```

[Federal Register Volume 79, Number 154 (Monday, August 11, 2014)]
[Notices]
[Pages 46830-46835]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-18901]

-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-3300-NC]
RIN 0938-ZB15

Medicare Program; Evaluation Criteria and Standards for Quality 
Improvement Networks Quality Improvement Program Contracts [Base and 
Task Order(s)]

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice with comment period.

-----------------------------------------------------------------------

SUMMARY: This notice with comment period describes the general criteria 
we intend to use to evaluate the effectiveness and efficiency of the 
Quality Innovation Network (QIN) Quality Improvement Organizations 
(QIOs) that will enter into contracts with CMS under the Quality 
Innovation Network Quality Improvement Organizations (Solicitation 
Number: HHSM-500-2014-RFP-QIN-QIO) Statement of Work (SOW) on August 1, 
2014. The evaluation of a QIN-QIO's performance related to their SOW 
will be based on evaluation criteria specified for the tasks and 
subtasks set forth in

[[Page 46831]]

Sections C.5, G.22 and G.29 of the QIN-QIO Base Contract and Attachment 
J-1(b) of the Base Contract; Attachment J-1 is QIN-QIO Task Order No. 
001.

DATES: Effective Date: August 1, 2014 to July 31, 2019 for the QIN-QIO 
contract.
    Comment Date: To be assured consideration, comments must be 
received at one of the addresses provided below, no later than 5 p.m. 
on September 10, 2014.

ADDRESSES: In commenting, refer to file code CMS-3300-NC. Because of 
staff and resource limitations, we cannot accept comments by facsimile 
(FAX) transmission.
    You may submit comments in one of four ways (please choose only one 
of the ways listed):
    1. Electronically. You may submit electronic comments on this 
regulation to http://www.regulations.gov. Follow the ``Submit a 
comment'' instructions.
    2. By regular mail. You may mail written comments to the following 
address only:

Centers for Medicare & Medicaid Services,
Department of Health and Human Services,
Attention: CMS-3300-NC,
P.O. Box 8010,
Baltimore, MD 21244-1850.

    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 to 
the following address only:

Centers for Medicare & Medicaid Services,
Department of Health and Human Services,
Attention: CMS-3300-NC,
Mail Stop C4-26-05,
7500 Security Boulevard,
Baltimore, MD 21244-1850.

    4. By hand or courier. Alternatively, you may deliver (by hand or 
courier) your written comments only to the following addresses:

a. For delivery in Washington, DC--
Centers for Medicare & Medicaid Services,
Department of Health and Human Services,
Room 445-G, Hubert H. Humphrey Building,
200 Independence Avenue SW.,
Washington, DC 20201

(Because access to the interior of the Hubert H. Humphrey 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.)

b. For delivery in Baltimore, MD--
Centers for Medicare & Medicaid Services,
Department of Health and Human Services,
7500 Security Boulevard,
Baltimore, MD 21244-1850.

    If you intend to deliver your comments to the Baltimore address, 
call telephone number (410) 786-9994 in advance to schedule your 
arrival with one of our staff members. Comments erroneously mailed to 
the addresses indicated as appropriate for hand or courier delivery may 
be delayed and received after the comment period.

FOR FURTHER INFORMATION CONTACT: Alfreda Staton, (410) 786-4194.

SUPPLEMENTARY INFORMATION:
    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.regulations.gov. Follow the search instructions 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

    Section 1153(h)(2) of the Social Security Act (the Act) requires 
the Secretary of the Department of Health and Human Services (the 
Secretary) to publish in the Federal Register the general criteria and 
standards that will be used to evaluate the effective and efficient 
performance of contract obligations by the Quality Improvement 
Organizations (QIOs), and to provide the opportunity for public comment 
with respect to these criteria and standards. This notice describes the 
general criteria that will be used to evaluate performance of the 
Quality Innovation Network (QIN)--QIOs under the QIN-QIO 11th Statement 
of Work (SOW) contract beginning August 1, 2014.

II. Provisions of the Notice With Comment Period

    The QIN-QIO contract supports our efforts to improve health and 
healthcare for all Medicare beneficiaries, including those who are 
eligible for both the Medicare and Medicaid programs, and promote 
quality of care to ensure the right care at the right time, every time. 
The QIN-QIO SOW is structured so that QIN-QIOs perform under the base 
contract and task orders. Task Order 001 outlines several tasks for the 
QIN-QIOs as well as a mechanism for the proposal and adoption of 
additional tasks known as ``Special Innovation Projects'' (SIPs). 
Specifically, SIPs are initiatives, efforts, and programs rooted in the 
QIN-QIO area. SIPs are recommended to the Centers for Medicare & 
Medicaid Services (CMS), through the QIN-QIO, by community advocates, 
organizers, and groups engaged with local health issues. The SIP is 
intended to either address a health issue the community finds acute but 
is less visible to high-level federal analytics or to respond to health 
issues, local or national, that are discovered during the course of the 
contract. In addition to the SIPs, QIOs are responsible for completing 
the requirements for the following Tasks as part of Task Order 001:
     Improving Cardiac Health and Reducing Cardiac Healthcare 
Disparities;
     Reducing Disparities in Diabetes Care;
     Improving Prevention Coordination through Meaningful Use 
of Health Information Technology (HIT) and Collaborating with Regional 
Extension Centers (RECs);
     Reducing Healthcare-Associated Infections in Hospitals;
     Reducing Healthcare-Acquired Conditions in Nursing Homes;
     Improving Coordination of Care;
     Quality Improvement through Value-Based Payment, Quality 
Reporting, and the Physician Feedback Reporting Program; and
     Quality Improvement Initiatives.

(Detailed information for each Task may be found in sections B.1 
through E.1 in Attachment J.1 posted on December 5, 2013 of 
Solicitation Number: HHSM-500-2014-RFP-QIN-QIO, posted at the http://www.fedbizopps.gov Web site: https://www.fbo.gov/index?s= 
opportunity&mode=form&id= dff522bababb 6b9859bb783 c08db6074.) 
References in this Notice to ``Attachments'' are to attachments of the 
RFP and SOW.

[[Page 46832]]

QIN-QIO Tasks

Improving Cardiac Health and Reducing Cardiac Healthcare Disparities 
(See Section B.1 of Attachment J.1, QIN-QIO Task Order No. 001)
    The purpose of this task is for the QIN-QIOs to work with providers 
and beneficiaries in collaboration with key partners and stakeholders, 
including RECs, to implement evidence-based practices to improve 
cardiovascular health, reduce cardiovascular healthcare disparities, 
and support the Department of Health and Human Services' Million 
Hearts[supreg] initiative's goal to prevent one million heart attacks 
and strokes. The Million Hearts[supreg] Web site is found at 
www.millionhearts.hhs.gov. While the QIN-QIO's work targets Medicare 
beneficiaries of all races and ethnicities, the QIN-QIO shall also 
propose the number of clinicians, practitioners, and providers, (as 
defined in section 1861(u) of the Act (42 U.S.C. 1395)), it will 
recruit to voluntarily participate in this initiative. Focus will be on 
those clinicians and provider that provide healthcare services to 
African American, Hispanic, and other racial and ethnic minority 
Medicare beneficiaries. Goals and targets will be monitored for 
improvement in promoting the use of Aspirin therapy when appropriate; 
Blood pressure (BP) control; Cholesterol management; and Smoking 
assessment and cessation (ABCS).
Reducing Disparities in Diabetes Care: Everyone With Diabetes Counts 
(EDC) (See Section B.2 in Attachment J.1, QIN-QIO Task Order No. 001)
    The purpose of this Task is to improve the quality of the lives for 
persons with diabetes, and to prevent or lessen the severity of 
complications resulting from diabetes. The QIN-QIOs will promote 
diabetes self-management education (DSME) for empowering Medicare 
beneficiaries with diabetes to take an active role in controlling their 
disease and improve clinical outcomes. The QIN-QIOs will work with 
healthcare providers, practitioners, certified diabetes educators, and 
community health workers to cultivate the knowledge and skills 
necessary to improve the quality of the lives for persons with 
diabetes. The QIN-QIOs will also work with stakeholders on preventing 
or lessening the severity of complications resulting from diabetes such 
as kidney failure, amputations, loss of vision, heart failure, and 
stroke.
Improving Prevention Coordination Through Meaningful Use of HIT and 
Collaborating With Regional Extension Centers (See Section B.4 in 
Attachment J.1, QIN-QIO Task Order No. 001)
    The purpose of this Task is to support physician and other 
clinician practices to improve care and outcomes for their population 
of patients through meaningful use of interoperable health IT in 
collaboration with RECs. The QIN-QIOs will collaborate with RECs to 
improve the quality of care and transitions in care through 
interoperable health IT in connection with the Medicare program. The 
QIN-QIOs will provide targeted technical assistance to Eligible 
Professionals (EP), Eligible Hospitals (EH) and Critical Access 
Hospitals (CAH) that are most challenged to successfully meet the 
requirements of the Medicare Electronic Health Record (EHR) Incentive 
Programs and utilizing EHR functionality for quality improvement.
Reducing Healthcare-Associated Infections in Hospitals (See Section C.1 
in Attachment J.1 of the QIN-QIO Task Order)
    The purpose of this Task is to improve beneficiary safety by 
reducing the incidence of patient harm in the areas of healthcare-
associated infections (HAIs) in hospital settings. The QIN-QIO will use 
evidence-based strategies and data to decrease and prevent HAIs in the 
hospital setting to improve patient care. The QIO will work to decrease 
Central Line-Associated Bloodstream Infection (CLABSI), Catheter-
Associated Urinary Tract Infection (CAUTI) and Clostridium Difficile 
Infection (CDI) Standardized Infection Ratios (SIRs) and improve 
Urinary Catheter Utilization in hospital acute care settings for 
Medicare beneficiaries.
Reducing Healthcare-Acquired Conditions in Nursing Homes (See Section 
C.2 in Attachment J.1, QIN-QIO Task Order No. 001)
    The purpose of this Task is to improve beneficiary safety by 
reducing the incidence of healthcare-acquired conditions in nursing 
home provider settings. The QIN-QIO will improve the quality of care 
for Medicare beneficiaries in Nursing Homes by achieving improvement in 
the Collaborative Quality Measure Composite Score composed of 13 NQF-
endorsed quality of care measures as listed in Attachment J.1--Task 
Order 001, Task C.2. Appendix 4; decrease the percentage of residents 
who received antipsychotic medications; and improve mobility of long-
stay residents. The QIN-QIO will work to support the creation of 
National Nursing Home Quality Care Collaboratives (NNHQCC) to ``instill 
quality and performance improvement practices, eliminate healthcare 
acquired conditions, and improve resident satisfaction.'' The QIN-QIO 
will work with participating nursing homes, beneficiaries, beneficiary 
family members and/or beneficiary advocates/representatives, and in 
collaboration with key partners and stakeholders to accomplish these 
objectives.
Coordination of Care (See Section C.3 in Attachment J.1,QIN-QIO Task 
Order No. 001)
    The purpose of this Task is to improve hospital admission and/or 
readmission rates, and adverse drug event rates by improving effective 
communication and the continuity and coordination of patient care using 
methods such as interoperable health IT. The QIN-QIO will improve the 
quality of care for Medicare beneficiaries who transition among care 
settings including home through a comprehensive community effort. These 
efforts aim to reduce readmissions following hospitalization and to 
yield sustainable and replicable strategies to achieve high-value 
health care, particularly for chronically ill and disabled Medicare 
beneficiaries. The QIN-QIOs will support the development of community 
coalitions for improving communication and the coordination of clinical 
decisions.
Quality Improvement Through Value-Based Payment, Quality Reporting, and 
the Physician Feedback Reporting Program (See Section D.1 in Attachment 
J.1, QIN-QIO Task Order No. 001)
    The purpose of this Task is to improve quality care to 
beneficiaries in physician settings by supporting provider use of and 
participation in the CMS physician value modifier program and 
coordinating community driven projects that advance efforts to achieve 
better care at lower costs. The QIN-QIOs will improve healthcare by 
identifying gaps and opportunities for improvement in quality, 
efficiency, and care coordination. The QIOs shall be called upon to 
assist hospitals, PPS-exempt Cancer Hospitals (PCHs), Inpatient 
Psychiatric Facilities (IPFs), Ambulatory Surgical Centers (ASCs) and 
physicians (as defined in section 1861(r) of the Act) in improving the 
quality and efficiency of care through outreach and education about 
CMS' hospital and physician value based payment programs, quality 
reporting

[[Page 46833]]

programs, Physician Feedback Reporting Program, and the use of the 
quality and cost measure information contained in the confidential 
quality and resource use reports.
QIN-QIO-Proposed Projects That Advance Efforts for Better Care at Lower 
Cost (See Section D.2 in Attachment J.1, QIN-QIO Task Order No. 001)
    We will use SIPs to support QIN-QIOs in their respective services 
areas to work with communities to improve healthcare quality and 
efficiencies. Specifically, SIPs are initiatives, efforts, and programs 
rooted in the QIN-QIO area. SIPs are recommended to us, through the 
QIN-QIO, by community advocates, organizers, and groups engaged with 
local health issues. The SIP is intended to address health issues that 
the community finds acute but is less visible at a national-level. 
Evaluation criteria and standards will be developed for each SIP.
Quality Improvement Initiatives (See Section E.1 in Attachment J.1, 
QIN-QIO Task Order No. 001)
    The purpose of this Task is to improve the quality of health care 
for Medicare beneficiaries by providing technical assistance to 
providers and practitioners. The QIN-QIO will improve healthcare 
quality by assisting providers and/or practitioners in identifying the 
root cause of a concern, developing a framework in which to address the 
concern, and improving a process or system based on their analyses. A 
Quality Improvement Initiative (QII) is any formal activity designed to 
serve as a catalyst and support for quality improvement that uses 
proven methodologies to achieve these improvements. The improvements 
may relate to safety, healthcare, health and value and involve 
providers, practitioners, beneficiaries, and/or communities. A QII may 
consist of system-wide and/or non-system-wide changes and may be based 
on a single, confirmed concern or multiple confirmed concerns. 
Additionally, the QIN-QIO will collaborate with the Beneficiary and 
Family Centered Care-QIO to improve Beneficiary (``Patient'') and 
Family Engagement in healthcare quality improvement efforts and 
actively supporting projects aimed at shared decision-making with 
beneficiaries, families, and caregivers and families. QIIs may also be 
based upon or responsive to referrals made by other contractors in the 
QIO Program.

III. Evaluation of the Tasks

    The QIN-QIO's performance will be evaluated based on achievement 
associated with the Tasks in each awarded Task Order and as described 
in Sections C.5, G.22 and G.29 of the QIN-QIO Base Contract and the 
QIN-QIO Statement of Work (including Attachments J.1 and other 
Attachments for measures and targets).
    If a QIN-QIO is not tasked to work on a specific Task or an area 
under a Task, the QIN-QIO will not be evaluated under that particular 
area. Any Special Innovation Project that the QIN-QIO may carry out 
will be evaluated separately and will not be considered in the overall 
performance evaluation criteria.
    We will conduct monitoring activities throughout the course of the 
contract and will act upon findings as necessary. We will monitor, at 
least quarterly, the QIN-QIO's performance relative to contract 
requirements and targets as well as milestones and progress toward 
successfully implementing plans and programs for each of the individual 
states/territories of the QIN-QIO's service area, as well as the 
aggregate, in the Task Award.
    Information used for these monitoring purposes includes but is not 
limited to:
     Deliverables submitted by the QIN-QIO to CMS in accordance 
with the Schedule of Deliverables;
     Data for measures indicated in Attachment J.1(b);
     Data from the QIN-QIO's Continuous Internal Quality 
Improvement Program;
     Other data submitted by QIN-QIOs as required by CMS;
     Additional information gathered by email, telephone, 
video, or in-person visits.
    Plans and programs against which progress will be monitored include 
but are not limited to:

                                                                Plan & Program Monitoring
--------------------------------------------------------------------------------------------------------------------------------------------------------
     Base contract or task order 001                Section(s)                                          Brief description
--------------------------------------------------------------------------------------------------------------------------------------------------------
Base Contract............................  C.6.1.1.....................  Comprehensive Strategic Plan.
Task Order 001...........................  A.1.1.......................  Comprehensive Strategic Plan.
Base Contract............................  C.6.1.2.....................  Integrated Communications Plan.
Task Order 001...........................  A.1.3.......................  Integrated Communications Plan.
Base Contract............................  C.6.1.3.....................  Task Order Work Plan.
Base Contract............................  C.6.4.2.....................  Recruitment.
Base Contract............................  C.6.4.3.....................  Provider and Practitioner Recruitment.
Base Contract............................  C.6.4.4.....................  Beneficiary (``Patient'') and Family Engagement.
Base Contract............................  C.6.4.5.....................  Partner and Stakeholder Recruitment and Collaboration.
Base Contract............................  C.6.4.6.....................  Sustainability Plan.
Task Order 001...........................  A.1.2.......................  Management Plan.
Task Order 001...........................  A.1.6.......................  Continuous Internal Quality Improvement Program.
All Task Orders from Task 001 forward....  All Sections................  Task Order 001, Excellence in Operations and Quality Improvement and all
                                                                          subsequent Task Orders as specified.
--------------------------------------------------------------------------------------------------------------------------------------------------------

    QIN-QIOs shall cooperate with the Contracting Officer 
Representative (COR) on all our monitoring processes and address any 
concerns identified by the COR. We will take appropriate contract 
action (for example, providing warning for the need for adjustment, 
instituting a formal correction plan, terminating an activity, or 
recommending early termination of a contract because of failure to meet 
contract timelines or performance as specified in the contract). This 
means that the QIO shall comply with the Base Contract, all Task 
Orders, Schedules of Deliverables, Evaluation Measures Tables, and any 
subsequent modifications (including HCQIS Memorandums) issued by CMS.
    Additionally, there will be multiple periods of evaluation under 
this contract. The first evaluation will occur at the end of the 12th 
month of the contract. Subsequent evaluations will

[[Page 46834]]

occur at the end of the 24, 36, 48 and 54th months of the contract. The 
evaluations will be based on the most recent data available to us. The 
performance results of the evaluation at each evaluation period (that 
is, 12, 24, 36, 48 and 54th months) will be used, in addition to 
ongoing monitoring activities, to determine the QIO's performance on 
the overall contract.

Annual and 54th Month Evaluation

    Annual and the 54th month contract evaluation will determine if the 
QIN-QIO has met the performance evaluation criteria as specified in the 
Task areas of the Base Contract. The annual and 54th month evaluation 
criteria are found in Section J, Attachment J.1(b), Evaluation Measures 
Table of the QIN-QIO SOW. Attachment J.1(b) includes the following 
measures, by Task:

 B.1. Improving Cardiac Health
    [cir] Percentage of patients whose blood pressure was adequately 
controlled.
    [cir] Percentage of patients who are screened about tobacco use at 
least one time within 24 months.
    [cir] Percentage of patients identified as tobacco users who are 
provided with cessation counseling intervention.
 B.2. Everyone with Diabetes Counts
    [cir] Percentage of clinical outcome data for Medicare 
beneficiaries who complete DSME classes through EDC. Clinical outcomes 
are: HbA1c, Lipids, Eye Exam, Blood Pressure and Weight.
    [cir] Percentage of physician practices recruited to participate in 
EDC.
    [cir] Percentage of New Beneficiaries Completing DSME.
 B.3. (Reserved)
 B.4. Meaningful Use of HIT and Collaborating With RECs
    [cir] Percentage of recruited EPs, EHs and CAHs using certified EHR 
technology (CEHRT) with signed agreements within each state or 
territory.
    [cir] Percentage of recruited EPs, EHs and CAHs using CEHRT 
receiving technical assistance within each state or territory.
    [cir] Percentage of recruited practitioners/providers attending 
QIO's educational sessions and the Learning and Action Network.
    [cir] Percentage of recruited EPs, EHs and CAHs that received 
Technical Assistance (TA) that meet EHR Incentive Programs clinical 
quality measures reporting requirements post TA within each state or 
territory.
    [cir] Percentage of recruited practitioners/providers working to 
establish an electronic connection with beneficiaries/family 
representative.
 C.1. Reducing Healthcare-Acquired Infections (HAIs) in 
Hospitals
    [cir] CLABSI Standardized Infection Ratio.
    [cir] CAUTI Standardized Infection Ratio.
    [cir] Urinary Catheter Utilization Rate.
    [cir] CDI Standardized Infection Rate.
    [cir] Recruitment of non-ICU and ICU units in acute care facilities 
to participate in HAI projects.
 C.2. Reducing Healthcare-Acquired Conditions in Nursing Homes
    [cir] Rate of reduction in percentage of residents who received 
antipsychotic medications.
    [cir] Percentage of long-stay residents with improved mobility.
    [cir] Percentage of One-Star Category Target Number recruited for 
Collaborative I.
    [cir] Sum of Percentages of One-Star Category Target Number 
recruited for Collaboratives I and II.
    [cir] Percentage of Recruitment Target Number recruited for 
Collaborative I.
    [cir] Sum of percentages of Recruitment Target Number recruited for 
Collaboratives I and II.
    [cir] NNHQCC Quality Composite Measure Score.
 C.3. Coordination of Care
    [cir] Percentage of interventions implemented (for a minimum of 6 
months) that show improvement (for a minimum of 5 interventions across 
the region annually).
    [cir] Percentage of 30-day readmissions per 1,000 Fee-for-Service 
(FFS) beneficiaries in region-wide coalition.
    [cir] Percentage of admissions per 1,000 FFS beneficiaries in 
region-wide coalition.
    [cir] Percentage of region-wide readmissions per 1,000 FFS 
beneficiaries.
    [cir] Percentage of adverse drug events per 1,000 screened 
beneficiaries.
    [cir] Increased community tenure in region-wide coalition. 
``Community tenure'' is defined as the number of days beneficiaries 
spend in their home setting.
 D.1. Quality Improvement through Physician Value-Based 
Modifiers
    [cir] Percentage of eligible physicians/physician groups attending 
QIO-convened forums related to the Value Modifier (VM) Program.
    [cir] Percentage of eligible physicians/physician groups that 
demonstrate improvement in quality-of-care measures (per Quality and 
Resource Use Reports) after receiving TA from QIOs.
    [cir] Percentage of eligible ASCs that demonstrate improvement in 
quality-of-care measures (per Ambulatory Surgical Center Quality 
Reporting) after receiving TA from QIOs.
    [cir] Percentage of eligible IPFs that demonstrate improvement in 
quality-of-care measures (per Inpatient Psychiatric Facility Quality 
Reporting) after receiving TA from QIOs.
    [cir] Percentage of eligible CAHs that demonstrate improvement in 
quality-of-care measures (per Inpatient Quality Reporting or Outpatient 
Quality Reporting (OQR)) after receiving TA from QIOs.
    [cir] Percentage of eligible PCHs that demonstrate improvement in 
quality-of-care measures (per PPS-Exempt Cancer Hospital Quality 
Reporting) after receiving TA from QIOs.
    [cir] Performance period median national measure rate on OQR 
measure as posted on Hospital Compare.
    [cir] Percentage of eligible physicians/physician groups actively 
participating in VM that require technical assistance for electronic 
submission (Physician Quality Reporting System) and are successful in 
subsequent submissions.
    [cir] Percentage of eligible physicians/eligible physician groups 
receiving payment adjustments through VM.
 E.1. Technical Assistance--Quality Improvement Initiatives 
(QIIs)
    [cir] Percentage of QIIs initiated within 30 days of the receipt of 
the applicable referral or request for QII technical assistance.
    [cir] Percentage of QIIs successfully resolved.
    Achievement within each of the Tasks for each Task Order will be 
evaluated on an individual basis for appropriate contract action. 
Though, in general, evaluation of each Task will relate only to that 
area, we reserve the right to take appropriate contract action in the 
event of failure in multiple Task areas.

Overall Contract Evaluation

    The results of the annual (12, 24, 36, 48th month) and 54th month 
evaluation periods, in addition to ongoing monitoring activities, will 
be used to determine how each QIN-QIO performed on the overall 
contract. Annual and 54th Month Evaluation Criteria are specifically 
defined in Attachment J-1(b) of the QIN-QIO SOW; the criteria for 
evaluating each deliverable under the contract and Task

[[Page 46835]]

Order No. 001 are identified in Attachment J.1(a) Schedule of 
Deliverables of the 11th SOW. Further, as indicated in Sections G.22 
and G.29, the Contracting Officer will use the Contractor Performance 
Assessment Reporting System (CPARS) criteria in performing evaluations: 
Quality, Schedule/Timeliness, Cost/Price Control, Business Relations, 
Management, and Small Business. Performance on the evaluation criteria 
defined in Attachment J-1(b) will be considered for assessment of the 
Quality sub-factor for the CPARS assessment.
    If we choose, we may notify the QIN-QIO of the intention not to 
renew the QIN-QIO contract, and inform the QIN-QIO of the QIN-QIO's 
rights under the current statute. Any failure at one or more of the 
annual or 54th month evaluations for any Task may result in the QIN-QIO 
receiving an adverse performance evaluation. Further, failure may 
impact on the QIN-QIO's ability to continue similar work in or 
eligibility for future QIO Program awards.
    We reserve the right at any point, prior to the notification of our 
intention not to continue the option for a Task and/or to renew the 
contract, to revise measures or adjust the expected minimum thresholds 
for satisfactory performance or remove criteria from a Task evaluation 
protocol for any reason, including, but not limited to, data gathered 
based on experience with the amount of improvement achieved during the 
contract cycle or in pilot projects currently in progress, information 
gathered through evaluation of the QIN-QIO performance overall, or any 
unforeseen circumstances. Further, in accordance with standard contract 
procedures, we reserve the right at any time to discontinue all or part 
of one or more tasks for one or more states or territories in the QIN 
area or any other part of this contract regardless of QIN-QIO 
performance on the Task.

Rounding Rules

    The rounding of results to assess the minimum performance criteria 
indicated in Section J, Attachment J.1(b) uses the following rules.
1. Interim Calculations
    We will not round the interim results of calculations used to 
produce results. (For example, we will not round the results from steps 
used to calculate the criteria or result). For example, we will not 
first round baseline and re-measurement rates for the calculation of 
relative improvement.
2. Percentages/Proportions/Rates
    Use conventional rounding ``round half up.'' For example, to round 
from the hundredth to the tenth digit, round using the tie-break rule 
of ``half-up.'' 5.45 will become 5.5 whereas 5.44 will become 5.4. 
Apply conventional rounding to one digit beyond that used to specify 
the criteria (for example, for whole numbers, to the tenths place). For 
example, for a criterion expressed as 5 percent, 4.46 percent rounds to 
4.5 percent and 4.44 percent rounds to 4.4 percent.
3. Integers
    For discrete numbers of units required for improvement, round to 
the more favorable (typically lower) integer with a minimum of one. We 
note that this method is applied selectively to special cases as 
indicated in Section J, Attachment J.1(b). This method is more than a 
rounding rule. We calculate a minimum performance target using the 
minimum performance criteria and the size of the re-measurement 
criteria. For example, for a minimum criteria of 95 percent and a re-
measurement denominator of 10, 10 x 0.95 = 9.5, which is rounded down 
(the more favorable direction) to 9. For this example, if CMS specified 
use of the integer rounding rule for this measure, the minimum 
performance criteria of 95 percent would be met by achieving at least 9 
cases given a re-measurement denominator count of size 10. If we do not 
specifically indicate that the integer rounding rule applied to this 
measure, the percentage rounding rule would be used.

III. Collection of Information Requirements

    This document does not impose information collection and 
recordkeeping requirements. Consequently, it need not be reviewed by 
the Office of Management and Budget under the authority of the 
Paperwork Reduction Act of 1995.

IV. Response to Comments

    Because of the large number of public comments we normally receive 
on Federal Register documents, we are not able to acknowledge or 
respond to them individually. We will consider all comments we receive 
by the date and time specified in the DATES section of this preamble, 
and, when we proceed with a subsequent document, we will respond to the 
comments in the preamble to that document.

VI. Regulatory Impact Statement

    In accordance with the provisions of Executive Order 12866, this 
notice was not reviewed by the Office of Management and Budget.

    Dated: June 3, 2014.
Marilyn Tavenner,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2014-18901 Filed 8-8-14; 8:45 am]
BILLING CODE 4120-01-P
```