74960 Federal Register / Vol. 89, No. 178 / Friday, September 13, 2024 / Notices 

would be inequitable or harmful to 

competition’’). 87 In the matter of Nestle ́ Holdings, Inc., et 

al., C–4082, 2005 WL 1786402, at *3 (F.T.C. 

July 15, 2005). 88 In the matter of the Readers’ Digest 

Ass’n. No. C–2075, 102 F.T.C. 1268, 1971 WL 

128725, at *2 (Sept. 30, 1983). 89Statement of Motives, P. de la C. 2440 

(‘‘Act 228’’) (as translated) at 2. 90See Ximena Benavides, Disparate Health 

Care In Puerto Rico: A Battle Beyond 

Statehood, 23 Univ. of Penn. J. of Law and 

Social Change 163, 175 (2020). 91 Id. 92 Id. 93 Id. 94NCPA, Local Pharmacies on the Brink, 

New Survey Reveals, https://ncpa.org/ 

newsroom/newsreleases/2024/02/27/localpharmacies-brink-new-survey-reveals (Feb. 

27, 2024). 95NCPA, NCPA Report for February 2024 

Survey of Independent Pharmacy Owners/ 

Managers, https://ncpa.org/sites/default/ 

files/2024-02/Feb2024- 

DIRsurvey.Exec%20Summary.pdf (Feb. 

2024). 96NCPA, Local Pharmacies on the Brink, 

New Survey Reveals, at 1 https://ncpa.org/ 

newsroom/newsreleases/2024/02/27/localpharmacies-brink-new-survey-reveals (Feb. 

27, 2024). 97 Id. 98 Id. 99Oct. 24, 2016 Letter to Sen. Orrin Hatch 

and Jose B. Carrio ́n III, https://

www.finance.senate.gov/imo/media/doc/ 

Puerto%20Rico%20Community

%20Pharmacies%20Association%20 

(Late%20-%20Submission%201).pdf (Oct. 

24, 2016). 100 Id. at 2. 101 Id. 102RURAL HEALTH RESEARCH 

GATEWAY, Research Alert: Sept. 1, 2022, 

https://www.ruralhealthresearch.org/alerts/ 

504#:∼:text=Between%202003%20

and%202021%2C%20the,percent%20

during%20the%20same%20period (last 

accessed June 19, 2024). 103RUPRI CENTER FOR RURAL HEALTH 

POLICY ANALYSIS, Update on Rural 

Independently Owned Pharmacy Closures in 

the United States, 2003–2021, https://rupri.

publichealth.uiowa.edu/publications/ 

policybriefs/2022/Independent%20Pharmacy

%20Closures.pdf (last accessed June 19, 

2024). 104See notes 78 and 79, supra. See also 

‘‘Letter to Pharmacy Benefit Managers, 

Medicare Part D Plans, Medicaid Managed 

Care Plans, and Private Insurance Plans,’’ 

https://www.cms.gov/newsroom/fact-sheets/ 

cms-letter-plansand-pharmacy-benefitmanagers (Dec. 13, 2023); see also, Sens. 

Wyden, Crapo Call for Swift Passage of 

Bipartisan PBM Reforms, https://

www.finance.senate.gov/chairmans-news/ 

wyden-crapo-call-for-swift-passageofbipartisan-pbm-reforms (Mar. 14, 2024). 105 In Re Toys ‘R Us, Petition to Modify 

Order, FTC File No. 131–0052, Docket C– 

4405, at 4, located at https://www.ftc.gov/ 

sites/default/files/documents/cases/ 

140109toysruspetition.pdf (Jan. 3, 2014). 

106 In Re Toys ‘R Us, Modified Order, FTC 

File No. 131–0052, Docket C–4405, at 4, 

located at https://www.ftc.gov/system/files/ 

documents/cases/140415toysrusorder.pdf 

(Apr. 11, 2014). 107 Id. at 4. 108See In the Matter of Occidental 

Petroleum Corp., 101 F.T.C. 373, 1974 WL 

175259, at *1. 109 In the Matter of Pendleton Woolen 

Mills, Inc., 122 F.T.C. 267, 270, FTC Docket 

No. C–2985 (1996). 110 In the Matter of Onkyo U.S.A. Corp., 

122 F.T.C. 325, 326. FTC Docket No. C–3092 

(1996). 111 In the Matter of Nat’l Fire Hose Corp., 

No. C–2935, 1978 WL 206076, at *10 (F.T.C. 

Nov. 1, 1978). 112See n. 8, supra. 113See Analysis of Agreement Containing 

Consent Order To Aid Public Comment to In 

the Matter of Coopharma, File No. 101–0079 

at 4 (August 21, 2012). It should also be 

noted that the Commission has recognized 

the enactment of and applicable of Act 228 

‘‘when negotiating with any Payor in 

compliance with Act 228.’’ See In the Matter 

of Cooperativa de Me ́dicos Oftalmo ́logos de 

Puerto Rico, No. C–4603 at 4 (Decision and 

Order, Mar. 3, 2017). Moreover, Act 228 

covers all of the conduct which is addressed 

in the Order, and, in fact goes further than 

the Order in prohibiting specific conduct. By 

way of specific example, 26 P.R. Laws § 3107 

explicitly states that any ‘‘threats to boycott, 

go on strike or other coordinated action by 

the providers shall be subject to oversight by 

the Antitrust Affairs Office of the Department 

of Justice, in order to determine whether the 

same is in violation of the provisions of this 

chapter or the Antitrust Act.’’ The section 

further authorizes the imposition of civil 

and/or criminal liability on any Health Care 

Cooperative engaged in such conduct. 

[FR Doc. 2024–20811 Filed 9–12–24; 8:45 am] 

BILLING CODE 6750–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Disease Control and 

Prevention 

[Docket No. CDC–2024–0065, NIOSH–352– 

A] 

Request for Public Comment on the 

Draft Hazard Review: Wildland Fire 

Smoke Exposure Among Farmworkers 

and Other Outdoor Workers 

AGENCY: Centers for Disease Control and 

Prevention (CDC), Department of Health 

and Human Services (HHS). 

ACTION: Request for comment. 

SUMMARY: The National Institute for 

Occupational Safety and Health 

(NIOSH) in the Centers for Disease 

Control and Prevention (CDC), an 

Operating Division of the Department of 

Health and Human Services (HHS), 

requests public comment and technical 

review on the draft Hazard Review: 

Wildland Fire Smoke Exposure Among 

Farmworkers and Other Outdoor 

Workers. 

DATES: Electronic or written comments 

must be received by November 12, 2024. 

ADDRESSES: You may submit comments, 

identified by docket number CDC– 

2024–0065 and docket number NIOSH– 

352–A, by either of the following 

methods: 

• Federal eRulemaking Portal: 

https://www.regulations.gov. Follow the 

instructions for submitting comments. 

• Mail: National Institute for 

Occupational Safety and Health, NIOSH 

Docket Office, 1090 Tusculum Avenue, 

MS C–34, Cincinnati, Ohio 45226–1998. 

Instructions: All information received 

in response to this notice must include 

the agency name and docket number 

(CDC–2024–0065; NIOSH–352–A). All 

relevant comments, including any 

personal information provided, will be 

posted without change to https://

www.regulations.gov. Do not submit 

comments by email. CDC does not 

accept comments by email. For access to 

the docket to read the draft Hazard 

Review document or comments 

received, go to https://

www.regulations.gov. 

FOR FURTHER INFORMATION CONTACT: R. 

Todd Niemeier, Ph.D., National Institute 

for Occupational Safety and Health, 

MS–C15, 1090 Tusculum Avenue, 

Cincinnati, OH 45226. Telephone: (513) 

533–8166. 

SUPPLEMENTARY INFORMATION: NIOSH is 

requesting public comment and 

technical review of the draft Hazard 

Review: Wildland Fire Smoke Exposure 

Among Farmworkers and Other Outdoor 

Workers, which is accessible in the 

docket (CDC–2024–0065; NIOSH–352– 

A). The final document will be edited, 

so comments that focus on the technical 

content are requested. The final 

document will be used as the scientific 

evidence base to inform the 

development of supplementary 

educational materials for workers, 

employers, and other relevant audiences 

to support the implementation of the 

recommendations. Therefore, comments 

that focus on the understandability, 

accessibility, and feasibility of the 

recommendations are requested. To 

facilitate the review of this document, 

NIOSH requests that responses to the 

following specific questions be 

considered: 

1. How could the outdoor worker 

populations who may be exposed to 

wildland fire smoke be more completely 

characterized in Chapter 2? Please 

provide supporting references. 


khammond on DSKJM1Z7X2PROD with NOTICES
Federal Register / Vol. 89, No. 178 / Friday, September 13, 2024 / Notices 74961 

2. How could this document better 

identify and characterize the health 

hazards of exposures to wildland fire 

smoke based on the available scientific 

literature in Chapter 3? Is there 

additional scientific information to be 

considered regarding the adverse health 

endpoints associated with exposure to 

wildland fire smoke? Please provide 

scientific references to support your 

response as necessary. 

3. What additional information 

should NIOSH consider adding or how 

should NIOSH modify the discussion of 

exposure assessment methods for 

wildland fire smoke (based on PM2.5

airborne concentration, and when 

desired, other airborne exposures) to 

measure outdoor worker exposures in 

Chapter 4? What are the barriers to 

employers to implement these 

recommended methods? Please provide 

scientific evidence to support your 

response as necessary. 

4. How can the recommendation in 

Chapter 4 to use the air quality index 

(AQI) for PM2.5 to define exposure 

control categories be better explained 

and supported from both a scientific 

and health communications standpoint? 

Please provide scientific evidence to 

support your response as necessary. 

5. What additional information 

should NIOSH consider to improve the 

strategies identified in Chapter 5 for 

controlling exposure to wildland fire 

smoke (e.g., engineering controls, work 

practices, personal protective 

equipment) to make them more effective 

and reduce barriers to implementation? 

What additional controls could be 

considered to protect outdoor workers 

from wildland fire smoke? Please 

provide scientific evidence to support 

your response as necessary. 

6. Do the recommendations in 

Chapter 5 adequately address the 

protection of potentially disadvantaged 

or at-risk outdoor workers, such as 

persons with pre-existing health 

conditions (e.g., asthma, cardiovascular 

disease), migrant workers, persons of 

lower socioeconomic status, and elderly 

or minor workers? If not, how could the 

recommendations be changed to better 

protect these populations? Are there 

additional recommendations to consider 

to protect these at-risk workers? 

7. How could the recommendations in 

Chapter 5 better address accessibility 

and feasibility for outdoor workers and 

employers? 

8. What are the potential barriers to 

the understandability of the 

recommendations in Chapter 5 for 

outdoor workers and employers? When 

developing supplementary educational 

materials to support the implementation 

of these recommendations, how can 

NIOSH best address those barriers? 

9. What other research needs should 

be considered in addition to those 

included in Chapter 6, Research Needs? 

Please provide a scientific justification 

for additional research needs. 

The draft Hazard Review was 

developed to provide the scientific 

rationale for characterizing hazards of 

exposure to wildland fire smoke for 

outdoor workers. The draft Hazard 

Review also provides recommendations 

and guidance for minimizing exposures 

and potential health effects associated 

with wildland fire smoke for outdoor 

workers. 

After the comments received on the 

draft Hazard Review are considered and 

addressed, the final Hazard Review will 

be posted on the NIOSH website. 

Background: The purpose of the 

Hazard Review document is to provide 

an overview of the relevant health 

effects literature and present evidencebased recommendations to protect 

outdoor workers, including farm 

workers, construction workers, oil and 

gas workers, park rangers, emergency 

responders, and others from the adverse 

health effects of occupational exposure 

to wildland fire smoke. On March 14, 

2024, CDC/NIOSH published a Request 

for Information (RFI) in the Federal 

Register (89 FR 18638). The Federal 

Register notice announced plans to 

develop a Hazard Review document that 

summarizes the scientific literature 

about the health effects from exposures 

to wildland fire smoke and provides 

recommendations to protect outdoor 

workers [NIOSH 2024]. In response to 

the RFI, NIOSH received 10 comment 

submissions, all of which were 

reviewed and considered during the 

development of this draft Hazard 

Review. The RFI and comments 

received are accessible in the docket 

(CDC–2024–0019, NIOSH–352). In 

addition to requesting information from 

the public, the Hazard Review 

development process involved review 

and assessment of the scientific 

literature about exposures to wildland 

fire smoke, potential health effects, 

outdoor worker populations at risk, and 

development or update of 

recommendations to protect outdoor 

workers. The information presented in 

this draft Hazard Review represents the 

scientific rationale and the current 

methodology about approaches to assess 

and control the hazards of wildland fire 

smoke to outdoor workers. Scientific 

information related to wildland fire 

smoke presented in the draft Hazard 

Review covers the following topics: 

• Background on wildland fire smoke 

• History of NIOSH and other 

government organizations’ related 

activity 

• Chemical and physical properties of 

the smoke 

• Population of outdoor workers with 

potential exposure 

• Routes of worker exposure 

• Health equity 

• Health effects of exposure 

• Exposure assessment 

• Controlling workplace exposures 

• Medical surveillance and medical 

monitoring 

• Research needs 

Reference 

NIOSH [2024]. National Institute for 

Occupational Safety and Health; Outdoor 

workers exposed to wildland fire smoke; 

Request for information. 89 FR 18638. 

https://www.federalregister.gov/ 

documents/2024/03/14/2024-05403/ 

national-institute-for-occupationalsafety-and-health-outdoor-workersexposed-to-wildland-fire-smoke. 

Dated: September 9, 2024. 

John J. Howard, 

Director, National Institute for Occupational 

Safety and Health, Centers for Disease Control 

and Prevention, Department of Health and 

Human Services. 

[FR Doc. 2024–20763 Filed 9–12–24; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Disease Control and 

Prevention 

Notice of Award of a Sole Source 

Cooperative Agreement To Fund 

Northwestern Provincial Health Office 

in Zambia 

AGENCY: Centers for Disease Control and 

Prevention (CDC), Department of Health 

and Human Services (HHS). 

ACTION: Notice. 

SUMMARY: The Centers for Disease 

Control and Prevention (CDC), located 

within the Department of Health and 

Human Services (HHS), announces the 

award of approximately $4,450,000, for 

Year 1 funding to Northwestern 

Provincial Health Office (NWPHO) in 

Zambia. The award will provide 

NWPHO with CDC Technical Assistance 

and financial support to maintain and 

sustain the province’s overall oversight 

and quality assurance for the 

implementation of high-impact HIV 

combination prevention, treatment, and 

support services, including clinical, 

surveillance, and laboratory services as 

well as to identify and mitigate 

emerging disease threats for people 


khammond on DSKJM1Z7X2PROD with NOTICES