Federal Register / Vol. 88, No. 191 / Wednesday, October 4, 2023 / Notices 68615 

j. Public Relations Services. This is 

the cost of a contract public relations 

service to manage HISA’s website, issue 

press releases, assist with the 

production and distribution of 

information to industry stakeholders, 

and provide continuing education 

information for industry stakeholders. 

The public relations firm that HISA is 

working with has many years of 

expertise in P/R for thoroughbred racing 

enterprises. The firm can perform the 

aforementioned tasks more efficiently 

and effectively than if HISA were to hire 

staff to perform these tasks in-house. 

k. Legal. This includes the cost of 

outside legal counsel for the creation, 

management, and updating of Racetrack 

Safety and ADMC rules as well as the 

cost of outside counsel that is working 

on the various lawsuits in which HISA 

is a party. Doing all of these tasks 

requires a decentralized group of 

lawyers with varied skill sets. At 

present, it is much more efficient and 

effective to utilize outside counsel than 

for HISA to hire a large in-house legal 

team to handle these issues. 

l. Insurance. This includes the 

following insurance policies for HISA: 

i. Directors & Officers insurance. 

ii. Workers’ Compensation insurance. 

iii. Liability insurance. 

All these policies were competitively 

shopped by a broker to get the lowest 

rate possible. 

m. Payroll Services. This includes all 

costs of HISA’s relationship with 

Resource Management, Inc. (RMI), a 

Professional Employer Organization 

(PEO). RMI provides Human Resources 

administration (handbook and policy 

management resources, new employee 

onboarding, labor law assistance, etc.), 

benefits management, compliance 

services (workers’ compensation claims 

management and annual reporting, 

unemployment claims management, 

etc.) and payroll administration (payroll 

processing, W2 management, vacation 

tracking, etc.). The relationship with 

RMI allows these functions to be 

performed in a more cost-effective 

manner than if HISA hired employees to 

perform those functions. 

n. Professional Services. This account 

consists of: 

i. Search fees to help HISA fill open 

positions with the most qualified 

candidates. 

ii. Consulting fees to assist HISA with 

board and executive functions. 

iii. $300,000 contingency fund set 

aside for unexpected expenses. 

These items will ensure that HISA has 

high quality employees who are welltrained to properly serve its 

constituents. Please note that the 2023 

HISA budget contemplated no 

repayment of loans, nor did it assume 

that any funding shortfall would be 

incurred. 

V. Information Concerning Rule 

1.150(b)(5). Appendix 10 is a 

comparison of the approved HISA 2022 

Budget to actual revenues and 

expenditures. A variance has been 

calculated for each line item, and a 

narrative explanation has been provided 

for all variances >10% and at least 

$100,000. 

Conclusion 

The budget furthers the purpose of the 

Act in that it allocates the funding 

necessary for the successful 

implementation by HISA of the 

requirements of the Act. The budget has 

been carefully analyzed and is narrowly 

tailored to the various regulatory 

activities of HISA as contemplated by 

the Act. 

By direction of the Commission. 

April J. Tabor, 

Secretary. 

[FR Doc. 2023–22058 Filed 10–3–23; 8:45 am] 

BILLING CODE 6750–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Agency for Healthcare Research and 

Quality 

Patient Safety Organizations: 

Voluntary Relinquishment for The 

Envision Healthcare Center for Quality 

and Patient Safety PSO 

AGENCY: Agency for Healthcare Research 

and Quality (AHRQ), Department of 

Health and Human Services (HHS). 

ACTION: Notice of delisting. 

SUMMARY: The Patient Safety and 

Quality Improvement Final Rule 

(Patient Safety Rule) authorizes AHRQ, 

on behalf of the Secretary of HHS, to list 

as a patient safety organization (PSO) an 

entity that attests that it meets the 

statutory and regulatory requirements 

for listing. A PSO can be ‘‘delisted’’ by 

the Secretary if it is found to no longer 

meet the requirements of the Patient 

Safety and Quality Improvement Act of 

2005 (Patient Safety Act) and Patient 

Safety Rule, when a PSO chooses to 

voluntarily relinquish its status as a 

PSO for any reason, or when a PSO’s 

listing expires. AHRQ accepted a 

notification of proposed voluntary 

relinquishment from The Envision 

Healthcare Center for Quality and 

Patient Safety PSO, PSO number P0197, 

of its status as a PSO, and has delisted 

the PSO accordingly. 

DATES: The delisting was effective at 

12:00 midnight ET (2400) on October 1, 

2023. 

ADDRESSES: The directories for both 

listed and delisted PSOs are ongoing 

and reviewed weekly by AHRQ. Both 

directories can be accessed 

electronically at the following HHS 

website: http://www.pso.ahrq.gov/listed. 

FOR FURTHER INFORMATION CONTACT: 

Cathryn Bach, Center for Quality 

Improvement and Patient Safety, AHRQ, 

5600 Fishers Lane, MS 06N100B, 

Rockville, MD 20857; Telephone (toll 

free): (866) 403–3697; Telephone (local): 

(301) 427–1111; TTY (toll free): (866) 

438–7231; TTY (local): (301) 427–1130; 

Email: pso@ahrq.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

Background 

The Patient Safety Act, 42 U.S.C. 

299b-21 to 299b-26, and the related 

Patient Safety Rule, 42 CFR part 3, 

published in the Federal Register on 

November 21, 2008 (73 FR 70732– 

70814), establish a framework by which 

individuals and entities that meet the 

definition of provider in the Patient 

Safety Rule may voluntarily report 

information to PSOs listed by AHRQ, on 

a privileged and confidential basis, for 

the aggregation and analysis of patient 

safety work product. 

The Patient Safety Act authorizes the 

listing of PSOs, which are entities or 

component organizations whose 

mission and primary activity are to 

conduct activities to improve patient 

safety and the quality of health care 

delivery. 

HHS issued the Patient Safety Rule to 

implement the Patient Safety Act. 

AHRQ administers the provisions of the 

Patient Safety Act and Patient Safety 

Rule relating to the listing and operation 

of PSOs. The Patient Safety Rule 

authorizes AHRQ to list as a PSO an 

entity that attests that it meets the 

statutory and regulatory requirements 

for listing. A PSO can be ‘‘delisted’’ if 

it is found to no longer meet the 

requirements of the Patient Safety Act 

and Patient Safety Rule, when a PSO 

chooses to voluntarily relinquish its 

status as a PSO for any reason, or when 

a PSO’s listing expires. Section 3.108(d) 

of the Patient Safety Rule requires 

AHRQ to provide public notice when it 

removes an organization from the list of 

PSOs. 

AHRQ has accepted a notification of 

proposed voluntary relinquishment 

from The Envision Healthcare Center for 

Quality and Patient Safety PSO to 

voluntarily relinquish its status as a 

PSO. Accordingly, The Envision 

Healthcare Center for Quality and 


lotter on DSK11XQN23PROD with NOTICES1
68616 Federal Register / Vol. 88, No. 191 / Wednesday, October 4, 2023 / Notices 

Patient Safety PSO, P0197, was delisted 

effective at 12:00 Midnight ET (2400) on 

October 1, 2023. 

More information on PSOs can be 

obtained through AHRQ’s PSO website 

at http://www.pso.ahrq.gov. 

Dated: September 29, 2023. 

Marquita Cullom, 

Associate Director. 

[FR Doc. 2023–22076 Filed 10–3–23; 8:45 am] 

BILLING CODE 4160–90–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Agency for Healthcare Research and 

Quality 

Supplemental Evidence and Data 

Request on Mental Health and 

Occupational Stress in the Emergency 

Medical Service and 911 Workforce 

AGENCY: Agency for Healthcare Research 

and Quality (AHRQ), HHS. 

ACTION: Request for supplemental 

evidence and data submissions. 

SUMMARY: The Agency for Healthcare 

Research and Quality (AHRQ) is seeking 

scientific information submissions from 

the public. Scientific information is 

being solicited to inform our review on 

Mental Health and Occupational Stress 

in the Emergency Medical Service and 

911 Workforce, which is currently being 

conducted by the AHRQ’s Evidencebased Practice Centers (EPC) Program. 

Access to published and unpublished 

pertinent scientific information will 

improve the quality of this review. 

DATES: Submission Deadline on or 

before November 3, 2023. 

ADDRESSES: 

Email submissions: epc@

ahrq.hhs.gov. 

Print submissions: 

Mailing Address: Center for Evidence 

and Practice Improvement, Agency for 

Healthcare Research and Quality, 

ATTN: EPC SEADs Coordinator, 5600 

Fishers Lane, Mail Stop 06E53A, 

Rockville, MD 20857 

Shipping Address (FedEx, UPS, etc.): 

Center for Evidence and Practice 

Improvement, Agency for Healthcare 

Research and Quality, ATTN: EPC 

SEADs Coordinator, 5600 Fishers 

Lane, Mail Stop 06E77D, Rockville, 

MD 20857 

FOR FURTHER INFORMATION CONTACT: 

Kelly Carper, Telephone: 301–427–1656 

or Email: epc@ahrq.hhs.gov. 

SUPPLEMENTARY INFORMATION: The 

Agency for Healthcare Research and 

Quality has commissioned the 

Evidence-based Practice Centers (EPC) 

Program to complete a review of the 

evidence for Mental Health and 

Occupational Stress in the Emergency 

Medical Service and 911 Workforce. 

AHRQ is conducting this review 

pursuant to Section 902 of the Public 

Health Service Act, 42 U.S.C. 299a. 

The EPC Program is dedicated to 

identifying as many studies as possible 

that are relevant to the questions for 

each of its reviews. In order to do so, we 

are supplementing the usual manual 

and electronic database searches of the 

literature by requesting information 

from the public (e.g., details of studies 

conducted). We are looking for studies 

that report on Mental Health and 

Occupational Stress in the Emergency 

Medical Service and 911 Workforce. The 

entire research protocol is available 

online at: https://effectivehealthcare.

ahrq.gov/products/ems-911-workforcemental-health/protocol. 

This is to notify the public that the 

EPC Program would find the following 

information on Mental Health and 

Occupational Stress in the Emergency 

Medical Service and 911 Workforce 

helpful: 

D A list of completed studies that 

your organization has sponsored for this 

topic. In the list, please indicate 

whether results are available on 

ClinicalTrials.gov along with the 

ClinicalTrials.gov trial number. 

D For completed studies that do not 

have results on ClinicalTrials.gov, a 

summary, including the following 

elements, if relevant: study number, 

study period, design, methodology, 

indication and diagnosis, proper use 

instructions, inclusion and exclusion 

criteria, primary and secondary 

outcomes, baseline characteristics, 

number of patients screened/eligible/ 

enrolled/lost to follow-up/withdrawn/ 

analyzed, effectiveness/efficacy, and 

safety results. 

D A list of ongoing studies that your 

organization has sponsored for this 

topic. In the list, please provide the 

ClinicalTrials.gov trial number or, if the 

trial is not registered, the protocol for 

the study including, if relevant, a study 

number, the study period, design, 

methodology, indication and diagnosis, 

proper use instructions, inclusion and 

exclusion criteria, and primary and 

secondary outcomes. 

D Description of whether the above 

studies constitute ALL Phase II and 

above clinical trials sponsored by your 

organization for this topic and an index 

outlining the relevant information in 

each submitted file. 

Your contribution is very beneficial to 

the Program. Materials submitted must 

be publicly available or able to be made 

public. Materials that are considered 

confidential; marketing materials; study 

types not included in the review; or 

information on topics not included in 

the review cannot be used by the EPC 

Program. This is a voluntary request for 

information, and all costs for complying 

with this request must be borne by the 

submitter. 

The draft of this review will be posted 

on AHRQ’s EPC Program website and 

available for public comment for a 

period of 4 weeks. If you would like to 

be notified when the draft is posted, 

please sign up for the email list at: 

https://www.effectivehealthcare.

ahrq.gov/email-updates. 

The review will answer the following 

questions. This information is provided 

as background. AHRQ is not requesting 

that the public provide answers to these 

questions. 

Key Questions (KQ) 

KQ 1: What are the incidence, 

prevalence, and severity of mental 

health issues (depression, anxiety, 

PTSD, suicidality, and substance use 

disorders) and occupational stress 

issues (burnout, stress, and moral 

injury) among the EMS and the 911 

workforce? 

a. Are the incidence, prevalence, and 

severity modified by: 

i. Agency composition including 

workflow, regulations, financing? 

ii. Characteristics of EMS and 911 

personnel (e.g., education/training, 

proficiency, experience, trauma 

exposure)? 

iii. Physical and mental health 

resources? 

KQ 2: What are the effectiveness and 

comparative effectiveness, including 

benefits and harms, of interventions 

addressing mental health issues 

(depression, anxiety, PTSD, suicidality, 

and substance use disorders) and 

occupational stress issues (burnout, 

stress, and moral injury) among the EMS 

and 911 workforce? 

a. Are the effectiveness of the 

interventions modified by: 

i. Intervention type? 

ii. Characteristics of EMS and 911 

personnel (e.g., education/training, 

proficiency, experience)? 

iii. EMS/911 agency characteristics 

including workflow, regulations, 

financing? 

iv. Physical and mental health 

resources? 

KQ 3: What are the context and 

implementation factors of studies with 

effective EMS/911 workforce practices 

to prevent, recognize and treat mental 

health issues (depression, anxiety, 

PTSD, suicidality, and substance use 

disorders) and occupational stress 

issues (burnout, stress, and moral 


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