Federal Register / Vol. 76, No. 107 / Friday, June 3, 2011 / Notices 32207 

ARRA ADJUSTMENTS TO Q3 FY11 

State 

Hold harmless 

FY11 FMAP 

with 1.2% pt 

increase 

State 

share 

Adjusted 

state 

share 

Hold harmless 

FY11 

unemployment 

tier 

Unemployment 

adjustment 

Q3 FY11 

Third quarter 

FY11 FMAP 

unemployment 

adjustment 

Alabama ........................... 69.74 31.46 30.86 11.5 3.55 73.29 

Alaska* ............................. 53.68 47.52 46.92 8.5 3.99 57.67 

Arizona ............................. 67.40 33.80 33.20 11.5 3.82 71.22 

Arkansas .......................... 74.14 27.06 26.46 8.5 2.25 76.39 

California .......................... 51.20 50.00 49.40 11.5 5.68 56.88 

Colorado ........................... 51.20 50.00 49.40 11.5 5.68 56.88 

Connecticut ...................... 51.20 50.00 49.40 11.5 5.68 56.88 

Delaware .......................... 54.35 46.85 46.25 11.5 5.32 59.67 

Dist of Columbia .............. 71.20 30.00 29.40 11.5 3.38 74.58 

Florida .............................. 58.03 43.17 42.57 11.5 4.90 62.93 

Georgia ............................ 66.53 34.67 34.07 11.5 3.92 70.45 

Hawaii .............................. 57.70 43.50 42.90 11.5 4.93 62.63 

Idaho ................................ 71.07 30.13 29.53 11.5 3.40 74.47 

Illinois ............................... 51.52 49.68 49.08 11.5 5.64 57.16 

Indiana ............................. 67.72 33.48 32.88 11.5 3.78 71.50 

Iowa .................................. 64.71 36.49 35.89 8.5 3.05 67.76 

Kansas ............................. 61.58 39.62 39.02 8.5 3.32 64.90 

Kentucky .......................... 72.69 28.51 27.91 11.5 3.21 75.90 

Louisiana .......................... 73.67 27.53 26.93 11.5 3.10 76.77 

Maine ............................... 66.19 35.01 34.41 11.5 3.96 70.15 

Maryland .......................... 51.20 50.00 49.40 11.5 5.68 56.88 

Massachusetts ................. 51.20 50.00 49.40 11.5 5.68 56.88 

Michigan ........................... 66.99 34.21 33.61 11.5 3.87 70.86 

Minnesota ......................... 51.20 50.00 49.40 11.5 5.68 56.88 

Mississippi ........................ 77.49 23.71 23.11 11.5 2.66 80.15 

Missouri ............................ 65.71 35.49 34.89 11.5 4.01 69.72 

Montana ........................... 69.73 31.47 30.87 11.5 3.55 73.28 

Nebraska .......................... 61.76 39.44 38.84 5.5 2.14 63.90 

Nevada ............................. 53.84 47.36 46.76 11.5 5.38 59.22 

New Hampshire* .............. 51.20 50.00 49.40 11.5 5.68 56.88 

New Jersey ...................... 51.20 50.00 49.40 11.5 5.68 56.88 

New Mexico ..................... 72.55 28.65 28.05 11.5 3.23 75.78 

New York ......................... 51.20 50.00 49.40 11.5 5.68 56.88 

North Carolina .................. 66.33 34.87 34.27 11.5 3.94 70.27 

North Dakota .................... 64.95 36.25 35.65 0 0.00 64.95 

Ohio .................................. 64.89 36.31 35.71 11.5 4.11 69.00 

Oklahoma ......................... 68.30 32.90 32.30 11.5 3.71 72.01 

Oregon ............................. 64.05 37.15 36.55 11.5 4.20 68.25 

Pennsylvania .................... 56.84 44.36 43.76 11.5 5.03 61.87 

Rhode Island .................... 54.17 47.03 46.43 11.5 5.34 59.51 

South Carolina ................. 71.52 29.68 29.08 11.5 3.34 74.86 

South Dakota ................... 63.92 37.28 36.68 8.5 3.12 67.04 

Tennessee ....................... 67.05 34.15 33.55 11.5 3.86 70.91 

Texas ............................... 61.76 39.44 38.84 11.5 4.47 66.23 

Utah .................................. 72.88 28.32 27.72 11.5 3.19 76.07 

Vermont* .......................... 60.65 40.55 39.95 11.5 4.59 65.24 

Virginia ............................. 51.20 50.00 49.40 11.5 5.68 56.88 

Washington ...................... 52.72 48.48 47.88 11.5 5.51 58.23 

West Virginia .................... 75.45 25.75 25.15 11.5 2.89 78.34 

Wisconsin ......................... 61.41 39.79 39.19 11.5 4.51 65.92 

Wyoming .......................... 51.20 50.00 49.40 11.5 5.68 56.88 

*The unemployment tier for these States decreased but the Department was not able to satisfy the 60 day notice requirement so their unemployment tier was held harmless. 

[FR Doc. 2011–13783 Filed 6–2–11; 8:45 am] 

BILLING CODE 4150–05–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Agency for Healthcare Research and 

Quality 

Agency Information Collection 

Activities; Proposed Collection; 

Comment Request 

AGENCY: Agency for Healthcare Research 

and Quality, HHS. 

ACTION: Notice. 

SUMMARY: This notice announces the 

intention of the Agency for Healthcare 

Research and Quality (AHRQ) to request 

that the Office of Management and 

Budget (OMB) approve the proposed 

information collection project: ‘‘Barriers 

to Meaningful Use in Medicaid.’’ In 

accordance with the Paperwork 

Reduction Act, 44 U.S.C. 3501–3521, 


jlentini on DSK4TPTVN1PROD with NOTICES
32208 Federal Register / Vol. 76, No. 107 / Friday, June 3, 2011 / Notices 

AHRQ invites the public to comment on 

this proposed information collection. 

This proposed information collection 

was previously published in the Federal 

Register on March 11th, 2011 and 

allowed 60 days for public comment. 

One comment was received. The 

purpose of this notice is to allow an 

additional 30 days for public comment. 

DATES: Comments on this notice must be 

received by July 5, 2011. 

ADDRESSES: Written comments should 

be submitted to: AHRQ’s OMB Desk 

Officer by fax at (202) 395–6974 

(attention: AHRQ’s desk officer) or by email at OIRA_submission@omb.eop.gov 

(attention: AHRQ’s desk officer). 

Copies of the proposed collection 

plans, data collection instruments, and 

specific details on the estimated burden 

can be obtained from the AHRQ Reports 

Clearance Officer. 

FOR FURTHER INFORMATION CONTACT: 

Doris Lefkowitz, AHRQ Reports 

Clearance Officer, (301) 427–1477, or by 

e-mail at 

doris.lefkowitz@AHRQ.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

Proposed Project 

Barriers to Meaningful Use in Medicaid 

The Health Information Technology 

for Economic and Clinical Health 

(HITECH) Act, Title XIII of Division A 

and Title IV of Division B of the 

American Recovery and Reinvestment 

Act of 2009 (ARRA) (Pub. L. 111–5), 

provides for financial incentives for 

Medicaid providers to adopt and 

‘‘meaningfully use’’ certified electronic 

health record (EHR) technologies. To 

ensure that eligible professionals (EPs) 

are able to qualify for and access these 

incentives, AHRQ proposes a 2-year 

project with the objective of 

understanding the barriers that 

Medicaid health providers encounter 

along the way to achieving the 

meaningful use of EHRs. This proposed 

information collection will allow AHRQ 

to synthesize knowledge regarding the 

barriers that EPs encounter when 

attempting to achieve meaningful use 

and translate that knowledge to develop 

technical assistance and support 

implementation and use of EHRs. 

Further, health care providers who 

serve Medicaid beneficiaries are serving 

many of AHRQ’s priority populations: 

Inner city; rural; low income; minority; 

women; children; elderly; and those 

with special health care needs. The 

project is designed to solicit actionable 

recommendations on what activities can 

best help Medicaid providers take 

advantage of incentive payments, 

achieve meaningful use, and ultimately 

use health IT to improve health care for 

the Medicaid population. The 

information gathered under this project 

will also be used to inform the 

development of the Stage 2 and 3 

Meaningful Use criteria. 

In order to gather, analyze, and 

synthesize information on the barriers to 

the meaningful use criteria experienced 

by Medicaid providers this research has 

the following goals: 

(1) Identify the barriers to eligibility 

for the incentive payments; barriers to 

adoption, implementation, or upgrading 

of EHR systems; and barriers to 

achieving meaningful use. 

(2) Develop actionable 

recommendations to overcoming the 

barriers identified in #1 above, 

including, but not limited to, technical 

assistance that could be made available 

to Medicaid providers. 

(3) Provide data to inform the 

meaningful use objectives being 

developed by the Center for Medicare & 

Medicaid Services (CMS) for Stages 2 

and 3 of the EHR Incentive Program. 

This study is being conducted by 

AHRQ through its contractor, RTI 

International, pursuant to AHRQ’s 

statutory authority to conduct and 

support research to advance both 

training for health care practitioners in 

the use of information systems and the 

use of computer-based health records. 

42 U.S.C. 299b–3(a)(2) and (6). 

Method of Collection 

To achieve the goals of this project the 

following data collections will be 

implemented: 

(1) A screening questionnaire will be 

used to identify eligible participants, as 

part of the sampling procedure for the 

focus groups. Appended to the 

screening questionnaire is a series of 

questions for individuals who have 

agreed to participate in the focus 

groups, in order to collect descriptive 

and demographic information prior to 

the focus group session, and as part of 

the analysis plan. 

(2) A total of 13 focus groups will be 

conducted with eligible Medicaid 

providers. Eight focus groups will 

include a mix of pediatricians, other 

physicians, dentists, nurse practitioners, 

physician assistants, and certified nurse 

midwives who have adopted an EHR. 

Four of the focus groups will include 

providers who have not adopted an 

EHR, and the final group will be 

comprised of private practice dentists. 

Private practice dentists are being 

considered separately due to the fact 

that their practice patterns are likely to 

vary substantially from those of primary 

care physicians and non-physician 

providers. The purpose of these focus 

groups is to gather information about 

adoption issues (factors in the decision 

to adopt an EHR), implementation 

issues (organizational or environmental 

factors that facilitate EHR 

implementation and training), upgrade 

issues (challenges to transitioning to 

certified EHRs), and challenges to 

achieving meaningful use of EHRs as 

defined in Federal regulations for Stage 

1 (particular functions that are 

problematic, the source of the 

challenge). Responses will also address 

topics related to participants’ 

knowledge of the EHR incentive 

program and other factors that may 

facilitate EHR use. The focus group 

moderator will use the moderator’s 

guide to guide discussion. The show 

cards will provide key reminders of 

content for discussion. 

The information will be used to 

develop actionable recommendations to 

overcoming barriers to meaningful use 

of EHRs for Medicaid providers, 

including but not limited to technical 

assistance that could be made available 

to Medicaid providers. Furthermore, the 

data gathered through this research will 

inform the meaningful use objectives 

being developed by CMS for Stages 2 

and 3 of the EHR Incentive Program. 

Three types of information will be 

collected: List of potential focus group 

participants, descriptive and 

demographic information about focus 

group participants, and the information 

gathered at each focus group related to 

the barriers to meaningful use. The 

information will be synthesized to 

provide information to the Federal 

government to inform the future 

meaningful use regulations and 

understand any disparities potentially 

resulting from the implementation of 

the incentive programs. 

Estimated Annual Respondent Burden 

Exhibit 1 shows the estimated 

annualized burden hours for the 

respondents’ time to participate in this 

research. The screening questionnaire 

will be completed by 300 clinicians and 

will take 12 minutes to complete on 

average. Focus groups will be conducted 

with not more than 89 clinicians and 

will last about 2 hours, except for the 

focus groups with non-users, which will 

last about 90 minutes. The total annual 

burden hours are estimated to be 228 

hours. 

Exhibit 2 shows the estimated 

annualized cost burden associated with 

the respondents’ time to participate in 

this research. The total annual cost 

burden is estimated to be $16,795. 

Exhibit 1. Estimated Annualized Burden 

Hours 


jlentini on DSK4TPTVN1PROD with NOTICES
Federal Register / Vol. 76, No. 107 / Friday, June 3, 2011 / Notices 32209 

Data collection Number of 

respondents 

Number of 

responses per 

respondent 

Hours per 

response 

Total burden 

hours 

Screening Questionnaire ................................................................................. 300 1 12/60 60 

In-Person Focus Groups EHR Users only ...................................................... 40 1 2 80 

Virtual Focus Groups EHR Users only ............................................................ 29 1 2 58 

Virtual Focus Groups EHR Non-users only ..................................................... 20 1 1.5 30 

Total .......................................................................................................... 389 na na 228 

Exhibit 2. Estimated Annualized Cost 

Burden 

Data collection Number of 

respondents 

Total burden 

hours 

Average hourly wage rate* Total cost 

burden 

Screening Questionnaire ................................................................................. 300 60 73.66 $4,420 

In-Person Focus Groups EHR Users only ...................................................... 40 80 73.66 5,893 

Virtual Focus Groups EHR Users only ............................................................ 29 58 73.66 4,272 

Virtual Focus Groups EHR Non-users only ..................................................... 20 30 73.66 2,210 

Total .......................................................................................................... 389 228 na $16,795 

*Hourly wage rate is the weighted average of hourly rates of the types of professionals who will complete the screening questionnaire and participate in the focus groups. The weighted average includes the following occupational codes and wage rates: 29–1065 (Pediatricians, General), 

$78.67; 29–1069 (Physicians and Surgeons, all others), $97.35; 29–1021 (Dentists, General), $76.61; 29–1111 (Registered Nurses, includes 

Certified Nurse Midwives), $32.35; 29–1071 (Physician Assistants), $41.86. Source: ‘‘National Compensation Survey: Occupational Wages in the 

United States 2009,’’ U.S. Department of Labor, Bureau of Labor Statistics. 

Estimated Annual Costs to the Federal 

Government 

Exhibit 3 shows the estimated total 

and annualized cost to the government 

for conducting this research. The total 

cost is estimated to be $424,493. 

Exhibit 3. Estimated Total and 

Annualized Cost 

Cost component Total cost Annualized 

cost 

Project Development ....................................................................................................................................................... $79,313 $39,657 

Data Collection Activities ................................................................................................................................................. 99,464 49,732 

Data Processing and Analysis ......................................................................................................................................... 49,732 24,866 

Publication of Results ...................................................................................................................................................... 38,415 19,208 

Project Management ........................................................................................................................................................ 37,601 18,801 

Overhead ......................................................................................................................................................................... 119,968 59,984 

Total .......................................................................................................................................................................... $424,493 $212,247 

Request for Comments 

In accordance with the Paperwork 

Reduction Act, comments on AHRQ’s 

information collection are requested 

with regard to any of the following: (a) 

Whether the proposed collection of 

information is necessary for the proper 

performance of AHRQ healthcare 

research and healthcare information 

dissemination functions, including 

whether the information will have 

practical utility; (b) the accuracy of 

AHRQ’s estimate of burden (including 

hours and costs) of the proposed 

collection(s) 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 upon the 

respondents, including the use of 

automated collection techniques or 

other forms of information technology. 

Comments submitted in response to 

this notice will be summarized and 

included in the Agency’s subsequent 

request for OMB approval of the 

proposed information collection. All 

comments will become a matter of 

public record. 

Dated: May 20, 2011. 

Carolyn M. Clancy, 

Director. 

[FR Doc. 2011–13740 Filed 6–2–11; 8:45 am] 

BILLING CODE 4160–90–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Agency for Healthcare Research and 

Quality 

Agency Information Collection 

Activities; Proposed Collection; 

Comment Request 

AGENCY: Agency for Healthcare Research 

and Quality, HHS. 

ACTION: Notice. 

SUMMARY: This notice announces the 

intention of the Agency for Healthcare 

Research and Quality (AHRQ) to request 

that the Office of Management and 

Budget (OMB) approve the proposed 

information collection project: ‘‘Using 

Nursing Home Antibiograms to Improve 

Antibiotic Prescribing and Delivery.’’ In 

accordance with the Paperwork 


jlentini on DSK4TPTVN1PROD with NOTICES