44150 Federal Register / Vol. 72, No. 151 / Tuesday, August 7, 2007 / Notices 

Dated: August 2, 2007. 

John Howard, 

Director, National Institute for Occupational 

Safety and Health. 

[FR Doc. 07–3845 Filed 8–6–07; 8:45 am] 

BILLING CODE 4163–19–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

National Institute for Occupational 

Safety and Health; Final Effect of 

Designation of a Class of Employees 

for Addition to the Special Exposure 

Cohort 

AGENCY: National Institute for 

Occupational Safety and Health 

(NIOSH), Department of Health and 

Human Services (HHS). 

ACTION: Notice. 

SUMMARY: The Department of Health and 

Human Services (HHS) gives notice 

concerning the final effect of the HHS 

decision to designate a class of 

employees at Los Alamos National 

Laboratory, Los Alamos, New Mexico, 

as an addition to the Special Exposure 

Cohort (SEC) under the Energy 

Employees Occupational Illness 

Compensation Program Act of 2000. On 

June 22, 2007, as provided for under 42 

U.S.C. 7384q(b), the Secretary of HHS 

designated the following class of 

employees as an addition to the SEC: 

Employees of the Department of Energy 

(DOE), its predecessor agencies, or DOE 

contractors or subcontractors who were 

monitored or should have been monitored for 

radiological exposure while working in 

operational Technical Areas with a history of 

radioactive material use at the Los Alamos 

National Laboratory (LANL) for a number of 

work days aggregating at least 250 work days 

from March 15, 1943 through December 31, 

1975, or in combination with work day as 

within parameters established for one or 

more other classes of employees in the 

Special Exposure Cohort. 

This designation became effective on 

July 22, 2007, as provided for under 42 

U.S.C. 7384l(14)(C). Hence, beginning 

on July 22, 2007, members of this class 

of employees, defined as reported in 

this notice, became members of the 

Special Exposure Cohort. 

FOR FURTHER INFORMATION CONTACT: 

Larry Elliott, Director, Office of 

Compensation Analysis and Support, 

National Institute for Occupational 

Safety and Health (NIOSH), 4676 

Columbia Parkway, MS C–46, 

Cincinnati, OH 45226, Telephone 513–

533–6800 (this is not a toll-free 

number). Information requests can also 

be submitted by e-mail to 

OCAS@CDC.GOV. 

Dated: August 2, 2007. 

John Howard, 

Director, National Institute for Occupational 

Safety and Health. 

[FR Doc. 07–3843 Filed 8–6–07; 8:45 am] 

BILLING CODE 4163–19–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

National Institute for Occupational 

Safety and Health; Final Effect of 

Designation of a Class of Employees 

for Addition to the Special Exposure 

Cohort 

AGENCY: National Institute for 

Occupational Safety and Health 

(NIOSH), Department of Health and 

Human Services (HHS). 

ACTION: Notice. 

SUMMARY: The Department of Health and 

Human Services (HHS) gives notice 

concerning the final effect of the HHS 

decision to designate a class of 

employees at W.R. Grace, Erwin, 

Tennessee, as an addition to the Special 

Exposure Cohort (SEC) under the Energy 

Employees Occupational Illness 

Compensation Program Act of 2000. On 

June 22, 2007, as provided for under 42 

U.S.C. 7384q(b), the Secretary of HHS 

designated the following class of 

employees as an addition to the SEC: 

Atomic Weapons Employer (AWE) 

employees who were monitored or should 

have been monitored for potential exposure 

to thorium while working in any of the 100 

series buildings or Buildings 220, 230, 233, 

234, 301, or 310 at the W.R. Grace site at 

Erwin, Tennessee for a number of work days 

aggregating at least 250 work days from 

January 1, 1958, through December 31, 1970, 

or in combination with work days within the 

parameters established for one or more other 

classes of employees in the Special Exposure 

Cohort. 

This designation became effective on 

July 22, 2007, as provided for under 42 

U.S.C. 7384l(14)(C). Hence, beginning 

on July 22, 2007, members of this class 

of employees, define as reported in this 

notice, became members of the Special 

Exposure Cohort. 

FOR FURTHER INFORMATION CONTACT: 

Larry Elliott, Director, Office of 

Compensation Analysis and Support, 

National Institute for Occupational 

Safety and Health (NIOSH), 4676 

Columbia Parkway, MS C–46, 

Cincinnati, OH 45226, Telephone 513–

533–6800 (this is not a toll-free 

number). Information requests can also 

be submitted by e-mail to 

OCAS@CDC.GOV. 

Dated: August 2, 2007. 

John Howard, 

Director, National Institute for Occupational 

Safety and Health. 

[FR Doc. 07–3844 Filed 8–6–07; 8:45 am] 

BILLING CODE 4163–19–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–3188–NC] 

Medicare Program; Evaluation Criteria 

and Standards for Quality 

Improvement Program Organization 

Contracts 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice with comment period. 

SUMMARY: This notice with comment 

period describes the criteria we intend 

to use to evaluate the efficiency and 

effectiveness of Quality Improvement 

Organizations (QIOs) currently under 

contract with CMS in accordance with 

the Social Security Act. These 

evaluation criteria are based on the tasks 

and related subtasks set forth in the 

QIO’s Scope of Work (SOW). The 

current 8th SOW includes Tasks 1, 3, 

and 4 (Task 2 is reserved) with subtasks 

included under Tasks 1 and 3. QIOs 

were awarded contracts for the 8th 

SOW, or 8th Round, for 3 years, with 

staggered starting dates beginning 

August 2005, November 2005, and 

February 2006. Comments on this notice 

will also be considered in the 

development of the 9th SOW. 

DATES: To be assured of consideration, 

comments must be received at one of 

the addresses provided below, no later 

than 5 p.m. on September 6, 2007. 

ADDRESSES: In commenting, please refer 

to file code CMS–3188–NC. Because of 

staff and resource limitations, we cannot 

accept comments by facsimile (FAX) 

transmission. 

You may submit comments in one of 

four ways (no duplicates, please): 

1. Electronically. You may submit 

electronic comments on specific issues 

in this regulation to http:// 

www.cms.hhs.gov/eRulemaking. Click 

on the link ‘‘Submit electronic 

comments on CMS regulations with an 

open comment period.’’ (Attachments 

should be in Microsoft Word, 

WordPerfect, or Excel; however, we 

prefer Microsoft Word.) 

2. By regular mail. You may mail 

written comments (one original and two 

copies) to the following address ONLY: 

Centers for Medicare & Medicaid 


jlentini on PROD1PC65 with NOTICES
Federal Register / Vol. 72, No. 151 / Tuesday, August 7, 2007 / Notices 44151 

Services, Department of Health and 

Human Services, Attention: CMS–3188–

NC, P.O. Box 8010, Baltimore, MD 

21244–8010. 

Please allow sufficient time for mailed 

comments to be received before the 

close of the comment period. 

3. By express or overnight mail. You 

may send written comments (one 

original and two copies) to the following 

address only: Centers for Medicare & 

Medicaid Services, Department of 

Health and Human Services, Attention: 

CMS–3188–NC, Mail Stop C4–26–05, 

7500 Security Boulevard, Baltimore, MD 

21244–8010. 

4. By hand or courier. If you prefer, 

you may deliver (by hand or courier) 

your written comments (one original 

and two copies) before the close of the 

comment period to one of the following 

addresses. If you intend to deliver your 

comments to the Baltimore address, 

please call telephone number (410) 786–

9994 in advance to schedule your 

arrival with one of our staff members. 

Room 445–G, Hubert H. Humphrey 

Building, 200 Independence Avenue, 

SW., Washington, DC 20201; or 7500 

Security Boulevard, Baltimore, MD 

21244–8010. 

(Because access to the interior of the 

HHH Building is not readily available to 

persons without Federal Government 

identification, commenters are 

encouraged to leave their comments in 

the CMS drop slots located in the main 

lobby of the building. A stamp-in clock 

is available for persons wishing to retain 

a proof of filing by stamping in and 

retaining an extra copy of the comments 

being filed.) 

Comments mailed to the addresses 

indicated as appropriate for hand or 

courier delivery may be delayed and 

received after the comment period. 

For information on viewing public 

comments, see the beginning of the 

SUPPLEMENTARY INFORMATION section. 

FOR FURTHER INFORMATION CONTACT: 

Terry Lied (410) 786–8973. 

SUPPLEMENTARY INFORMATION: 

Submitting Comments: We welcome 

comments from the public on all issues 

set forth in this notice with comment 

period to assist us in fully considering 

issues and developing policies. You can 

assist us by referencing the file code 

CMS–3188–NC and the specific ‘‘issue 

identifier’’ that precedes the section on 

which you choose to comment. 

Inspection of Public Comments: All 

comments received before the close of 

the comment period are available for 

viewing by the public, including any 

personally identifiable or confidential 

business information that is included in 

a comment. We post all comments 

received before the close of the 

comment period on the following Web 

site as soon as possible after they have 

been received: http://www.cms.hhs.gov/ 

eRulemaking. Click on the link 

‘‘Electronic Comments on CMS 

Regulations’’ on that Web site to view 

public comments. 

Comments received timely will also 

be available for public inspection as 

they are received, generally beginning 

approximately 3 weeks after publication 

of a document, at the headquarters of 

the Centers for Medicare & Medicaid 

Services, 7500 Security Boulevard, 

Baltimore, Maryland 21244, Monday 

through Friday of each week from 8:30 

a.m. to 4 p.m. To schedule an 

appointment to view public comments, 

phone 1–800–743–3951. 

I. Background 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘BACKGROUND’’ at the 

beginning of your comments.] 

The Peer Review Improvement Act of 

1982 (Title I, Subtitle C of Pub. L. 97–

248) amended Part B of Title XI of the 

Social Security Act (the Act) to establish 

the Peer Review Organization (PRO) 

programs. The PRO program (now 

called the Quality Improvement 

Organization (QIO) program) was 

established to redirect, simplify, and 

enhance the cost-effectiveness and 

efficiency of the medical peer review 

process. Sections 1152, 1153(b), and 

1153(c) of the Act define the types of 

organizations eligible to become QIOs, 

and establish certain limitations and 

priorities regarding QIO contracting. 

The Secretary enters into contracts 

with QIOs to perform three broad 

functions: 

• Improve quality of care for 

beneficiaries by ensuring that 

beneficiary care meets professionally 

recognized standards of health care; 

• Protect the integrity of the Medicare 

Trust Fund by ensuring that Medicare 

pays only for services and items that are 

reasonable and medically necessary and 

that are provided in the most 

economical setting; 

• Protect beneficiaries by 

expeditiously addressing individual 

cases such as beneficiary quality of care 

complaints, contested hospital issued 

notices of noncoverage (HINNs), alleged 

Emergency Medical Treatment and 

Labor Act (EMTALA) violations, and 

other statutory responsibilities. 

Section 1154 of the Act requires that 

QIOs review those services furnished by 

physicians; other health care 

practitioners; and institutional and noninstitutional providers of health care 

services, including health maintenance 

organizations and competitive medical 

plans. Section 109 of the Medicare 

Prescription Drug, Improvement, and 

Modernization Act of 2003 (MMA), 

Public Law 108–173, amended section 

1154(a)(1) of the Act to expand the 

scope of review of QIOs to include 

Medicare Advantage Organizations, and 

prescription drug sponsors. Section 109 

of the MMA also created a new section 

1154(a)(17) of the Act, which requires 

QIOs to offer to providers, practitioners, 

Medicare Advantage Plans and 

prescription drug sponsors, quality 

improvement assistance pertaining to 

prescription drug therapy. 

Section 1153(h)(2) of the Act requires 

the Secretary to publish in the Federal 

Register the general criteria and 

standards that would be used to 

evaluate the efficient and effective 

performance of contract obligations by 

QIOs and to provide the opportunity for 

public comment. The QIO contracts for 

the 8th SOW were awarded for 3 years 

with starting dates staggered into three 

approximately equal groups (rounds) 

starting August 2005, November 2005, 

and February 2006, respectively. 

Comments on this notice will also be 

considered in the development of the 

9th scope of work. 

II. Measuring QIO Performance & 

Criteria for Non-Competitive Renewal 

of Contracts 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘MEASURING QIO 

PERFORMANCE’’ at the beginning of 

your comments.] 

Under the 8th Round contracts, QIOs 

are responsible for completing the 

requirements of the following specific 

tasks and subtasks: 

Task 1: Assisting Providers in 

Developing the Capacity for and 

Achieving Excellence. 

a. Subtask 1a: Nursing Home. 

b. Subtask 1b: Home Health. 

c. Subtask 1c1: Hospital. 

d. Subtask 1c2: Critical Access 

Hospital/Rural Hospital. 

e. Subtask 1d1: Physician Practice. 

f. Subtask 1d2: Physician Practice: 

Underserved Populations. 

g. Subtask 1d3: Physician Practice/ 

Pharmacy: Part D Benefit. 

Task 2: Reserved. 

Task 3: Protecting Beneficiaries and 

the Medicare Program. 

a. Subtask 3a: Beneficiary Protection. 

b. Subtask 3b: Hospital Payment 

Monitoring Program 

Task 4: Special Studies and Projects 

(Special Studies defined as work that 

CMS directs a QIO to perform or work 

that a QIO elects to perform with CMS 

approval which is not currently defined 


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under Tasks 1–3 of the SOW but falls 

within the scope of the contract and 

section 1154 of the Act). 

Under this SOW, to merit having its 

contract renewed non-competitively, the 

QIO must meet the performance criteria 

on the tasks and subtasks. For Tasks 1 

and 3, the QIO will be scored using the 

following four classifications: 

• Excellent Pass 

• Full Pass 

• Conditional Pass 

• Not Pass 

For all nine subtasks related to tasks 

1 and 3, the QIO must achieve at least 

a Conditional Pass to be eligible to have 

its contract renewed non-competitively. 

A QIO that receives a ‘‘Not Pass’’ on any 

subtask will be invited to our evaluation 

panel (subject to CMS approval). In 

addition, the QIO must achieve at least 

a ‘‘Full Pass’’ or ‘‘Excellent Pass’’ on 

seven of the nine subtasks to be eligible 

to have its contract renewed noncompetitively. A QIO that receives a 

‘‘Conditional Pass’’ on three or more 

subtasks will be invited to our 

evaluation panel (subject to CMS 

approval). However, an ‘‘Excellent Pass’’

on one or more subtasks may negate a 

‘‘Conditional Pass’’ on one subtask. That 

is, a QIO that receives an ‘‘Excellent 

Pass’’ on one or more subtasks and 

receives a ‘‘Conditional Pass’’ on no 

more than three subtasks and does not 

receive a ‘‘Not Pass’’ on any subtasks 

may be eligible to have its contract 

renewed non-competitively. A QIO 

working only seven or eight subtasks 

due to valid exemptions as specified in 

the SOW will be treated as though it has 

received a ‘‘Full Pass’’ in the subtasks 

from which it is exempt. The QIO must 

still achieve at least a ‘‘Full Pass’’ or 

‘‘Excellent Pass’’ on seven of the nine 

subtasks in order to have its contract 

non-competitively renewed. 

We may revise the performance 

criteria for a QIO before signing a 

contract with that QIO. The target 

performance levels for individual tasks 

and subtasks may vary across QIOs. We 

will provide these specific performance 

criteria during the Request for Proposal 

(RFP) process. 

We will assess the QIO’s task and 

subtask-specific performance in 

November 2007 based on the data 

available at that time. The specific 

evaluation criteria are described below 

for each task and subtask. Task 4 

(special projects) will not be subject to 

these evaluation criteria. Projects 

funded to reduce hospital payment error 

under Task 4 will affect QIOs evaluation 

as specified in Task 3b. The assessment 

of performance on all other special 

projects under Task 4 will affect the 

QIO’s eligibility to receive funding for 

additional special projects under the 

current or subsequent QIO contracts, but 

will not affect eligibility for noncompetitive renewal of the QIO 

contract. 

For the 9th SOW, we intend to revise 

the criteria required for non-competitive 

renewal of contracts. For the 9th SOW, 

we are considering a requirement that 

QIOs achieve a ‘‘full pass’’ or an 

‘‘excellent pass’’ on all tasks and subtasks for the non-competitive renewal of 

their contracts for the 10th SOW. We are 

also reviewing the process by which a 

QIO contract can be terminated, during 

the course of a SOW, on performance 

grounds. 

III. Standards for Minimum 

Performance 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘STANDARDS FOR MINIMUM 

PERFORMANCE’’ at the beginning of 

your comments.] 

Task 1: Assisting Providers in 

Developing the Capacity for and 

Achieving Excellence 

Subtasks of Task 1 will include 

statewide and identified participant 

components. (The term ‘‘statewide’’ is 

used for activities directed toward a 

QIO’s entire State/jurisdiction—that is, 

one of the 50 States, the District of 

Columbia, Puerto Rico, or the Virgin 

Islands.) Subtask evaluation will be 

based on the following five dimensions 

of performance: 

• Performance measure results 

(changes and improvements in rates). 

• Clinical performance reporting 

(increases in number of measures 

reported). 

• Providers’ adoption and use of 

systems. 

• Implementation of key process 

changes. 

• Changes in organizational culture. 

Each subtask of Task 1 will include a 

requirement to meet Satisfaction and 

Knowledge/Perception performance 

criteria for provider identified 

participants (IPG) and non-identified 

participants (Non-IPG). Satisfaction and 

knowledge/perception surveys and 

stakeholder knowledge/perception 

surveys will be used to measure 

performance. ‘‘Identified Participants’’

are providers that received focused 

assistance on at least one quality 

measure from QIOs. ‘‘Non-Identified 

Participants’’ are providers that received 

no focused assistance from QIOs. 

Task 1a: Nursing Home 

Under Task 1a, the QIO will focus on 

the following: 

• Improving clinical performance. 

• Setting improvement targets. 

• Measuring the nursing home 

experience. 

The QIO will focus on decreasing the 

rate of pressure ulcers among high risk 

individuals, decreasing the use of 

physical restraints, improving the 

management of depressive symptoms, 

and improving the management of pain 

in chronic (long stay) residents among a 

select group of identified participant 

nursing homes (IPG1) as well as other 

nursing homes requesting assistance 

from the QIO. The QIO must also work 

with a second select group of identified 

participants (IPG2) that focuses on 

decreasing the rate of pressure ulcers 

among high risk individuals and 

decreasing the use of physical restraints. 

The QIO will set statewide targets for 

(at a minimum) pressure ulcers among 

high-risk residents and physical 

restraints. In addition, the QIO will 

work with all nursing homes throughout 

the State/jurisdiction to set quality 

improvement targets for (at a minimum) 

pressure ulcers and physical restraints 

on an annual basis. 

In the area of organizational culture, 

the QIO must work with both groups of 

identified participants (IPG1 and IPG2) 

to collect information on resident and 

staff experience/satisfaction with care 

and staff turnover by engaging in 

activity that is likely to improve 

organizational culture. (Note: In four 

States/jurisdictions (WY, AK, DC, and 

PR), the QIO must work with its Project 

Officer to develop alternative Task 1a 

evaluation criteria for this SOW. The 

QIO must receive approval from its 

Project Officer and the Task 1a 

Government Task Leader (GTL) on its 

alternative Task 1a evaluation criteria). 

Task 1b: Home Health 

QIO work in the home health setting 

will focus at the statewide level on 

meeting or exceeding the statewide 

targets on the Outcome and Assessment 

Information Set (OASIS). Information on 

OASIS can be found at http:// 

www.cms.hhs.gov/OASIS/. In addition, 

the QIO must work with home health 

agencies (HHAs) in setting targets for 

acute care hospitalization and other 

publicly reported OASIS measures to be 

determined by CMS. The QIO must also 

work to increase the number of HHAs 

that incorporate an assessment of 

influenza and pneumococcal 

vaccination status into the patient 

comprehensive assessment, offer these 

vaccinations, and provide follow-up. 

The QIO must also work with two 

groups of identified participants: A 

Clinical Performance Identified 

Participant Group (IPG) and a Systems 

Improvement and Organizational 


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Culture Change (SIOC) IPG. The QIO 

will focus in the Clinical Performance 

IPG on meeting or exceeding the IPG 

target on the OASIS measure for acute 

care hospitalization and one additional 

HHA-selected publicly reported OASIS 

measure through the Outcome Based 

Quality Improvement (OBQI) process. 

Information on OBQI can be found at: 

http://www.cms.hhs.gov/ 

HomeHealthQualityInits/ 

16_HHQIOASISOBQI.asp. With the 

SIOC IPG, the QIO will work to 

implement and/or use emerging 

telehealth technologies to help reduce 

acute care hospitalization and work to 

build capacity within these HHAs to 

evaluate and improve organizational 

culture. Both at the statewide level and 

with a Clinical Performance IPG, the 

QIO must improve clinical performance 

measure results. The QIO will be 

evaluated on its ability to work with 

HHAs to incorporate influenza and 

pneumococcal immunizations into the 

comprehensive patient assessment. The 

QIO will also be evaluated on the 

following: 

• Implementation of a CMS survey 

tool that measures specific dimensions 

of organizational culture change. 

• Submission by an HHA of a Plan of 

Action (POA) based on the results of the 

organizational culture change survey 

and implementation of a quality 

improvement activity. 

• The QIO will have extra credit 

added to its total Task 1b evaluation 

score for improving results on both the 

OASIS acute care hospitalization 

measure and the selected publicly 

reported OASIS outcome measure. 

The QIO may receive extra credit for 

one or more of the following: 

• Improving results for the identified 

participant OASIS measure. 

• Improving results for the statewide 

and identified participant Acute Care 

Hospitalization measure. 

• Improving the statewide 

immunization assessment rate beyond 

the target rate. 

• Working with HHAs to set targets. 

Task 1c1: Hospital 

For Task 1c1, the QIO must work with 

hospitals to achieve system-level 

changes through the use of four 

strategies: Increasing clinical 

performance measurement and 

reporting; process improvement; 

systems improvement; and 

organizational culture change. The QIO 

will work to improve quality of care in 

hospitals through several distinct efforts 

aligned with each strategy. For clinical 

performance measure results, the QIO 

will assist an IPG, including both rural 

and urban Prospective Payment System 

(PPS) hospitals, in improving 

performance on an Appropriate Care 

Measure (ACM). (The ACM is defined as 

a composite measure of care at the 

patient level for three clinical topics—

AMI, HF, and PNE.) The QIO will work 

at the statewide level to encourage 

hospitals to submit data on the full 

Hospital Quality Alliance (HQA) 

measure set of 22 measures (http:// 

www.cms.hhs.gov/HospitalQualityInits/ 

15_HospitalQualityAlliance.asp.). The 

QIO will also work to increase the 

validity of all data the hospitals submit 

to the QIO Clinical Data Warehouse. 

With a major focus on process 

improvement in this SOW, the QIO will 

work through statewide and identified 

participant efforts to get hospitals to 

adopt standard processes of care in five 

different areas: Prevention of surgical 

site infections, cardiovascular 

complications, venous 

thromboembolism, ventilator-associated 

pneumonia, and promotion of the use of 

fistulas for hemodialysis. 

To encourage systems improvement 

and organizational culture change, the 

QIO will work with identified 

participants (including both PPS and 

Critical Access Hospitals (CAHs)) to 

engage senior hospital leadership in the 

use of Computerized Physician Order 

Entry (CPOE), barcoding, and/or 

telehealth systems. 

Task 1c2: Critical Access Hospital/Rural 

PPS Hospital 

The QIO must promote 

transformational change in CAHs and 

rural PPS hospitals by working on 

clinical performance quality measures 

and organizational safety culture 

relevant to the care provided in these 

hospitals. For purposes of Task 1c2, a 

rural PPS hospital is defined as a PPS 

hospital located in a non-Metropolitan 

Statistical Area (non-MSA) county. The 

QIO must assist identified participant 

CAHs/rural PPS hospitals in assessing 

their organizational safety culture. The 

QIO must also assist these hospitals in 

selecting, testing, and implementing 

changes that will demonstrate 

improvement in the organization’s 

safety culture. 

Task 1d1: Physician Practice 

The QIO will work with physician 

practice sites statewide and with an IPG. 

With an IPG, the QIO will focus on more 

reliable delivery of preventive services 

and effective management of patients 

with chronic conditions, in particular 

diabetes and heart disease. Working 

with their IPG, the QIO will seek to 

demonstrate improvement in clinical 

performance measures through the 

production and effective use of 

electronic clinical information (ECI) in 

conjunction with redesign of patient 

care processes within the physician 

practice sites. 

In addition to executing the work 

described for Task 1d1, the QIO will 

work with other organizations and 

agencies that have similar goals. The 

QIO must be actively involved with or 

promote the convening of local multistakeholder organizations that seek to 

promote the production and use of 

electronic clinical information and 

healthcare information exchange 

necessary for improving clinical 

performance. The QIO may work with 

these organizations to: 

• Provide information on products, 

functionality, value, and costs of ECI 

systems; 

• Promote production and use of ECI; 

• Promote ECI sharing in accordance 

with the Health Insurance Portability 

and Accountability Act standards 

(including the Privacy and Security 

Rules) and QIO confidentiality 

requirements, as applicable; and 

• Promote improved healthcare 

through use of and reporting of 

performance on the clinical quality 

measures specified for this Task. 

The QIO must work with physician 

practice sites and others to improve care 

for Medicare beneficiaries on a 

statewide basis. The QIO must support 

quality initiatives including the 

Physician Voluntary Reporting Program 

(PVRP) by activities that include 

providing information to physicians on 

participation in the initiative and on 

physician performance and 

improvement for those that report. 

The QIO must promote statewide 

quality improvement by working with 

public health, provider groups, and 

other broad-based agencies to support 

the use of appropriate preventive and 

disease-based care processes. 

Medicare Advantage 

The Project Officer will evaluate 

performance based on the assistance 

provided to Medicare Advantage 

Organizations. The Medicare Advantage 

part of Task 1d1 will be waived for 

States/jurisdictions that had low MA 

enrollment among the eligible Medicare 

beneficiaries during calendar year 2004. 

Clinical Performance Measurement and 

Reporting: 

The objective of this element is to 

encourage physician practice sites to 

submit data on the DOQ clinical 

measures to the QIO Data Warehouse for 

all Medicare patients. Practice sites 

must demonstrate an ability to submit 

data to the Data Warehouse. 

The QIO must collaborate with the 

Medicare Care Management 


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Performance Demonstration (section 649 

of MMA) contractors by providing them 

with physician practice information the 

QIO already has or will collect, acquire, 

or generate in performing its own QIO 

tasks, provided the individual practices 

have requested and agreed to these 

disclosures. The QIO will be evaluated 

using the criteria deemed acceptable by 

CMS as outlined in the QIO’s proposal. 

Task 1d2: 

As part of QIO efforts in the physician 

practice setting, the QIO must, at the 

statewide level, work to improve 

clinical performance measure results for 

clinical quality indicators in the areas of 

diabetes, mammography, and adult 

immunizations for underserved racial/ 

ethnic populations. 

With one IPG, the QIO will work to 

promote systems improvement through 

DOQ activities with a representative 

underserved population under Task 

1d1. With a Task 1d2-specific IPG, the 

QIO will work on practice site and 

practitioner system changes related to 

Culturally and Linguistically 

Appropriate Services (CLAS) standards 

and culturally competent care. For more 

information on CLAS standards refer to: 

http://www.omhrc.gov/templates/ 

browse.aspx?lvl=2&lvlID=15. 

Task 1d2 is composed of core and 

non-core tasks. The core tasks include 

satisfactory completion of the CLAS/ 

Cultural Competency IPG at the practice 

site and practitioner level and the 

Satisfaction and Knowledge/Perception 

survey for the relevant respondents. The 

non-core task is statewide measure 

improvement. Satisfactory completion 

of the core tasks will achieve a Full Pass 

for Task 1d2. 

Task 1d3: Physician Practice/Pharmacy: 

Part D Benefit 

As part of QIO efforts in the physician 

practice setting in this SOW, the QIO 

must focus on improving safety in the 

delivery of prescription drugs. 

Widespread use of e-prescribing with 

comprehensive decision support tools is 

expected to improve the quality of 

prescription drug delivery. Until this 

broader use is in place, the QIO must 

implement quality improvement 

projects focusing on improved 

prescribing, using evidence-based 

guidelines. 

Over the course of the 8th SOW 

contract, we will work with the QIO to 

develop and implement new methods to 

gather and disseminate better evidence 

for healthcare decision-making. This 

activity will include collection, linkage, 

and de-identification of Part D and other 

public and private administrative data; 

assisting in implementation of clinical 

registries and practical clinical trials; 

and other work necessary to support the 

development and use of better evidence 

for decisions. 

A variety of methods are available to 

accomplish these activities. We support 

engaging physicians because improving 

prescribing begins with modifying 

physicians’ behavior. This can be 

accomplished by providing data and 

information in ways that support 

behavior change. We also support 

working with dispensing pharmacists 

because they detect errors and problems 

with the medications they dispense, and 

they interact with beneficiaries. 

Pharmacy policies, procedures, and 

quality checks need to be implemented 

to be consistent with quality, safety, and 

cost-effectiveness goals. 

By partnering with prescription drug 

plans (PDPs) and using the drug data 

available, the QIO can affect prescribing 

by physicians and improve delivery of 

services at the pharmacy level. Medicare 

Advantage PDPs will have similar goals 

as fee-for-service (FFS) Medicare PDPs 

and will have both more information 

and more direct control than FFS 

Medicare PDPs over the care that 

Medicare beneficiaries receive. 

With the enactment of MMA, we are 

committed to providing a robust drug 

benefit to seniors, implementing 

responsible cost management 

provisions, as well as monitoring and 

improving drug therapies using current 

evidence-based guidelines. As 

authorized by section 109(b) of MMA, 

the QIO must offer quality improvement 

assistance pertaining to prescription 

drug therapy to the following: 

• All Medicare providers and 

practitioners; 

• Medicare Advantage organizations 

offering Medicare Advantage plans 

under Part C; and 

• Organizations offering Prescription 

Drug Plans (PDPs) under Part D. 

The Part D benefit was implemented 

January 1, 2006. The QIOs began to 

implement quality improvement 

projects starting August 2006. Before 

August 2006, we identified the set of 

quality measures for Task 1d3 which 

were derived from evidence-based 

guidelines and developed in 

collaboration with participating PDPs, 

physician societies, and other national 

leaders. The QIO will be held 

accountable for work with identified 

participants on clinical performance 

measure results. 

Because of the relatively new nature 

of the work, the evaluation of this task 

is more process and customer 

satisfaction oriented than other tasks in 

the contract. The QIO earns a 

conditional pass if it designs and 

completes, to CMS satisfaction, a quality 

improvement project designed to 

improve care with its stakeholders. The 

QIO will receive a full pass if, in 

addition to completing the project, 80 

percent of its surveyed project partners 

report that they are satisfied with their 

work with the QIO. The QIO will earn 

an excellent pass if, in addition to the 

above two criteria, the project achieves 

improvement in the measures targeted 

by its project. 

Task 2: (Reserved) 

Task 3a: Beneficiary Protection 

This task involves all case review 

activities, including mediation, that are 

necessary to conduct statutorily 

mandated review of beneficiary 

complaints about the quality of health 

care services. It also involves all 

activities associated with other required 

case reviews, including Emergency 

Medical Treatment and Active Labor 

Act (EMTALA) reviews, beneficiary 

appeals of discharge, and fiscal 

intermediary referrals. All case review 

activities must be conducted in 

accordance with our instructions. 

Additional required activities under this 

Task are physician acknowledgment 

monitoring; inter-rater reliability (IRR) 

assessment; procedures based on the 

result of a review or analysis of review 

data; development of an Annual Report; 

and maintenance of a Medicare 

Helpline. 

Task 3b: Hospital Payment Monitoring 

Program 

In the 8th SOW contract, we directed 

the QIOs to continue the Hospital 

Payment Monitoring Program (HPMP). 

The purpose of HPMP is to measure, 

monitor, and reduce the incidence of 

improper fee-for-service inpatient 

payments, including errors in: DRG 

coding; provision of medically 

necessary services; and appropriateness 

of setting, billing, and prepayment 

denial. 

The basis for HPMP is statutory and 

regulatory. Section 1154 of the Act 

statutorily mandates utilization review 

of professional activities subject to the 

requirements of subsection (d). In 

accordance with 42 CFR 412.508(a), QIO 

review must include long-term acute 

care services. For FFS inpatient hospital 

claims (paid and denied), HPMP fulfills 

our requirement to comply with the 

Improper Payment Information Act of 

2002 (Pub. L. 107–300). 

The QIO will be judged successful if, 

at remeasurement, the absolute (gross 

total of under- and overpayments) and 

net (difference between over- and 

underpayments) payment error rates are 


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Federal Register / Vol. 72, No. 151 / Tuesday, August 7, 2007 / Notices 44155 

no greater than 1.5 standard errors 

above the respective absolute and net 

baseline payment error rate. 

The QIOs will also be judged in terms 

of timeliness of reviews. Monitoring 

activities must be summarized for 

payment error rates and hospital 

admission, coding, and billing patterns 

for short-term acute care inpatient FFS 

reimbursements in the QIO’s State/ 

jurisdiction including hospital profiling 

and trend monitoring. The QIO must 

submit its summary electronically to the 

Project Officer via a designated database 

as directed by CMS. Whether 

demonstrations of reductions in dollars 

or percent dollars paid in error and 

whether substantive knowledge are 

gained in the project will be determined 

by the Task 3b GTL and the QIO’s 

Project Officer. 

Task 4: Special Studies and Projects 

A Special Project is defined as work 

that we direct a QIO to perform or work 

that a QIO elects to perform with our 

approval that is not defined under Tasks 

1–3 of the contract. The Special Project 

work must fall within the scope of the 

contract and of section 1154 of the Act. 

The Special Project must be conducted 

in accordance with contract sections 

B.4, Task 4 Special Projects; G.18, 

Procedures for Special Projects; and 

H.12, CMS-Directed Subcontracts/ 

Special Project Lead QIOs. The term 

‘‘Special Project’’ is a more accurate 

term for the type of activities and 

requirements characteristically 

implemented under Task 4. Other terms, 

previously commonly used, for 

activities under this task include 

‘‘special study’’, ‘‘special study project’’, 

and ‘‘special work.’’

All Special Projects awarded/ 

approved under Task 4 will be 

evaluated individually. The QIO’s 

success or failure on a Special Project 

will not be factored into the evaluation 

of the QIO’s work under Tasks 1–3 of 

the contract, except for projects funded 

to meet the requirements of Task 3b: 

Hospital Payment Monitoring Program. 

The assessment of performance on all 

other special projects under Task 4 will 

affect the QIO’s eligibility to receive 

funding for additional special projects 

under the current or subsequent QIO 

contracts, but will not affect eligibility 

for non-competitive renewal of the QIO 

contract. Although individual projects 

may include additional project-specific 

assessment criteria and performance 

measures, every project awarded/ 

approved under Task 4 is subject to 

evaluation on at least the following 

dimensions of performance, which 

apply to any and all projects awarded/ 

approved under Task 4: 

• Completion of specific tasks 

(deliverables) required in the special 

project. 

• Financials. 

• Appropriateness of QIO staffing for 

this special project including number of 

staff as well as skill sets of staff. 

• Performance in meeting the needs 

of QIOs, other Quality Improvement 

Organization Support Centers, GTLs, 

etc., and the quality of activities to 

improve performance. 

• Participation in other improvement 

activities. 

• Efforts to address issues/barriers 

identified. 

Performance assessment for each 

project will be conducted jointly by the 

QIO’s regularly assigned CMS Project 

Officer and the specific Special Project 

GTL (SPGTL). 

Authority: Section 1153 of the Social 

Security Act (42 U.S.C. 1320c–2) (Catalog of 

Federal Domestic Assistance Program No. 

93.774, Medicare—Supplementary Medical 

Insurance Program). 

Dated: March 8, 2007. 

Leslie Norwalk, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

Editorial Note: The Office of the Federal 

Register received this document on August 2, 

2007. 

[FR Doc. E7–15342 Filed 8–6–07; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

Privacy Act of 1974; Report of a New 

System of Records 

AGENCY: Department of Health and 

Human Services (HHS) Centers for 

Medicare & Medicaid Services (CMS). 

ACTION: Notice of a New System of 

Records (SOR). 

SUMMARY: In accordance with the 

requirements of the Privacy Act of 1974, 

we are proposing to establish a new 

system titled, ‘‘Healthcare Common 

Procedure Coding System (HCPCS) 

Level II, System No. 09–70–0576.’’ In 

October 2003, the Secretary of HHS 

delegated authority under the Health 

Insurance Portability and 

Accountability Act of 1996 (HIPAA) to 

CMS to maintain and distribute HCPCS 

Level II Codes. Level II of the HCPCS is 

a standardized coding system that is 

used primarily to identify products and 

services not included in the HCPCS 

Level I Current Procedural Terminology 

(CPT) codes, such as: Injectable drugs 

administered in a physician office; 

durable medical equipment, prosthetics, 

orthotics, and supplies (DMEPOS) when 

used outside a physician’s office; and 

ambulance services. HCPCS Level II 

codes were established to identify these 

products on insurance claims. There are 

about 4000 HCPCS Level II codes 

available for assignment by insurers in 

accordance with their policies. 

The primary purpose of this system is 

to facilitate the management and 

maintenance of the HCPCS Level II code 

set. Information in this system will also 

be used to: (1) Support regulatory and 

policy functions performed within the 

Agency or by a contractor, consultant, or 

grantee; (2) assist another Federal or 

state agency; (3) support litigation 

involving the Agency related to this 

system; and (4) combat fraud, waste, 

and abuse in certain health benefits 

programs. We have provided 

background information about the 

proposed system in the SUPPLEMENTARY

INFORMATION section below. Although 

the Privacy Act requires only that the 

‘‘routine use’’ portion of the system be 

published for comment, CMS invites 

comments on all portions of this notice. 

See Effective Dates section for comment 

period. 

DATES: Effective Dates: CMS filed a new 

SOR report with the Chair of the House 

Committee on Oversight and 

Government Reform, the Chair of the 

Senate Committee on Homeland 

Security & Governmental Affairs, and 

the Administrator, Office of Information 

and Regulatory Affairs, Office of 

Management and Budget (OMB) on 

August 1, 2007. To ensure that all 

parties have adequate time in which to 

comment, the new system will become 

effective 30 days from the publication of 

the notice, or 40 days from the date it 

was submitted to OMB and the 

Congress, whichever is later. We may 

defer implementation of this system or 

one or more of the routine use 

statements listed below if we receive 

comments that persuade us to defer 

implementation. 

ADDRESSES: The public should address 

comments to: CMS Privacy Officer, 

Division of Privacy Compliance, 

Enterprise Architecture and Strategy 

Group, CMS, Mail Stop N2–04–27, 7500 

Security Boulevard, Baltimore, 

Maryland 21244–1850. Comments 

received will be available for review at 

this location, by appointment, during 

regular business hours, Monday through 

Friday from 9 a.m.–3 p.m., eastern 

daylight time. 

FOR FURTHER INFORMATION CONTACT: 

Trish Brooks, Division of Home Health, 

Hospice, and HCPCS, Chronic Care 


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