–10–PCS) codes. These changes would be applicable to hospital discharges occurring on or after October 1, 2014. The proposed ICD–10– CM/PCS codes are posted on the AHRQ QI Web site for review at: http:// www.qualityindicators.ahrq.gov/icd10/ default.aspx

**DATES :**  Comments on this notice must be received no later than 5 p.m. EDT of December 26, 2013.

**ADDRESSES :**  Comments can be filed via email or on paper. Write ‘‘AHRQ QI
ICD–10 Conversion’’ on the comments.

Postal mail addressed to AHRQ is subject to delay due to security screening. As a result, AHRQ encourages submission of comments via
email. Please submit email comments

to: QIComment@AHRQ.hhs.gov.

If comments are filed on paper, write ‘‘AHRQ QI ICD–10 Conversion’’ on such comments and on the envelope, and mail them to the following address: Pam Owens, Scientific Lead, AHRQ QI Program, Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850.

AHRQ will remove all identifying
information from the comments and will not provide individual responses. AHRQ will provide a summary of
comments and actions taken as a result of those comments. The summary document will be posted on the AHRQ QI Web site no later than the end of January 2014.

**FOR FURTHER INFORMATION CONTACT :**  Pam Owens, Agency for Healthcare Research and Quality, Center for Delivery, Organization and Markets, 540 Gaither Road, Rockville, MD 20850, Email: pam.owens@AHRQ.hhs.gov, Phone: (301) 427–1412.

**SUPPLEMENTARY INFORMATION :**  A structured approach was adopted for


### 70559 Federal Register / Vol. 78, No. 228 / Tuesday, November 26, 2013 / Notices

converting the existing AHRQ QI specifications from ICD–9–CM to ICD– 10–CM/PCS, incorporating coding expertise, clinical expertise, and health services research/quality measurement expertise. This process is summarized
in a document available for review at: http://www.qualityindicators.ahrq.gov/
Downloads/Resources/Publications/ 2013/ICD-10%20Report%2007-15- 2013.pdf

Each current AHRQ QI technical specification with ICD–9–CM codes
must be converted to ICD–10–CM/PCS codes. In each AHRQ QI technical specification, there can be one or more clinical concepts of selected ICD–9–CM codes for the numerator, denominator, and exclusion specifications. These clinical concepts are called ‘set names,’ and they represent the basic foundation or building blocks in the construction of the AHRQ QIs. Every set name, whether diagnosis or procedure, must be mapped
and reviewed for its clinical relationship to the clinical concept used within the current QI technical specification.

Following consensus guidance from the National Quality Forum (http:// www.qualityforum.org/Publications/
2010/10/ICD-10-CM/PCS

_ Coding

_ Maintenance

_ Operational

_ Guidance.aspx), AHRQ’s process for QI
conversion in 2012 and 2013 included the following components:

1. ‘‘Convene Clinical and Coding Experts: * * *use a team approach that involves experts in the code sets and the appropriate clinical domain. The team should be used to identify specific areas where questions of clinical comparability exist, evaluate consistency of clinical concepts, and ensure appropriate conversion. Experts
are needed in both the source and the target code set (e.g., ICD–9–CM and ICD–10–CM/PCS). Clinical expertise should be in the care setting represented by the clinical domain for the measure and may require specialized knowledge in some clinical areas.’’ To this end, AHRQ contracted with clinical and coding experts at the University of
California Davis and convened ten workgroups with a total of 27 physicians, 22 nurses, 26 coding professionals, and 9 QI data users in the following domains: Cancer, Cardiac, Critical Care/Pulmonary, Infection, Internal Medicine, Neonatal/Pediatric, Neurology, Obstetrics and Gynecology, Orthopedic, General and Trauma Surgery. Work group members were
trained on the ICD–10 code sets and supported by at least two American Health Information Management Association (AHIMA)-approved ICD–
10–CM/PCS Trainers. 2. ‘‘Determine Intent: When converting a quality measure from ICD– 9–CM to ICD–10–CM/PCS, rather than doing a code-to-code conversion, a measure developer may choose to take advantage of the added granularity and specificity [that] ICD–10–CM/PCS offers, potentially making the updated measure inherently different* * * [T]he most ideal way to convert code sets for quality measures would be to examine the original intent of the measure and select codes directly from the target code set to define the concepts rather than relying on mapping alone* * * (1) The measure steward’s goal was to convert this measure to a new code set, fully consistent with the intent of the original measure; (2) The measure steward’s goal was to take advantage of the more specific code set to form a new version of the measure, but fully consistent with the original intent; (3) The measure steward has changed the intent of the measure.’’ AHRQ adopted approaches (1) and (2) in the current conversion effort. Specifications consistent with (1) are called ‘‘legacy specifications’’ and are offered for historical analyses that require maximal comparability over time. Specifications consistent with (2) are called ‘‘enhanced specifications’’ and are offered for use in analyses of current health care quality, including public reporting and other accountability applications.

3. ‘‘Use Appropriate Conversion Tool: When converting from ICD–9–CM to ICD–10–CM/PCS, for example, maps such as General Equivalence Maps (GEMs) can be useful for narrowing the choice of target codes* * *’’ GEM files were the foundation of AHRQ’s code mapping effort.

4. ‘‘Assess for Material Change: Measure developers should determine during the process whether the measure has materially changed based on the intent of the updated measure and any testing that has been performed . . . This step is intended to address the comparability of the converted measure (using ICD–10–CM/PCS) to its predecessor (using ICD–9–CM) . . . Measure sponsors also should assess, if possible, whether the conversion results
in rates that are similar within defined
tolerances . . . ’’ This work will be undertaken over the next year as dual
coded data becomes available for testing. AHRQ welcomes suggestions regarding dual-coded (ICD–9–CM and ICD–10–CM/PCS) data that may be available for testing purposes in early

2014.

5. ‘‘Solicit Stakeholder Comments: Conversion to new code sets requires involvement of many stakeholders; measure developers should solicit comments from a wide audience for additions and deletions, and with specific attention to new codes.’’ This notice represents one component of AHRQ’s comprehensive effort to solicit and respond to stakeholder comments.

6. ‘‘Version the Updated Measure: Measures with coding updates should be identified by version. Different versions of measures may be used longitudinally for various purposes but may not be exactly comparable.’’ This final step will be implemented when the updated AHRQ QI specifications have been tested and are ready for public use,
not later than October 2014.

For additional information about the AHRQ QIs, please visit the AHRQ Web

site at http:// www.QUALITYindicators.AHRQ.gov.

Background

The AHRQ Quality Indicators (AHRQ QIs) are a unique set of measures of health care quality that make use of readily available hospital inpatient administrative data. The AHRQ QIs are provider- and area-level quality indicators and currently consist of four modules: The Prevention Quality Indicators (PQI), the Inpatient Quality Indicators, the Patient Safety Indicators (PSI), and the Pediatric Quality Indicators (PDIs). The AHRQ QIs serve multiple purposes, including research, needs assessments for planning at the local, state, and national levels, hospital quality improvement initiatives, performance assessment for public reporting to enable consumers to make
more informed choices about their sites of care, public reporting to reward favorable outcomes and encourage changes in provider behavior, and information to be used by healthcare purchasers that link performance with payment. Users of the AHRQ QIs vary and include researchers, State data organizations, hospital systems and networks, hospital associations, State Medicaid agencies, Centers for Medicare & Medicaid Services (CMS), large private purchasers and public-private purchaser coalitions, and consumer

groups.

AHRQ is committed to converting the AHRQ QIs from ICD–9–CM to ICD–10– CM/PCS in an accurate and transparent manner, taking advantage of the additional specificity of ICD–10–CM/ PCS to improve the validity and usefulness of the QIs from October 2014
onward.

Dated: November 13, 2013.

Richard Kronick,

AHRQ Director.

[FR Doc. 2013–28282 Filed 11–25–13; 8:45 am]

**BILLING CODE 4160–90–P**