70786 Federal Register / Vol. 77, No. 228 / Tuesday, November 27, 2012 / Notices 

• Developing and implementing 

education and outreach programs for 

individuals enrolled in, or eligible for, 

Medicare, Medicaid and the Children’s 

Health Insurance Program (CHIP). 

• Enhancing the federal government’s 

effectiveness in informing Medicare, 

Medicaid and CHIP consumers, 

providers and stakeholders pursuant to 

education and outreach programs of 

issues regarding these and other health 

coverage programs, including the 

appropriate use of public-private 

partnerships to leverage the resources of 

the private sector in educating 

beneficiaries, providers and 

stakeholders. 

• Expanding outreach to vulnerable 

and underserved communities, 

including racial and ethnic minorities, 

in the context of Medicare, Medicaid 

and CHIP education programs. 

• Assembling and sharing an 

information base of ‘‘best practices’’ for 

helping consumers evaluate health plan 

options. 

• Building and leveraging existing 

community infrastructures for 

information, counseling and assistance. 

• Drawing the program link between 

outreach and education, promoting 

consumer understanding of health care 

coverage choices and facilitating 

consumer selection/enrollment, which 

in turn support the overarching goal of 

improved access to quality care, 

including prevention services, 

envisioned under health care reform. 

The current members of the Panel are: 

Samantha Artiga, Principal Policy 

Analyst, Kaiser Family Foundation; 

Joseph Baker, President, Medicare 

Rights Center; Philip Bergquist, 

Manager, Health Center Operations, 

CHIPRA Outreach & Enrollment Project 

and Director, Michigan Primary Care 

Association; Marjorie Cadogan, 

Executive Deputy Commissioner, 

Department of Social Services; Jonathan 

Dauphine, Senior Vice President, AARP; 

Barbara Ferrer, Executive Director, 

Boston Public Health Commission; 

Shelby Gonzales, Senior Health 

Outreach Associate, Center on Budget & 

Policy Priorities; Jan Henning, Benefits 

Counseling & Special Projects 

Coordinator, North Central Texas 

Council of Governments’ Area Agency 

on Aging; Warren Jones, Executive 

Director, Mississippi Institute for 

Improvement of Geographic Minority 

Health; Cathy Kaufmann, Administrator, 

Oregon Health Authority; Sandy 

Markwood, Chief Executive Officer, 

National Association of Area Agencies 

on Aging; Miriam Mobley-Smith, Dean, 

Chicago State University, College of 

Pharmacy; Ana Natale-Pereira, 

Associate Professor of Medicine, 

University of Medicine & Dentistry of 

New Jersey; Megan Padden, Vice 

President, Sentara Health Plans; David 

W. Roberts, Vice-President, Healthcare 

Information and Management System 

Society; Julie Bode ̈n Schmidt, Associate 

Vice President, National Association of 

Community Health Centers; Alan 

Spielman, President & Chief Executive 

Officer, URAC; Winston Wong, Medical 

Director, Community Benefit Director, 

Kaiser Permanente and Darlene YeeMelichar, Professor & Coordinator, San 

Francisco State University. 

The agenda for the December 18, 2012 

meeting will include the following: 

• Welcome and Listening Session 

with CMS Leadership. 

• Recap of the Previous (August 2, 

2012) Meeting. 

• Affordable Care Act Initiatives. 

• Quality Initiatives. 

• An Opportunity for Public 

Comment. 

• Meeting Summary, Review of 

Recommendations and Next Steps. 

Individuals or organizations that wish 

to make a 5-minute oral presentation on 

an agenda topic should submit a written 

copy of the oral presentation to the DFO 

at the address listed in the ADDRESSES

section of this notice by the date listed 

in the DATES section of this notice. The 

number of oral presentations may be 

limited by the time available. 

Individuals not wishing to make a 

presentation may submit written 

comments to the DFO at the address 

listed in the ADDRESSES section of this 

notice by the date listed in the DATES

section of this notice. 

Authority: Sec. 222 of the Public Health 

Service Act (42 U.S.C. 217a) and sec. 10(a) 

of Pub. L. 92–463 (5 U.S.C. App. 2, sec. 10(a) 

and 41 CFR 102–3). 

(Catalog of Federal Domestic Assistance 

Program No. 93.733, Medicare—Hospital 

Insurance Program; and Program No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program) 

Dated: November 20, 2012. 

Marilyn Tavenner, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

[FR Doc. 2012–28647 Filed 11–26–12; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–9962–NC] 

Request for Information Regarding 

Health Care Quality for Exchanges 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Request for Information. 

SUMMARY: This notice is a request for 

information to seek public comments 

regarding health plan quality 

management in Affordable Insurance 

Exchanges. 

DATES: To be assured consideration, 

comments must be received at one of 

the addresses provided below, no later 

than 5 p.m. on December 27, 2012. 

ADDRESSES: In commenting, refer to file 

code CMS–9962–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–9962– 

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 to the 

following address ONLY: 

Centers for Medicare & Medicaid 

Services, Department of Health and 

Human Services, Attention: CMS–9962– 

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 


wreier-aviles on DSK5TPTVN1PROD with 
Federal Register / Vol. 77, No. 228 / Tuesday, November 27, 2012 / Notices 70787 

1See Report to Congress: National Strategy for 

Quality Improvement in Health Care available at 

http://www.healthcare.gov/law/resources/reports/ 

quality03212011a.html. 

2See ‘‘General Guidance on Federally-facilitated 

Exchanges,’’ available at http://cciio.cms.gov/

resources/files/FFE_Guidance_FINAL_VERSION

_051612.pdf. 

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 information on viewing public 

comments, see the beginning of the 

‘‘SUPPLEMENTARY INFORMATION’’ section. 

FOR FURTHER INFORMATION CONTACT: 

Rebecca Zimmermann, (301) 492–4396. 

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 

Last year, the Department of Health 

and Human Services (HHS) adopted the 

National Strategy for Quality 

Improvement in Health Care (National 

Quality Strategy) to create national aims 

and priorities that would guide local, 

state, and national efforts to improve the 

quality of health care in the United 

States. The priorities of the National 

Quality Strategy include making care 

safer; ensuring person- and familycentered care; promoting effective 

communication and coordination of 

care; promoting the most effective 

prevention and treatment for the leading 

causes of mortality, starting with 

cardiovascular disease; working with 

communities to promote wide use of 

best practices to enable healthy living; 

and making quality care more 

affordable.1 As discussed in the 

National Quality Strategy, ‘‘[t]he 

Affordable Care Act seeks to increase 

access to high-quality, affordable health 

care for all Americans.’’ To that end, the 

Affordable Care Act contains several 

provisions that help to foster and 

support health care quality 

improvement across the insurance 

marketplace, including section 2717 of 

the Public Health Service Act (PHS Act). 

The Affordable Care Act places 

additional quality-related requirements 

on health insurance issuers offering 

qualified health plans (QHPs) in the 

new Exchange marketplace, including 

section 1311 which directs QHP issuers 

to implement quality improvement 

strategies, enhance patient safety 

through specific contracting 

requirements, and publicly report 

quality data. The Affordable Care Act 

also directs the Secretary of HHS to 

develop and administer a quality rating 

system and an enrollee satisfaction 

survey system, the results of which will 

be available to Exchange consumers 

shopping for insurance plans. In 

addition, section 10329 of the 

Affordable Care Act, which relates to 

plans both inside and outside the 

Exchange, directs the Secretary, in 

consultation with relevant stakeholders, 

to develop a methodology for 

calculating the value of a health plan. 

HHS’s strategy for establishing quality 

reporting requirements to ensure that 

quality health care is delivered through 

the Exchange marketplace includes the 

consideration of existing relevant 

quality measure sets and quality 

improvement initiatives in conjunction 

with other factors, such as 

characteristics of the Exchange 

population. States, employers, health 

insurance issuers, and other 

stakeholders, in addition to the Centers 

for Medicare and Medicaid Services 

(CMS) and other HHS agencies, are 

currently engaged in health plan quality 

reporting and improvement initiatives. 

As indicated in the National Quality 

Strategy, HHS is interested in promoting 

effective quality measurement while 

minimizing the burden of data 

collection by aligning measures across 

programs. These efforts would also ease 

comparability across plans, providers, 

and insurance markets, and promote 

delivery of high-quality and high-value 

health care. 

As set forth in the May 2012 General 

Guidance on Federally-facilitated 

Exchanges, HHS intends to propose a 

phased approach to quality reporting 

and display standards for all Exchanges 

and QHP issuers. No new quality 

reporting standards would be in place 

until 2016 (other than those related to 

accreditation, if applicable), which 

allows time to develop standards 

appropriately matched to the Exchange 

enrollee population and plan offerings. 

Until final regulations are issued, statebased Exchanges would have the choice 

of adopting a similar approach or 

implementing their own quality 

reporting standards immediately and 

over time.2

In preparation for the implementation 

of the quality provisions affecting QHPs 

in the new Exchange marketplace under 

the Affordable Care Act, HHS is 

requesting information through this 

notice from stakeholders regarding 

existing quality measures and rating 

systems, strategies and requirements for 

quality improvement, purchasing 

strategies to promote care redesign and 

patient safety, as well as effective 

methodologies to measure health plan 

value. This notice also offers the 

opportunity to provide 

recommendations on the most effective 

ways to enhance and align the quality 

reporting and display requirements for 

QHPs starting in 2016 in conjunction 

with existing quality improvement 

initiatives, such as the National Quality 

Strategy. We note that this notice should 

not be viewed as final policy that will 

be adopted pursuant to rulemaking. 

II. Solicitation of Comments 

CMS is requesting information 

regarding the following: 

Understanding the Current Landscape 

1. What quality improvement 

strategies do health insurance issuers 

currently use to drive health care 

quality improvement in the following 

categories: (1) Improving health 

outcomes; (2) preventing hospital 

readmissions; (3) improving patient 

safety and reducing medical errors; (4) 

implementing wellness and health 

promotion activities; and (5) reducing 

health disparities? 

2. What challenges exist with quality 

improvement strategy metrics and 


wreier-aviles on DSK5TPTVN1PROD with 
70788 Federal Register / Vol. 77, No. 228 / Tuesday, November 27, 2012 / Notices 

3For more information on Medicare Advantage 

rating system domains see http://www.cms.gov/ 

Medicare/Health-Plans/HealthPlansGenInfo/ 

Downloads/2013-Call-Letter.pdf; http:// 

www.cms.gov/Medicare/Prescription-DrugCoverage/PrescriptionDrugCovGenIn/ 

PerformanceData.html. 

tracking quality improvement over time 

(for example, measure selection criteria, 

data collection and reporting 

requirements)? What strategies 

(including those related to health 

information technology) could mitigate 

these challenges? 

3. Describe current public reporting or 

transparency efforts that states and 

private entities use to display health 

care quality information. 

4. How do health insurance issuers 

currently monitor the performance of 

hospitals and other providers with 

which they have relationships? Do 

health insurance issuers monitor patient 

safety statistics, such as hospital 

acquired conditions and mortality 

outcomes, and if so, how? Do health 

insurance issuers monitor care 

coordination activities, such as hospital 

discharge planning activities, and 

outcomes of care coordination activities, 

and if so, how? 

Applicability to the Health Insurance 

Exchange Marketplace 

5. What opportunities exist to further 

the goals of the National Quality 

Strategy through quality reporting 

requirements in the Exchange 

marketplace? 

6. What quality measures or measure 

sets currently required or recognized by 

states, accrediting entities, or CMS are 

most relevant to the Exchange 

marketplace? 

7. Are there any gaps in current 

clinical measure sets that may create 

challenges for capturing experience in 

the Exchange? 

8. What are some issues to consider in 

establishing requirements for an issuer’s 

quality improvement strategy? How 

might an Exchange evaluate the 

effectiveness of quality improvement 

strategies across plans and issuers? 

What is the value in narrative reports to 

assess quality improvement strategies? 

9. What methods should be used to 

capture and display quality 

improvement activities? Which publicly 

and privately funded activities to 

promote data collection and 

transparency could be leveraged (for 

example, Meaningful Use Incentive 

Program) to inform these methods? 

10. What are the priority areas for the 

quality rating in the Exchange 

marketplace? (for example, delivery of 

specific preventive services, health plan 

performance and customer service)? 

Should these be similar to or different 

from the Medicare Advantage five-star 

quality rating system (for example, 

staying healthy: screenings, tests and 

vaccines; managing chronic (long-term) 

conditions; ratings of health plan 

responsiveness and care; health plan 

members’ complaints and appeals; and 

health plan telephone customer 

service)? 3

11. What are effective ways to display 

quality ratings that would be 

meaningful for Exchange consumers and 

small employers, especially drawing on 

lessons learned from public reporting 

and transparency efforts that states and 

private entities use to display health 

care quality information? 

12. What types of methodological 

challenges may exist with public 

reporting of quality data in an 

Exchange? What suggested strategies 

would facilitate addressing these issues? 

13. Describe any strategies that states 

are considering to align quality 

reporting requirements inside and 

outside the Exchange marketplace, such 

as creating a quality rating for 

commercial plans offered in the nonExchange individual market. 

14. Are there methods or strategies 

that should be used to track the quality, 

impact and performance of services for 

those with accessibility and 

communication barriers, such as 

persons with disabilities or limited 

English proficiency? 

15. What factors should HHS consider 

in designing an approach to calculate 

health plan value that would be 

meaningful to consumers? What are 

potential benefits and limitations of 

these factors? How should Exchanges 

align their programs with value-based 

purchasing and other new payment 

models (for example, Accountable Care 

Organizations) being implemented by 

payers? 

Dated: November 6, 2012. 

Marilyn Tavenner, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

Approved: November 16, 2012. 

Kathleen Sebelius, 

Secretary. 

[FR Doc. 2012–28473 Filed 11–23–12; 11:15 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Health Resources and Services 

Administration 

National Advisory Council on Migrant 

Health; Cancellation of Meeting 

Name: National Advisory Council on 

Migrant Health. 

Dates and Times: December 4, 2012, 

8:30 a.m. to 5:00 p.m. December 5, 2012, 

8:00 a.m. to 12:00 p.m. 

STATUS: The meeting of the National 

Advisory Council on Migrant Health, 

scheduled for December 4 and 5, 2012, 

is cancelled. This cancellation applies 

to all sessions of the meeting. The 

meeting was announced in the Federal 

Register of November 8, 2012 (77 FR 

67014). 

FOR FURTHER INFORMATION CONTACT: 

Gladys Cate, Office of Special 

Population Health, Bureau of Primary 

Health Care, Health Resources and 

Services Administration, 5600 Fishers 

Lane, Room 15–74, Rockville, Maryland 

20857; telephone (301) 594–0367. 

Dated: November 20, 2012. 

Bahar Niakan, 

Director, Division of Policy and Information 

Coordination. 

[FR Doc. 2012–28699 Filed 11–26–12; 8:45 am] 

BILLING CODE 4165–15–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

National Institutes of Health 

Government-Owned Inventions; 

Availability for Licensing 

AGENCY: National Institutes of Health, 

Public Health Service, HHS. 

ACTION: Notice. 

SUMMARY: The inventions listed below 

are owned by an agency of the U.S. 

Government and are available for 

licensing in the U.S. in accordance with 

35 U.S.C. 207 to achieve expeditious 

commercialization of results of 

federally-funded research and 

development. Foreign patent 

applications are filed on selected 

inventions to extend market coverage 

for companies and may also be available 

for licensing. 

FOR FURTHER INFORMATION CONTACT: 

Licensing information and copies of the 

U.S. patent applications listed below 

may be obtained by writing to the 

indicated licensing contact at the Office 

of Technology Transfer, National 

Institutes of Health, 6011 Executive 

Boulevard, Suite 325, Rockville, 


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