3744 Federal Register / Vol. 75, No. 14 / Friday, January 22, 2010 / Notices 

proposed changes in regulations and 

manual instructions related to physician 

services, as identified by the Secretary. 

To the extent feasible and consistent 

with statutory deadlines, the Council’s 

consultation must occur before Federal 

Register publication of the proposed 

changes. The Council submits an annual 

report on its recommendations to the 

Secretary and the Administrator of the 

Centers for Medicare & Medicaid 

Services (CMS) not later than December 

31 of each year. 

The Council consists of 15 physicians, 

including the Chair. Members of the 

Council include both participating and 

nonparticipating physicians, and 

physicians practicing in rural and 

underserved urban areas. At least 11 

members of the Council must be 

physicians as described in section 

1861(r)(1) of the Act; that is, Statelicensed doctors of medicine or 

osteopathy. The remaining 4 members 

may include dentists, podiatrists, 

optometrists, and chiropractors. 

Members serve for overlapping 4-year 

terms. 

Section 1868(a)(2) of the Act requires 

that the Council meet quarterly to 

discuss certain proposed changes in 

regulations and manual issuances that 

relate to physicians’ services, identified 

by the Secretary. Section 1868(a)(3) of 

the Act provides for payment of 

expenses and per diem for Council 

members in the same manner as 

members of other advisory committees 

appointed by the Secretary. In addition 

to making these payments, the 

Department of Health and Human 

Services and CMS provide management 

and support services to the Council. The 

Secretary will appoint new members to 

the Council from among those 

candidates determined to have the 

expertise required to meet specific 

agency needs in a manner to ensure 

appropriate balance of the Council’s 

membership. 

The Council held its first meeting on 

May 11, 1992. The current members are: 

Chiledum A. Ahaghotu, M.D.; John E. 

Arradondo, M.D., MPH; Vincent J. 

Bufalino, M.D., Chairperson; Joseph A. 

Giaimo, D.O.; Pamela A. Howard, M.D.; 

Roger L. Jordan, O.D.; Janice A. Kirsch, 

M.D.; Tye J. Ouzounian, M.D.; Jeffrey A. 

Ross, DPM, M.D.; Jonathan E. Siff, M.D., 

MBA; Fredrica E. Smith, M.D.; Richard 

E. Smith, M.D.; Arthur D. Snow, Jr., 

M.D.; Christopher J. Standaert, M.D.; 

and Karen S. Williams, M.D. 

II. Meeting Format and Agenda 

The meeting will commence with the 

Council’s Executive Director providing a 

status report, and the CMS responses to 

the recommendations made by the 

Council at the December 7, 2009 

meeting, as well as prior meeting 

recommendations. Additionally, an 

update will be provided on the 

Physician Regulatory Issues Team. In 

accordance with the Council charter, we 

are requesting assistance with the 

following agenda topics: 

• Provider Enrollment and Chain 

Ownership System (PECOS) Update. 

• Fraud and Abuse Update. 

• Electronic Health Records (EHR) 

Update. 

For additional information and 

clarification on these topics, contact the 

DFO as provided in the FOR FURTHER

INFORMATION CONTACT section of this 

notice. Individual physicians or medical 

organizations that represent physicians 

wishing to present a 5-minute oral 

testimony on agenda issues must 

register with the DFO by the date listed 

in the DATES section of this notice. 

Testimony is limited to agenda topics 

only. The number of oral testimonies 

may be limited by the time available. A 

written copy of the presenter’s oral 

remarks must be submitted to the DFO 

for distribution to Council members for 

review before the meeting by the date 

listed in the DATES section of this notice. 

Physicians and medical organizations 

not scheduled to speak may also submit 

written comments to the DFO for 

distribution by the date listed in the 

DATES section of this notice. 

III. Meeting Registration and Security 

Information 

The meeting is open to the public, but 

attendance is limited to the space 

available. Persons wishing to attend this 

meeting must register by contacting the 

DFO at the address listed in the 

ADDRESSES section of this notice or by 

telephone at the number listed in the 

FOR FURTHER INFORMATION CONTACT

section of this notice by the date 

specified in the DATES section of this 

notice. 

Since this meeting will be held in a 

Federal Government Building, the 

Hubert H. Humphrey Building, Federal 

security measures are applicable. In 

planning your arrival time, we 

recommend allowing additional time to 

clear security. To gain access to the 

building, participants will be required 

to show a government-issued photo 

identification (for example, driver’s 

license, or passport), and must be listed 

on an approved security list before 

persons are permitted entrance. Persons 

not registered in advance will not be 

permitted into the Hubert H. Humphrey 

Building and will not be permitted to 

attend the Council meeting. 

All persons entering the building 

must pass through a metal detector. In 

addition, all items brought to the Hubert 

H. Humphrey Building, whether 

personal or for the purpose of 

presentation, are subject to inspection. 

We cannot assume responsibility for 

coordinating the receipt, transfer, 

transport, storage, set-up, safety, or 

timely arrival of any personal 

belongings or items used for the purpose 

of presentation. 

Individuals requiring sign language 

interpretation or other special 

accommodations must contact the DFO 

via the contact information specified in 

the FOR FURTHER INFORMATION CONTACT

section of this notice by the date listed 

in the DATES section of this notice. 

Authority: (Section 1868 of the Social 

Security Act (42 U.S.C. 1395ee) and section 

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

section 10(a)).) 

Dated: January 14, 2010. 

Charlene Frizzera, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

[FR Doc. 2010–1333 Filed 1–21–10; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Health Resources and Services 

Administration 

National Advisory Committee on Rural 

Health and Human Services; Notice of 

Meeting 

In accordance with section 10(a)(2) of 

the Federal Advisory Committee Act 

(Pub. L. 92–463), notice is hereby given 

that the following committee will 

convene its sixty-fourth meeting. 

Name: National Advisory Committee on 

Rural Health and Human Services. 

Dates and Times: February 17, 2010, 1 

p.m.–5 p.m. 

February 18, 2010, 9 a.m.–5 p.m. 

February 19, 2010, 9 a.m.–10:30 a.m. 

Place: The Sofitel Lafayette Square, 806 

15th Street, NW., Washington, DC, 20005, 

Phone: 202–730–8800. 

Status: The meeting will be open to the 

public. 

Purpose: The National Advisory 

Committee on Rural Health and Human 

Services provides advice and 

recommendations to the Secretary with 

respect to the delivery, research, 

development and administration of health 

and human services in rural areas. 

Agenda: Wednesday afternoon, February 

17, at 1 p.m., the meeting will be called to 

order by the Chairperson of the Committee, 

the Honorable David Beasley and the Vice 

Chairperson, the Honorable Larry Otis. The 

Chair will open with a review of the 

Committee’s 2010 Report to the Secretary and 

a vote on the approval of that report. The 

meeting will then focus on the Committee’s 


erowe on DSK5CLS3C1PROD with NOTICES
Federal Register / Vol. 75, No. 14 / Friday, January 22, 2010 / Notices 3745 

work for the 2011 report, which will focus on 

the implications of health system change in 

rural communities. The meeting will include 

an address by HRSA Administrator 

Dr. Mary Wakefield as well as 

presentations by experts in the fields of 

hospital and health care delivery as well as 

workforce. Committee discussion on the 

issues and an overview of rest of the meeting 

will follow. The Wednesday meeting will 

close at 5 p.m. 

Thursday morning, February 18, at 9 a.m., 

the Committee will open with presentations 

by experts in the area of human service 

delivery and will be followed by another 

presentation by a speaker from the Rural 

Policy Research Institute. This will be 

followed by Committee discussion and 

overview from staff to the Committee. 

Following these presentations, 

Subcommittees will be selected and meet for 

small group discussions. There will be a 

review of the Subcommittee meetings and 

action items will be developed for the 

Committee members and staff. The formal 

meeting for Thursday will close at 5 p.m. 

The final session will be convened Friday 

morning, February 19, at 9 a.m. The 

Committee will hear additional presentations 

on emerging rural policy issues from both 

internal and external experts. This will be 

followed by Committee discussion on the 

Report format and an overview of the Work 

Plan. The Committee will draft the letter to 

the Secretary and discuss the June meeting. 

The meeting will be adjourned at 10:30 a.m. 

For Further Information Contact: Anyone 

requiring information regarding the 

Committee should contact Thomas F. Morris, 

MPA, Acting Executive Secretary, National 

Advisory Committee on Rural Health and 

Human Services, Health Resources and 

Services Administration, Parklawn Building, 

Room 9A–42, 5600 Fishers Lane, Rockville, 

MD 20857, Telephone (301) 443–0835, Fax 

(301) 443–2803. 

Persons interested in attending any portion 

of the meeting should contact Michele Pray 

Gibson, Office of Rural Health Policy 

(ORHP), Telephone (301) 443–0835. The 

Committee meeting agenda will be posted on 

ORHP’s Web site http:// 

www.ruralhealth.hrsa.gov. 

Dated: January 14, 2010. 

Sahira Rafiullah, 

Deputy Director, Division of Policy Review 

and Coordination. 

[FR Doc. 2010–1178 Filed 1–21–10; 8:45 am] 

BILLING CODE 4165–15–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

National Institutes of Health 

NIH Consensus Development 

Conference on Vaginal Birth After 

Cesarean: New Insights; Notice 

Notice is hereby given by the National 

Institutes of Health (NIH) of the ‘‘NIH 

Consensus Development Conference on 

Vaginal Birth After Cesarean: New 

Insights’’ to be held March 8–10, 2010, 

in the NIH Natcher Conference Center, 

45 Center Drive, Bethesda, Maryland 

20892. The conference will begin at 8:30 

a.m. on March 8 and 9 and at 9 a.m. on 

March 10, and it will be open to the 

public. 

Vaginal birth after cesarean (VBAC) is 

the delivery of a baby through the 

vagina after a previous cesarean 

delivery. For most of the 20th century, 

once a woman had undergone a 

cesarean (the delivery of a baby through 

an incision made in the abdominal wall 

and uterus), many clinicians believed 

that all of her future pregnancies 

required delivery by cesarean as well. 

However, in 1980, an NIH Consensus 

Development Conference panel 

questioned the necessity of routine 

repeat cesarean deliveries and outlined 

situations in which VBAC could be 

considered. The option for a woman 

with a previous cesarean delivery to try 

to labor and deliver vaginally rather 

than plan a cesarean delivery was thus 

offered and exercised more often from 

the 1980s through the early 1990s. Since 

1996, however, VBAC rates in the 

United States have consistently 

declined, while cesarean delivery rates 

have been steadily rising. 

The exact causes of these shifts are 

not entirely understood. A frequently 

cited concern about VBAC is the 

possibility of uterine rupture during 

labor because a cesarean delivery leaves 

a scar in the wall of the uterus at the 

incision site, which is weaker than other 

uterine tissue. Attempted VBAC may 

also be associated with endometritis 

(infection of the lining of the uterus), 

the need for a hysterectomy (removal of 

the uterus) or blood transfusion, as well 

as neurologic injury to the baby. 

However, repeat cesarean delivery may 

also carry a risk of bleeding or 

hysterectomy, uterine infections, and 

respiratory problems for the newborn. 

Having multiple cesarean deliveries 

may also be associated with placental 

problems in future pregnancies. Other 

important considerations that may 

influence decisionmaking include the 

number of previous cesarean deliveries 

a woman has experienced, the surgical 

incision used during previous cesarean 

delivery, the reason for the previous 

surgical delivery, her age, how far along 

the pregnancy is relative to her due 

date, and the size and position of her 

baby. Given the complexity of this issue, 

a thorough examination of the relative 

balance of benefits and harms to mother 

and baby will be of immediate utility to 

practitioners and pregnant mothers in 

deciding upon a planned mode of 

delivery. 

A number of nonclinical factors are 

involved in this decision as well and 

may be influencing the decline in VBAC 

rates. Some individual practitioners and 

hospitals in the U.S. have decreased or 

eliminated their use of VBAC. 

Professional society guidelines may 

influence utilization rates because some 

medical centers do not offer the 

recommended supporting services for a 

trial of labor after cesarean (e.g., 

immediate availability of a surgeon who 

can perform a cesarean delivery and onsite anesthesiologists). Information 

related to complications of an 

unsuccessful attempt at VBAC, medicolegal concerns, personal preferences of 

patients and clinicians, and insurance 

policies and economic considerations 

may all play a role in changing practice 

patterns. Improved understanding of the 

clinical risks and benefits and how they 

interact with legal, ethical, and 

economic forces to shape provider and 

patient choices about VBAC may have 

important implications for health 

services planning. 

To advance understanding of these 

important issues, the Eunice Kennedy 

Shriver National Institute of Child 

Health and Human Development and 

the Office of Medical Applications of 

Research of the NIH will convene a 

Consensus Development Conference 

from March 8 to 10, 2010. The 

conference will address the following 

key questions: 

• What are the rates and patterns of 

utilization of trial of labor after prior 

cesarean, vaginal birth after cesarean, 

and repeat cesarean delivery in the 

United States? 

• Among women who attempt a trial 

of labor after prior cesarean, what are 

the vaginal delivery rate and the factors 

that influence it? 

• What are the short- and long-term 

benefits and harms to the mother of 

attempting trial of labor after prior 

cesarean versus elective repeat cesarean 

delivery, and what factors influence 

benefits and harms? 

• What are the short- and long-term 

benefits and harms to the baby of 

maternal attempt at trial of labor after 

prior cesarean versus elective repeat 

cesarean delivery, and what factors 

influence benefits and harms? 

• What are the nonmedical factors 

that influence the patterns and 

utilization of trial of labor after prior 

cesarean? 

• What are the critical gaps in the 

evidence for decision-making, and what 

are the priority investigations needed to 

address these gaps? 

An impartial, independent panel will 

be charged with reviewing the available 

published literature in advance of the 


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