Attachment G -- Federal Register Notice

32207

Federal Register / Vol. 76, No. 107 / Friday, June 3, 2011 / Notices
ARRA ADJUSTMENTS TO Q3 FY11
State

Hold harmless
FY11 FMAP
with 1.2% pt
increase

Alabama ...........................
Alaska* .............................
Arizona .............................
Arkansas ..........................
California ..........................
Colorado ...........................
Connecticut ......................
Delaware ..........................
Dist of Columbia ..............
Florida ..............................
Georgia ............................
Hawaii ..............................
Idaho ................................
Illinois ...............................
Indiana .............................
Iowa ..................................
Kansas .............................
Kentucky ..........................
Louisiana ..........................
Maine ...............................
Maryland ..........................
Massachusetts .................
Michigan ...........................
Minnesota .........................
Mississippi ........................
Missouri ............................
Montana ...........................
Nebraska ..........................
Nevada .............................
New Hampshire* ..............
New Jersey ......................
New Mexico .....................
New York .........................
North Carolina ..................
North Dakota ....................
Ohio ..................................
Oklahoma .........................
Oregon .............................
Pennsylvania ....................
Rhode Island ....................
South Carolina .................
South Dakota ...................
Tennessee .......................
Texas ...............................
Utah ..................................
Vermont* ..........................
Virginia .............................
Washington ......................
West Virginia ....................
Wisconsin .........................
Wyoming ..........................

69.74
53.68
67.40
74.14
51.20
51.20
51.20
54.35
71.20
58.03
66.53
57.70
71.07
51.52
67.72
64.71
61.58
72.69
73.67
66.19
51.20
51.20
66.99
51.20
77.49
65.71
69.73
61.76
53.84
51.20
51.20
72.55
51.20
66.33
64.95
64.89
68.30
64.05
56.84
54.17
71.52
63.92
67.05
61.76
72.88
60.65
51.20
52.72
75.45
61.41
51.20

Hold harmless
FY11
unemployment
tier

Adjusted
state
share

State
share
31.46
47.52
33.80
27.06
50.00
50.00
50.00
46.85
30.00
43.17
34.67
43.50
30.13
49.68
33.48
36.49
39.62
28.51
27.53
35.01
50.00
50.00
34.21
50.00
23.71
35.49
31.47
39.44
47.36
50.00
50.00
28.65
50.00
34.87
36.25
36.31
32.90
37.15
44.36
47.03
29.68
37.28
34.15
39.44
28.32
40.55
50.00
48.48
25.75
39.79
50.00

30.86
46.92
33.20
26.46
49.40
49.40
49.40
46.25
29.40
42.57
34.07
42.90
29.53
49.08
32.88
35.89
39.02
27.91
26.93
34.41
49.40
49.40
33.61
49.40
23.11
34.89
30.87
38.84
46.76
49.40
49.40
28.05
49.40
34.27
35.65
35.71
32.30
36.55
43.76
46.43
29.08
36.68
33.55
38.84
27.72
39.95
49.40
47.88
25.15
39.19
49.40

Unemployment
adjustment
Q3 FY11

11.5
8.5
11.5
8.5
11.5
11.5
11.5
11.5
11.5
11.5
11.5
11.5
11.5
11.5
11.5
8.5
8.5
11.5
11.5
11.5
11.5
11.5
11.5
11.5
11.5
11.5
11.5
5.5
11.5
11.5
11.5
11.5
11.5
11.5
0
11.5
11.5
11.5
11.5
11.5
11.5
8.5
11.5
11.5
11.5
11.5
11.5
11.5
11.5
11.5
11.5

3.55
3.99
3.82
2.25
5.68
5.68
5.68
5.32
3.38
4.90
3.92
4.93
3.40
5.64
3.78
3.05
3.32
3.21
3.10
3.96
5.68
5.68
3.87
5.68
2.66
4.01
3.55
2.14
5.38
5.68
5.68
3.23
5.68
3.94
0.00
4.11
3.71
4.20
5.03
5.34
3.34
3.12
3.86
4.47
3.19
4.59
5.68
5.51
2.89
4.51
5.68

Third quarter
FY11 FMAP
unemployment
adjustment
73.29
57.67
71.22
76.39
56.88
56.88
56.88
59.67
74.58
62.93
70.45
62.63
74.47
57.16
71.50
67.76
64.90
75.90
76.77
70.15
56.88
56.88
70.86
56.88
80.15
69.72
73.28
63.90
59.22
56.88
56.88
75.78
56.88
70.27
64.95
69.00
72.01
68.25
61.87
59.51
74.86
67.04
70.91
66.23
76.07
65.24
56.88
58.23
78.34
65.92
56.88

*The unemployment tier for these States decreased but the Department was not able to satisfy the 60 day notice requirement so their unemployment tier was held harmless.

[FR Doc. 2011–13783 Filed 6–2–11; 8:45 am]
BILLING CODE 4150–05–P

DEPARTMENT OF HEALTH AND
HUMAN SERVICES

ACTION:

Notice.

This notice announces the
intention of the Agency for Healthcare
Research and Quality (AHRQ) to request
that the Office of Management and
Budget (OMB) approve the proposed
information collection project: ‘‘Barriers
to Meaningful Use in Medicaid.’’ In
accordance with the Paperwork
Reduction Act, 44 U.S.C. 3501–3521,

SUMMARY:

jlentini on DSK4TPTVN1PROD with NOTICES

Agency for Healthcare Research and
Quality
Agency Information Collection
Activities; Proposed Collection;
Comment Request
Agency for Healthcare Research
and Quality, HHS.

AGENCY:

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32208

Federal Register / Vol. 76, No. 107 / Friday, June 3, 2011 / Notices

AHRQ invites the public to comment on
this proposed information collection.
This proposed information collection
was previously published in the Federal
Register on March 11th, 2011 and
allowed 60 days for public comment.
One comment was received. The
purpose of this notice is to allow an
additional 30 days for public comment.
DATES: Comments on this notice must be
received by July 5, 2011.
ADDRESSES: Written comments should
be submitted to: AHRQ’s OMB Desk
Officer by fax at (202) 395–6974
(attention: AHRQ’s desk officer) or by email at [email protected]
(attention: AHRQ’s desk officer).
Copies of the proposed collection
plans, data collection instruments, and
specific details on the estimated burden
can be obtained from the AHRQ Reports
Clearance Officer.
FOR FURTHER INFORMATION CONTACT:
Doris Lefkowitz, AHRQ Reports
Clearance Officer, (301) 427–1477, or by
e-mail at
[email protected].
SUPPLEMENTARY INFORMATION:

jlentini on DSK4TPTVN1PROD with NOTICES

Proposed Project
Barriers to Meaningful Use in Medicaid
The Health Information Technology
for Economic and Clinical Health
(HITECH) Act, Title XIII of Division A
and Title IV of Division B of the
American Recovery and Reinvestment
Act of 2009 (ARRA) (Pub. L. 111–5),
provides for financial incentives for
Medicaid providers to adopt and
‘‘meaningfully use’’ certified electronic
health record (EHR) technologies. To
ensure that eligible professionals (EPs)
are able to qualify for and access these
incentives, AHRQ proposes a 2-year
project with the objective of
understanding the barriers that
Medicaid health providers encounter
along the way to achieving the
meaningful use of EHRs. This proposed
information collection will allow AHRQ
to synthesize knowledge regarding the
barriers that EPs encounter when
attempting to achieve meaningful use
and translate that knowledge to develop
technical assistance and support
implementation and use of EHRs.
Further, health care providers who
serve Medicaid beneficiaries are serving
many of AHRQ’s priority populations:
Inner city; rural; low income; minority;
women; children; elderly; and those
with special health care needs. The
project is designed to solicit actionable
recommendations on what activities can
best help Medicaid providers take
advantage of incentive payments,
achieve meaningful use, and ultimately
use health IT to improve health care for

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the Medicaid population. The
information gathered under this project
will also be used to inform the
development of the Stage 2 and 3
Meaningful Use criteria.
In order to gather, analyze, and
synthesize information on the barriers to
the meaningful use criteria experienced
by Medicaid providers this research has
the following goals:
(1) Identify the barriers to eligibility
for the incentive payments; barriers to
adoption, implementation, or upgrading
of EHR systems; and barriers to
achieving meaningful use.
(2) Develop actionable
recommendations to overcoming the
barriers identified in #1 above,
including, but not limited to, technical
assistance that could be made available
to Medicaid providers.
(3) Provide data to inform the
meaningful use objectives being
developed by the Center for Medicare &
Medicaid Services (CMS) for Stages 2
and 3 of the EHR Incentive Program.
This study is being conducted by
AHRQ through its contractor, RTI
International, pursuant to AHRQ’s
statutory authority to conduct and
support research to advance both
training for health care practitioners in
the use of information systems and the
use of computer-based health records.
42 U.S.C. 299b–3(a)(2) and (6).
Method of Collection
To achieve the goals of this project the
following data collections will be
implemented:
(1) A screening questionnaire will be
used to identify eligible participants, as
part of the sampling procedure for the
focus groups. Appended to the
screening questionnaire is a series of
questions for individuals who have
agreed to participate in the focus
groups, in order to collect descriptive
and demographic information prior to
the focus group session, and as part of
the analysis plan.
(2) A total of 13 focus groups will be
conducted with eligible Medicaid
providers. Eight focus groups will
include a mix of pediatricians, other
physicians, dentists, nurse practitioners,
physician assistants, and certified nurse
midwives who have adopted an EHR.
Four of the focus groups will include
providers who have not adopted an
EHR, and the final group will be
comprised of private practice dentists.
Private practice dentists are being
considered separately due to the fact
that their practice patterns are likely to
vary substantially from those of primary
care physicians and non-physician
providers. The purpose of these focus
groups is to gather information about

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adoption issues (factors in the decision
to adopt an EHR), implementation
issues (organizational or environmental
factors that facilitate EHR
implementation and training), upgrade
issues (challenges to transitioning to
certified EHRs), and challenges to
achieving meaningful use of EHRs as
defined in Federal regulations for Stage
1 (particular functions that are
problematic, the source of the
challenge). Responses will also address
topics related to participants’
knowledge of the EHR incentive
program and other factors that may
facilitate EHR use. The focus group
moderator will use the moderator’s
guide to guide discussion. The show
cards will provide key reminders of
content for discussion.
The information will be used to
develop actionable recommendations to
overcoming barriers to meaningful use
of EHRs for Medicaid providers,
including but not limited to technical
assistance that could be made available
to Medicaid providers. Furthermore, the
data gathered through this research will
inform the meaningful use objectives
being developed by CMS for Stages 2
and 3 of the EHR Incentive Program.
Three types of information will be
collected: List of potential focus group
participants, descriptive and
demographic information about focus
group participants, and the information
gathered at each focus group related to
the barriers to meaningful use. The
information will be synthesized to
provide information to the Federal
government to inform the future
meaningful use regulations and
understand any disparities potentially
resulting from the implementation of
the incentive programs.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated
annualized burden hours for the
respondents’ time to participate in this
research. The screening questionnaire
will be completed by 300 clinicians and
will take 12 minutes to complete on
average. Focus groups will be conducted
with not more than 89 clinicians and
will last about 2 hours, except for the
focus groups with non-users, which will
last about 90 minutes. The total annual
burden hours are estimated to be 228
hours.
Exhibit 2 shows the estimated
annualized cost burden associated with
the respondents’ time to participate in
this research. The total annual cost
burden is estimated to be $16,795.
Exhibit 1. Estimated Annualized Burden
Hours

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32209

Federal Register / Vol. 76, No. 107 / Friday, June 3, 2011 / Notices
Number of
respondents

Data collection

Number of
responses per
respondent

Hours per
response

Total burden
hours

Screening Questionnaire .................................................................................
In-Person Focus Groups EHR Users only ......................................................
Virtual Focus Groups EHR Users only ............................................................
Virtual Focus Groups EHR Non-users only .....................................................

300
40
29
20

1
1
1
1

12/60
2
2
1.5

60
80
58
30

Total ..........................................................................................................

389

na

na

228

Exhibit 2. Estimated Annualized Cost
Burden
Number of
respondents

Data collection

Total burden
hours

Average hourly wage rate*

Total cost
burden

Screening Questionnaire .................................................................................
In-Person Focus Groups EHR Users only ......................................................
Virtual Focus Groups EHR Users only ............................................................
Virtual Focus Groups EHR Non-users only .....................................................

300
40
29
20

60
80
58
30

73.66
73.66
73.66
73.66

$4,420
5,893
4,272
2,210

Total ..........................................................................................................

389

228

na

$16,795

*Hourly wage rate is the weighted average of hourly rates of the types of professionals who will complete the screening questionnaire and participate in the focus groups. The weighted average includes the following occupational codes and wage rates: 29–1065 (Pediatricians, General),
$78.67; 29–1069 (Physicians and Surgeons, all others), $97.35; 29–1021 (Dentists, General), $76.61; 29–1111 (Registered Nurses, includes
Certified Nurse Midwives), $32.35; 29–1071 (Physician Assistants), $41.86. Source: ‘‘National Compensation Survey: Occupational Wages in the
United States 2009,’’ U.S. Department of Labor, Bureau of Labor Statistics.

Estimated Annual Costs to the Federal
Government

for conducting this research. The total
cost is estimated to be $424,493.

Exhibit 3. Estimated Total and
Annualized Cost

Exhibit 3 shows the estimated total
and annualized cost to the government

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Cost component

Total cost

Annualized
cost

Project Development .......................................................................................................................................................
Data Collection Activities .................................................................................................................................................
Data Processing and Analysis .........................................................................................................................................
Publication of Results ......................................................................................................................................................
Project Management ........................................................................................................................................................
Overhead .........................................................................................................................................................................

$79,313
99,464
49,732
38,415
37,601
119,968

$39,657
49,732
24,866
19,208
18,801
59,984

Total ..........................................................................................................................................................................

$424,493

$212,247

Request for Comments
In accordance with the Paperwork
Reduction Act, comments on AHRQ’s
information collection are requested
with regard to any of the following: (a)
Whether the proposed collection of
information is necessary for the proper
performance of AHRQ healthcare
research and healthcare information
dissemination functions, including
whether the information will have
practical utility; (b) the accuracy of
AHRQ’s estimate of burden (including
hours and costs) of the proposed
collection(s) of information; (c) ways to
enhance the quality, utility, and clarity
of the information to be collected; and
(d) ways to minimize the burden of the
collection of information upon the
respondents, including the use of
automated collection techniques or
other forms of information technology.

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Comments submitted in response to
this notice will be summarized and
included in the Agency’s subsequent
request for OMB approval of the
proposed information collection. All
comments will become a matter of
public record.
Dated: May 20, 2011.
Carolyn M. Clancy,
Director.

DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Agency for Healthcare Research and
Quality
Agency Information Collection
Activities; Proposed Collection;
Comment Request
Agency for Healthcare Research
and Quality, HHS.
ACTION: Notice.
AGENCY:

[FR Doc. 2011–13740 Filed 6–2–11; 8:45 am]
BILLING CODE 4160–90–M

PO 00000

This notice announces the
intention of the Agency for Healthcare
Research and Quality (AHRQ) to request
that the Office of Management and
Budget (OMB) approve the proposed
information collection project: ‘‘Using
Nursing Home Antibiograms to Improve
Antibiotic Prescribing and Delivery.’’ In
accordance with the Paperwork

SUMMARY:

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