78440 Federal Register / Vol. 79, No. 249 / Tuesday, December 30, 2014 / Notices 

QIO’s performance might lead to the 

erroneous perception by the public that 

reviews or appeals may be biased either 

toward the beneficiary (when obtaining 

beneficiary feedback), or toward 

providers (when obtaining provider 

feedback). One commenter encouraged 

CMS to carefully consider public 

perception of the evaluation criterion of 

beneficiary experience with the quality 

of care complaints and appeal reviews. 

The other commenter suggested 

removing customer feedback from the 

evaluation criteria. 

Response: We appreciate the concern 

with maintaining the integrity of public 

perception of our oversight of the 

performance of numerous statutory and 

regulatory review functions to safeguard 

beneficiaries. The evaluation criteria 

and standards include safeguards to 

monitor the quality of the reviews, such 

as inter-rater reliability, the QIOs’ 

timeliness in completing the reviews 

and ongoing monitoring of the BFCC– 

QIO’s internal quality control program. 

The beneficiary satisfaction survey 

allows CMS to monitor the QIOs’ ability 

to provide superior customer service 

while incorporating processes that 

engage beneficiaries and their 

representatives in ways that are patient 

and family centered. With appropriate 

monitoring and safeguards, we benefit 

from consideration of beneficiaries’ 

experience with the review and appeals 

process while maintaining consistently 

high levels of program integrity. 

Comment: One commenter agreed 

with the importance of instituting 

rigorous standards for inter-rater 

reliability and suggested that CMS 

consider developing evaluation 

standards that assess the accuracy as 

well as reliability of reviews. 

Response: We agree with the 

importance of reliable and accurate 

reviews relating to the execution of the 

numerous statutory and regulatory 

review functions to safeguard 

beneficiaries. The evaluation criteria 

includes annual (and at the 54th month) 

assessment of minimum performance 

criteria for inter-rater reliability. 

Additionally, we will monitor the 

quality program in place at each BFCC– 

QIO to ensure that the work is both 

reliable and accurate. We agree on the 

merits of developing more formal 

evaluation standards and criteria for 

assessing the validity of work by BFCC– 

QIO reviewers. We intend to investigate 

suitable measures for consideration in 

the future. 

Comment: Both commenters noted the 

potential for external factors and 

perhaps the outcome of the review or 

appeal itself to influence the 

beneficiaries’ experience and their 

willingness to participate in the survey 

process. One commenter stated that 

there should be careful consideration of 

these factors in the evaluation standards 

and criteria; the other commenter 

recommended not using beneficiary 

participation in the survey as part of the 

evaluation. 

Response: We believe that the BFCC– 

QIOs must exercise diplomacy, 

professionalism and compassion in their 

performance of numerous statutory and 

regulatory review functions to safeguard 

beneficiaries. Our monitoring of the 

internal quality control processes of the 

BFCC–QIOs and ongoing monitoring 

activities focuses in part on the 

professionalism in their interactions 

with beneficiaries and their 

representatives. We recognize that 

external factors may, to some limited 

extent, have an impact on the 

beneficiaries’ willingness to participate 

in the survey of their experience with 

the appeal or review process. However, 

based on previous experience with these 

surveys, we are confident that the 

proficiency of the work by the BFCC– 

QIO with beneficiaries or their 

representatives will be the dominant 

factor that impacts the willingness by 

beneficiaries or their representatives to 

participate in the survey. 

Comment: Both commenters indicated 

that although the BFCC–QIO is 

primarily responsible for its 

performance on the evaluation 

standards and criteria, external factors 

outside the control of the BFCC–QIO 

may also impact performance on 

measures such as timeliness (of 

Beneficiary Complaints and Other 

Quality of Care Reviews, Discharge/

Service Termination Reviews, and 

EMTALA and Higher-Weighted 

Diagnosis Related Group Reviews). Both 

commenters suggested that we consider, 

if appropriate, factors outside the 

control of the contractors. 

Response: We agree with the 

commenters that there are certain 

factors, such as natural calamities, for 

example, hurricanes or earthquakes, in 

addition to transitional issues at the 

beginning and end of the contract cycle 

that may, despite the best mitigating 

efforts, have an impact on the BFCC– 

QIO’s ability to conduct work in specific 

regions. We are confident that these 

extraordinary circumstances can be 

addressed using our intervention and 

evaluation standards and criteria. 

Comment: One commenter noted the 

importance of the BFCC–QIO’s Internal 

Quality Control (IQC) Program but 

recommended that we consider only 

whether the BFCC–QIO had a process in 

place and not the quality and 

competence of the execution of the IQC. 

Response: We agree with the 

importance of the BFCC–QIO instituting 

an IQC Program. However, we believe 

that it is in the Government’s and 

beneficiaries’ best interest to conduct 

ongoing monitoring to ensure that the 

IQC is kept current and accurately 

reflects the competent execution of the 

BFCC–QIO’s performance of numerous 

statutory and regulatory review 

functions to safeguard beneficiaries. We 

plan to use ongoing monitoring of the 

IQC as a critical element to inform 

discussions with the BFCC–QIO on their 

improvement efforts. 

IV. Provisions of the Final Notice 

We have analyzed these comments 

and determined that it is appropriate to 

finalize without modification the 

provisions set forth in the July 28, 2014 

notice with comment period entitled, 

‘‘Evaluation Criteria and Standards for 

Beneficiary and Family Centered Care 

Quality Improvement Organization 

Contracts.’’ (79 FR 43747 through 

43749). 

V. Collection of Information 

Requirements 

This document does not impose 

information collection requirements, 

that is, reporting, recordkeeping or 

third-party disclosure requirements. 

Consequently, there is no need for 

review by the Office of Management and 

Budget under the authority of the 

Paperwork Reduction Act of 1995. 

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: November 19, 2014. 

Marilyn Tavenner, 

Administrator, Centers for Medicare & 

Medicaid Services. 

[FR Doc. 2014–30448 Filed 12–29–14; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–3300–FN] 

RIN 0938–ZB15 

Medicare Program; Evaluation Criteria 

and Standards for Quality 

Improvement Networks Quality 

Improvement Program Contracts; Base 

and Task Orders 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

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Federal Register / Vol. 79, No. 249 / Tuesday, December 30, 2014 / Notices 78441 

ACTION: Final notice. 

SUMMARY: This final notice announces 

the general criteria we will use to 

evaluate the effectiveness and efficiency 

of Quality Innovation Network (QIN) 

Quality Improvement Organizations 

(QIOs) that entered into contracts with 

CMS under the 11th Statement of Work 

(SOW) in July 2014. (The activities for 

the QIN–QIO SOW began August 1, 

2014). In addition, this notice addresses 

public comments on the August 11, 

2014 notice with comment period 

entitled, ‘‘Evaluation Criteria and 

Standards for Quality Improvement 

Networks Quality Improvement Program 

Contracts [Base and Task Order(s)]’’ 

DATES: Effective Dates: August 1, 2014 

to July 31, 2019. 

FOR FURTHER INFORMATION CONTACT: 

Alfreda Staton, (410) 786–4194. 

SUPPLEMENTARY INFORMATION: 

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. 

II. Provisions of the Notice With 

Comment Period 

On August 11, 2014, we published a 

notice with comment period in the 

Federal Register (79 FR 46830 through 

46835) entitled, ‘‘Evaluation Criteria 

and Standards for Quality Improvement 

Networks Quality Improvement Program 

Contracts [Base and Task Order(s)]’’ to 

announce the general criteria that we 

would use to evaluate performance of 

the Quality Innovation Network (QIN)— 

QIOs under the QIN–QIO 11th 

Statement of Work (SOW) contract 

beginning August 1, 2014. (Solicitation 

Number: HHSM–500–2014–RFP–QIN– 

QIO). That notice summarized the tasks 

of the QIN–QIOs and the criteria to be 

used for annual performance 

evaluations during the 5-year term of 

the contract. 

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 

Section C.5 of the QIN–QIO Base 

Contract and Attachment J–1(b) of the 

QIN–QIO Task Order. The general 

criteria that will be used to evaluate the 

QIN–QIOs under the QIN–QIO 11th 

SOW contract beginning August 1, 2014, 

include performance of the following 

Tasks: 

• 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 ValueBased Payment, Quality Reporting, and 

the Physician Feedback Reporting 

Program. 

• Quality Improvement Initiatives. 

The Table at Attachment J.1(b) of the 

SOW lists performance measures by the 

following Tasks: 

• B.1. Improving Cardiac Health 

• B.2. Everyone with Diabetes Counts 

• B.3. (Reserved) 

• B.4. Meaningful Use of HIT and 

Collaborating With RECs 

• C.1. Reducing Healthcare-Acquired 

Infections (HAIs) in Hospitals 

• C.2. Reducing Healthcare-Acquired 

Conditions in Nursing Homes 

• C.3. Coordination of Care 

• D.1. Quality Improvement through 

Physician Value-Based Modifiers 

• E.1. Technical Assistance—Quality 

Improvement Initiatives (QIIs) 

Evaluation Criteria. Annual (12, 24, 

36, 48th month) and 54th month 

Evaluation Criteria are defined in 

Attachment J–1(b) of the QIN–QIO 

SOW. 

Additional details provided in the 

notice are posted at: http://

www.gpo.gov/fdsys/pkg/FR-2014-08-11/

pdf/2014-18901.pdf. 

III. Analysis of and Responses to Public 

Comments on the Notice With Comment 

Period 

A commenter affiliated with a private 

healthcare quality improvement entity 

submitted several comments concerning 

the general criteria we would use to 

evaluate the effectiveness and efficiency 

of QIN–QIOs that entered into contracts 

with CMS under the 11th SOW. 

A summary of the comments and our 

responses are as follows: 

Comment: The commenter expressed 

appreciation for the opportunity to 

submit comments on the general 

evaluation criteria and standards and 

noted the importance of the three-part 

aim in the QIN–QIO SOW of better 

health, better healthcare, and lower 

costs through improved quality for 

Medicare enrollees. The commenter 

suggested that CMS continue its efforts 

to assess the effectiveness of the QIN– 

QIOs using measures of: improved 

patient quality and safety, improved 

population health, reduction of 

avoidable costs, engagement of patients, 

families and consumers in care and 

population health improvement and 

improved coordination of care and 

integrative services. 

Response: We agree with the 

commenter that the QIN–QIO contract 

and the general evaluation criteria and 

standards focus on strategic initiatives 

including the three part aim and the 

projects identified in the QIN–QIO Task 

Order support our goals of the three 

broad aims of better healthcare, better 

health, and lower healthcare costs 

through improvement for all Medicare 

beneficiaries. Measures for better 

healthcare include those for the Aim, 

Better Healthcare for Communities: 

Beneficiary-Centered, Reliable, 

Accessible, and Safe Care and includes 

measures for Tasks C.1 Reducing 

Healthcare-Associated Infections in 

Hospitals,C.2, Reducing HealthcareAcquired Conditions in Nursing Homes, 

and C.3, Promote Effective 

Communication and Coordination of 

Care. Measures for the better health 

include those for the Aim, Healthy 

People, Healthy Communities: 

Improving the Health Status of 

Communities and include Tasks B.1, 

Improving Cardiac Health and Reducing 

Cardiac Healthcare Disparities, B.2, 

Reducing Disparities in Diabetes Care: 

Everyone with Diabetes Counts, and B.4, 

Improving Prevention Coordination 

through Meaningful Use of HIT and 

Collaborating with Regional Extension 

Centers. Measures for lower healthcare 

costs include Aim D, Better Care at 

Lower Cost and Task D.1, Quality 

Improvement through Value-Based 

Payment, Quality Reporting, and the 

Physician Feedback Reporting Program. 

These efforts will likely have a 

secondary effect of aiding in the 

transformation of the healthcare system. 

Comment: The commenter stated that 

CMS should provide QIN–QIOs with 

timely communication after award of 

the contract regarding operational and 

implementation issues that may arise 

over the 5-year period of performance. 

Response: We agree with the need for 

timely, systematic documentation of 

questions and answers to each QIN–QIO 

regarding all aspects of the SOW, 

including deliverables and the 

evaluation measures. We established an 

electronic system for submitting and 

documenting responses to contract 

performance concerns and questions; 

mstockstill on DSK4VPTVN1PROD with NOTICES

78442 Federal Register / Vol. 79, No. 249 / Tuesday, December 30, 2014 / Notices 

this system was made available to each 

of the QIN–QIOs. 

IV. Comment Outside the Scope of the 

Notice 

A second commenter submitted a 

comment suggesting that CMS provide 

beneficiaries with an option to pay 

annually rather than only monthly for 

the Part D benefit. This comment is 

outside the scope of the notice of 

evaluation standards and criteria for the 

QIN–QIO SOW therefore, we are not 

providing a response to that comment. 

V. Provisions of the Final Notice 

We have analyzed these comments 

and determined that it is appropriate to 

finalize without modification the 

provisions set forth in the August 11, 

2014 notice with comment period 

entitled, ‘‘Evaluation Criteria and 

Standards for Quality Improvement 

Networks Quality Improvement Program 

Contracts [Base and Task Order(s)].’’ (79 

FR 46830 through 46835). 

VI. Collection of Information 

Requirements 

This document does not impose 

information collection requirements, 

that is, reporting, recordkeeping or 

third-party disclosure requirements. 

Consequently, there is no need for 

review by the Office of Management and 

Budget under the authority of the 

Paperwork Reduction Act of 1995. 

VII. 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: November 19, 2014. 

Marilyn Tavenner, 

Administrator, Centers for Medicare & 

Medicaid Services. 

[FR Doc. 2014–30447 Filed 12–29–14; 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 

Title: Temporary Assistance for Needy 

Families Two-Parent Study. 

OMB No.: New Collection. 

Description: The Administration for 

Children and Families (ACF) is 

proposing an information collection 

activity as part of the Temporary 

Assistance for Needy Families TwoParent Study. Through this information 

collection, ACF seeks to gain an indepth, systematic understanding of the 

characteristics of two-parent families 

participating in or eligible to receive 

TANF, the variety of services two-parent 

families receive through TANF, how 

state policies may help or hinder 

participation in TANF among twoparent families, and how the beliefs of 

staff and eligible families help or hinder 

two-parent families’ participation in 

TANF. 

The proposed information collection 

consists of semi-structured interviews 

with key State and local staff, 

community-based organization 

representatives, and adult members of 

two-parent TANF or likely eligible 

families on questions of TANF policies, 

service delivery, and program context, 

as well as focus groups with adult 

members of two-parent TANF or likely 

eligible families. 

Respondents: State- and local-level 

TANF administrators and staff, 

representatives from community-based 

organizations, and adults from twoparent families on or likely eligible for 

TANF. 

Annual Burden Estimates 

Information collection will be 

completed within one year. 

Instrument 

Total/annual 

number of 

respondents 

Number of 

responses 

per respondent 

Average burden 

hours per 

response 

Annual burden 

hours 

Discussion Guide for use with state TANF directors .................................... 10 1 1 .5 15 

Discussion Guide for use with local TANF directors ..................................... 5 1 1 .5 8 

Discussion Guide for use with local TANF front-line staff ............................. 15 1 1 15 

Discussion Guide for use with community-based organizations ................... 5 1 1 5 

Discussion Guide for use with client focus groups ....................................... 112 1 1 .5 168 

Discussion guide for use with client interviews ............................................. 25 1 1 25 

Estimated Total Annual Burden 

Hours: 236. 

In compliance with the requirements 

of section 3506(c)(2)(A) of the 

Paperwork Reduction Act of 1995, the 

Administration for Children and 

Families is soliciting public comment 

on the specific aspects of the 

information collection described above. 

Copies of the proposed collection of 

information can be obtained and 

comments may be forwarded by writing 

to the Administration for Children and 

Families, Office of Planning, Research 

and Evaluation, 370 L’Enfant 

Promenade SW., Washington, DC 20447, 

Attn: OPRE Reports Clearance Officer. 

Email address: OPREinfocollection@

acf.hhs.gov. All requests should be 

identified by the title of the information 

collection. 

The Department specifically requests 

comments on (a) whether the proposed 

collection of information is necessary 

for the proper performance of the 

functions of the agency, including 

whether the information shall have 

practical utility; (b) the accuracy of the 

agency’s estimate of the burden of the 

proposed collection of information; (c) 

the quality, utility, and clarity of the 

information to be collected; and (d) 

ways to minimize the burden of the 

collection of information on 

respondents, including through the use 

of automated collection techniques or 

other forms of information technology. 

Consideration will be given to 

comments and suggestions submitted 

within 60 days of this publication. 

Karl Koerper, 

Reports Clearance Officer. 

[FR Doc. 2014–30470 Filed 12–29–14; 8:45 am] 

BILLING CODE 4184–73–P 

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