46830 Federal Register / Vol. 79, No. 154 / Monday, August 11, 2014 / Notices 

specific request that describes project 

purpose, use, and methodology. 

CDC plans to request OMB approval 

to extend the MTTCA clearance, with 

changes, for three years. The Revision 

information collection request (ICR) will 

propose further increases in the 

annualized estimated number of 

respondents and the annualized 

estimated burden hours. These increases 

are needed to support CDC’s planned 

information collections and to 

accommodate additional needs that CDC 

may identify during the next three 

years. For example, the MTTCA generic 

clearance may be used to facilitate the 

development of tobacco-related health 

communications of interest for CDC’s 

collaborative efforts with other federal 

partners including, but not limited to, 

the Food and Drug Administration 

(FDA), the Substance Abuse and Mental 

Health Services Administration 

(SAMHSA), the National Institutes of 

Health (NIH), and the National Cancer 

Institute (NCI). At this time the MTTCA 

clearance is expected to be sufficient to 

test tobacco related messages developed 

by CDC. However, the MTTCA 

clearance should not replace the need 

for additional generic clearance 

mechanisms HHS and other federal 

partners may need to test tobacco 

messages related to their campaigns and 

initiatives. 

CDC’s revised MTTCA clearance will 

also describe expansion of the target 

audience(s) that may be involved in 

message testing, such as youth ages 13– 

17 years. The 2014 Surgeon General’s 

Report concluded that there is already 

sufficient evidence to caution youth 

against the use of electronic cigarettes. 

Tobacco and electronic cigarette 

advertising and promotional activities 

can prompt smoking initiation, 

especially among youth. Recent studies 

have found that 90.7% of middle school 

students and 92.9% of high school 

students have been exposed to protobacco advertisements in stores, 

magazines and on the internet. Media 

campaigns have been shown to be 

effective as part of a comprehensive 

tobacco control program to decrease the 

initiation of tobacco use among youths 

and young adults. A coordinated series 

of health message testing activities will 

be required to support future 

development of effective, audiencespecific and channel-specific messages 

for CDC’s ACA-funded campaign. 

Finally, there may be a need to test 

prevention and cessation messages 

related to products that are not currently 

regulated, including non-combustible 

tobacco products (electronic nicotine 

delivery systems such as electronic 

cigarettes or e-cigarettes) and some 

combustible products (such as cigars/

little cigars and cigarillos). In the event 

that the FDA receives authority to 

regulate these products and decides to 

do a campaign about them, CDC will 

work closely with FDA to avoid 

duplication. Additionally, CDC will 

share with FDA the findings from any 

formative work related to the youth 

audience. 

CDC will continue to use the MTTCA 

clearance to develop and test messages 

and materials for current and future 

phases of the ACA-funded media 

campaign, OSH’s ongoing programmatic 

initiatives including, but not limited to, 

the Media Campaign Resource Center, 

reports from the Office of the Surgeon 

General, and other communication 

efforts and materials. Participation is 

voluntary and there are no costs to 

respondents other than their time. 

ESTIMATED ANNUALIZED BURDEN HOURS

Type of respondents Form name Number of 

respondents 

Number of 

responses per 

respondent 

Average 

burden per 

response 

(in hours) 

Total burden 

(in hours) 

General Public and Special Populations.Screening and Recruitment ................................. 20,000 1 2/60 667 

In-depth Interviews (In Person, telephone, etc.) 96 1 1 96 

Focus Groups (In Person) ................................... 160 1 1.5 240 

Focus Groups (Online) ........................................ 120 1 1 120 

Short Surveys/information needed to screen individuals being considered for inclusion in 

campaign ads (Online, Bulletin Board, etc.).

9,800 1 10/60 1,633 

Medium Surveys (Online) .................................... 9,940 1 25/60 4,142 

In-depth Surveys (Online) ................................... 4,100 1 1 4,100 

Total ........................ .............................................................................. 44,216 ........................ ........................ 10,998 

Leroy Richardson, 

Chief, Information Collection Review Office, 

Office of Scientific Integrity, Office of the 

Associate Director for Science, Office of the 

Director, Centers for Disease Control and 

Prevention. 

[FR Doc. 2014–18902 Filed 8–8–14; 8:45 am] 

BILLING CODE 4163–18–P 

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 

mstockstill on DSK4VPTVN1PROD with NOTICES

Federal Register / Vol. 79, No. 154 / Monday, August 11, 2014 / Notices 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 highlevel 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. 

mstockstill on DSK4VPTVN1PROD with NOTICES

46832 Federal Register / Vol. 79, No. 154 / Monday, August 11, 2014 / Notices 

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® initiative’s goal to prevent one 

million heart attacks and strokes. The 

Million Hearts® 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 NQFendorsed 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 ValueBased 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, PPSexempt 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 

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Federal Register / Vol. 79, No. 154 / Monday, August 11, 2014 / Notices 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 CareQIO 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 

mstockstill on DSK4VPTVN1PROD with NOTICES

46834 Federal Register / Vol. 79, No. 154 / Monday, August 11, 2014 / Notices 

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 

Æ Percentage of patients whose blood 

pressure was adequately controlled. 

Æ Percentage of patients who are 

screened about tobacco use at least 

one time within 24 months. 

Æ Percentage of patients identified as 

tobacco users who are provided 

with cessation counseling 

intervention. 

• B.2. Everyone with Diabetes Counts 

Æ 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. 

Æ Percentage of physician practices 

recruited to participate in EDC. 

Æ Percentage of New Beneficiaries 

Completing DSME. 

• B.3. (Reserved) 

• B.4. Meaningful Use of HIT and 

Collaborating With RECs 

Æ Percentage of recruited EPs, EHs 

and CAHs using certified EHR 

technology (CEHRT) with signed 

agreements within each state or 

territory. 

Æ Percentage of recruited EPs, EHs 

and CAHs using CEHRT receiving 

technical assistance within each 

state or territory. 

Æ Percentage of recruited 

practitioners/providers attending 

QIO’s educational sessions and the 

Learning and Action Network. 

Æ 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. 

Æ Percentage of recruited 

practitioners/providers working to 

establish an electronic connection 

with beneficiaries/family 

representative. 

• C.1. Reducing Healthcare-Acquired 

Infections (HAIs) in Hospitals 

Æ CLABSI Standardized Infection 

Ratio. 

Æ CAUTI Standardized Infection 

Ratio. 

Æ Urinary Catheter Utilization Rate. 

Æ CDI Standardized Infection Rate. 

Æ 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 

Æ Rate of reduction in percentage of 

residents who received 

antipsychotic medications. 

Æ Percentage of long-stay residents 

with improved mobility. 

Æ Percentage of One-Star Category 

Target Number recruited for 

Collaborative I. 

Æ Sum of Percentages of One-Star 

Category Target Number recruited 

for Collaboratives I and II. 

Æ Percentage of Recruitment Target 

Number recruited for Collaborative 

I. 

Æ Sum of percentages of Recruitment 

Target Number recruited for 

Collaboratives I and II. 

Æ NNHQCC Quality Composite 

Measure Score. 

• C.3. Coordination of Care 

Æ Percentage of interventions 

implemented (for a minimum of 6 

months) that show improvement 

(for a minimum of 5 interventions 

across the region annually). 

Æ Percentage of 30-day readmissions 

per 1,000 Fee-for-Service (FFS) 

beneficiaries in region-wide 

coalition. 

Æ Percentage of admissions per 1,000 

FFS beneficiaries in region-wide 

coalition. 

Æ Percentage of region-wide 

readmissions per 1,000 FFS 

beneficiaries. 

Æ Percentage of adverse drug events 

per 1,000 screened beneficiaries. 

Æ 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 

Æ Percentage of eligible physicians/

physician groups attending QIOconvened forums related to the 

Value Modifier (VM) Program. 

Æ 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. 

Æ Percentage of eligible ASCs that 

demonstrate improvement in 

quality-of-care measures (per 

Ambulatory Surgical Center Quality 

Reporting) after receiving TA from 

QIOs. 

Æ Percentage of eligible IPFs that 

demonstrate improvement in 

quality-of-care measures (per 

Inpatient Psychiatric Facility 

Quality Reporting) after receiving 

TA from QIOs. 

Æ 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. 

Æ Percentage of eligible PCHs that 

demonstrate improvement in 

quality-of-care measures (per PPSExempt Cancer Hospital Quality 

Reporting) after receiving TA from 

QIOs. 

Æ Performance period median 

national measure rate on OQR 

measure as posted on Hospital 

Compare. 

Æ 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. 

Æ Percentage of eligible physicians/

eligible physician groups receiving 

payment adjustments through VM. 

• E.1. Technical Assistance—Quality 

Improvement Initiatives (QIIs) 

Æ Percentage of QIIs initiated within 

30 days of the receipt of the 

applicable referral or request for QII 

technical assistance. 

Æ 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 

mstockstill on DSK4VPTVN1PROD with NOTICES

Federal Register / Vol. 79, No. 154 / Monday, August 11, 2014 / Notices 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 remeasurement 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 × 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 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Proposed Information Collection 

Activity; Comment Request 

Proposed Projects: 

Title: Annual Report/ACF 204 (State 

MOE)—1 collection. 

OMB No.: 0970–0248. 

Description: The Administration for 

Children and Families (ACF) is 

requesting a three-year extension of the 

ACF–204 (Annual MOE Report). The 

report is used to collect descriptive 

program characteristics information on 

the programs operated by States and 

Territories in association with their 

Temporary Assistance for Needy 

Families (TANF) programs. All State 

and Territory expenditures claimed 

toward States and Territories MOE 

requirements must be appropriate, i.e., 

meet all applicable MOE requirements. 

The Annual MOE Report provides the 

ability to learn about and to monitor the 

nature of State and Territory 

expenditures used to meet States and 

Territories MOE requirements, and it is 

an important source of information 

about the different ways that States and 

Territories are using their resources to 

help families attain and maintain selfsufficiency. In addition, the report is 

used to obtain State and Territory 

program characteristics for ACFs annual 

report to Congress, and the report serves 

as a useful resource to use in 

Congressional hearings about how 

TANF programs are evolving, in 

assessing State the Territory MOE 

expenditures, and in assessing the need 

for legislative changes. 

Respondents: The 50 States of the 

United States, the District of Columbia, 

Guam, Puerto Rico, and the Virgin 

Islands. 

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