[Federal Register Volume 79, Number 154 (Monday, August 11, 2014)]
[Notices]
[Pages 46830-46835]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-18901]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-3300-NC]
RIN 0938-ZB15
Medicare Program; Evaluation Criteria and Standards for Quality
Improvement Networks Quality Improvement Program Contracts [Base and
Task Order(s)]
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice with comment period.
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SUMMARY: This notice with comment period describes the general criteria
we intend to use to evaluate the effectiveness and efficiency of the
Quality Innovation Network (QIN) Quality Improvement Organizations
(QIOs) that will enter into contracts with CMS under the Quality
Innovation Network Quality Improvement Organizations (Solicitation
Number: HHSM-500-2014-RFP-QIN-QIO) Statement of Work (SOW) on August 1,
2014. 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
[[Page 46831]]
Sections C.5, G.22 and G.29 of the QIN-QIO Base Contract and Attachment
J-1(b) of the Base Contract; Attachment J-1 is QIN-QIO Task Order No.
001.
DATES: Effective Date: August 1, 2014 to July 31, 2019 for the QIN-QIO
contract.
Comment Date: To be assured consideration, comments must be
received at one of the addresses provided below, no later than 5 p.m.
on September 10, 2014.
ADDRESSES: In commenting, refer to file code CMS-3300-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-3300-NC,
P.O. Box 8010,
Baltimore, MD 21244-1850.
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-3300-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 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 FURTHER INFORMATION CONTACT: Alfreda Staton, (410) 786-4194.
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
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. This notice describes the
general criteria that will be used to evaluate performance of the
Quality Innovation Network (QIN)--QIOs under the QIN-QIO 11th Statement
of Work (SOW) contract beginning August 1, 2014.
II. Provisions of the Notice With Comment Period
The QIN-QIO contract supports our efforts to improve health and
healthcare for all Medicare beneficiaries, including those who are
eligible for both the Medicare and Medicaid programs, and promote
quality of care to ensure the right care at the right time, every time.
The QIN-QIO SOW is structured so that QIN-QIOs perform under the base
contract and task orders. Task Order 001 outlines several tasks for the
QIN-QIOs as well as a mechanism for the proposal and adoption of
additional tasks known as ``Special Innovation Projects'' (SIPs).
Specifically, SIPs are initiatives, efforts, and programs rooted in the
QIN-QIO area. SIPs are recommended to the Centers for Medicare &
Medicaid Services (CMS), through the QIN-QIO, by community advocates,
organizers, and groups engaged with local health issues. The SIP is
intended to either address a health issue the community finds acute but
is less visible to high-level federal analytics or to respond to health
issues, local or national, that are discovered during the course of the
contract. In addition to the SIPs, QIOs are responsible for completing
the requirements for the following Tasks as part of Task Order 001:
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 Value-Based Payment, Quality
Reporting, and the Physician Feedback Reporting Program; and
Quality Improvement Initiatives.
(Detailed information for each Task may be found in sections B.1
through E.1 in Attachment J.1 posted on December 5, 2013 of
Solicitation Number: HHSM-500-2014-RFP-QIN-QIO, posted at the http://www.fedbizopps.gov Web site: https://www.fbo.gov/index?s=
opportunity&mode=form&id= dff522bababb 6b9859bb783 c08db6074.)
References in this Notice to ``Attachments'' are to attachments of the
RFP and SOW.
[[Page 46832]]
QIN-QIO Tasks
Improving Cardiac Health and Reducing Cardiac Healthcare Disparities
(See Section B.1 of Attachment J.1, QIN-QIO Task Order No. 001)
The purpose of this task is for the QIN-QIOs to work with providers
and beneficiaries in collaboration with key partners and stakeholders,
including RECs, to implement evidence-based practices to improve
cardiovascular health, reduce cardiovascular healthcare disparities,
and support the Department of Health and Human Services' Million
Hearts[supreg] initiative's goal to prevent one million heart attacks
and strokes. The Million Hearts[supreg] Web site is found at
www.millionhearts.hhs.gov. While the QIN-QIO's work targets Medicare
beneficiaries of all races and ethnicities, the QIN-QIO shall also
propose the number of clinicians, practitioners, and providers, (as
defined in section 1861(u) of the Act (42 U.S.C. 1395)), it will
recruit to voluntarily participate in this initiative. Focus will be on
those clinicians and provider that provide healthcare services to
African American, Hispanic, and other racial and ethnic minority
Medicare beneficiaries. Goals and targets will be monitored for
improvement in promoting the use of Aspirin therapy when appropriate;
Blood pressure (BP) control; Cholesterol management; and Smoking
assessment and cessation (ABCS).
Reducing Disparities in Diabetes Care: Everyone With Diabetes Counts
(EDC) (See Section B.2 in Attachment J.1, QIN-QIO Task Order No. 001)
The purpose of this Task is to improve the quality of the lives for
persons with diabetes, and to prevent or lessen the severity of
complications resulting from diabetes. The QIN-QIOs will promote
diabetes self-management education (DSME) for empowering Medicare
beneficiaries with diabetes to take an active role in controlling their
disease and improve clinical outcomes. The QIN-QIOs will work with
healthcare providers, practitioners, certified diabetes educators, and
community health workers to cultivate the knowledge and skills
necessary to improve the quality of the lives for persons with
diabetes. The QIN-QIOs will also work with stakeholders on preventing
or lessening the severity of complications resulting from diabetes such
as kidney failure, amputations, loss of vision, heart failure, and
stroke.
Improving Prevention Coordination Through Meaningful Use of HIT and
Collaborating With Regional Extension Centers (See Section B.4 in
Attachment J.1, QIN-QIO Task Order No. 001)
The purpose of this Task is to support physician and other
clinician practices to improve care and outcomes for their population
of patients through meaningful use of interoperable health IT in
collaboration with RECs. The QIN-QIOs will collaborate with RECs to
improve the quality of care and transitions in care through
interoperable health IT in connection with the Medicare program. The
QIN-QIOs will provide targeted technical assistance to Eligible
Professionals (EP), Eligible Hospitals (EH) and Critical Access
Hospitals (CAH) that are most challenged to successfully meet the
requirements of the Medicare Electronic Health Record (EHR) Incentive
Programs and utilizing EHR functionality for quality improvement.
Reducing Healthcare-Associated Infections in Hospitals (See Section C.1
in Attachment J.1 of the QIN-QIO Task Order)
The purpose of this Task is to improve beneficiary safety by
reducing the incidence of patient harm in the areas of healthcare-
associated infections (HAIs) in hospital settings. The QIN-QIO will use
evidence-based strategies and data to decrease and prevent HAIs in the
hospital setting to improve patient care. The QIO will work to decrease
Central Line-Associated Bloodstream Infection (CLABSI), Catheter-
Associated Urinary Tract Infection (CAUTI) and Clostridium Difficile
Infection (CDI) Standardized Infection Ratios (SIRs) and improve
Urinary Catheter Utilization in hospital acute care settings for
Medicare beneficiaries.
Reducing Healthcare-Acquired Conditions in Nursing Homes (See Section
C.2 in Attachment J.1, QIN-QIO Task Order No. 001)
The purpose of this Task is to improve beneficiary safety by
reducing the incidence of healthcare-acquired conditions in nursing
home provider settings. The QIN-QIO will improve the quality of care
for Medicare beneficiaries in Nursing Homes by achieving improvement in
the Collaborative Quality Measure Composite Score composed of 13 NQF-
endorsed quality of care measures as listed in Attachment J.1--Task
Order 001, Task C.2. Appendix 4; decrease the percentage of residents
who received antipsychotic medications; and improve mobility of long-
stay residents. The QIN-QIO will work to support the creation of
National Nursing Home Quality Care Collaboratives (NNHQCC) to ``instill
quality and performance improvement practices, eliminate healthcare
acquired conditions, and improve resident satisfaction.'' The QIN-QIO
will work with participating nursing homes, beneficiaries, beneficiary
family members and/or beneficiary advocates/representatives, and in
collaboration with key partners and stakeholders to accomplish these
objectives.
Coordination of Care (See Section C.3 in Attachment J.1,QIN-QIO Task
Order No. 001)
The purpose of this Task is to improve hospital admission and/or
readmission rates, and adverse drug event rates by improving effective
communication and the continuity and coordination of patient care using
methods such as interoperable health IT. The QIN-QIO will improve the
quality of care for Medicare beneficiaries who transition among care
settings including home through a comprehensive community effort. These
efforts aim to reduce readmissions following hospitalization and to
yield sustainable and replicable strategies to achieve high-value
health care, particularly for chronically ill and disabled Medicare
beneficiaries. The QIN-QIOs will support the development of community
coalitions for improving communication and the coordination of clinical
decisions.
Quality Improvement Through Value-Based Payment, Quality Reporting, and
the Physician Feedback Reporting Program (See Section D.1 in Attachment
J.1, QIN-QIO Task Order No. 001)
The purpose of this Task is to improve quality care to
beneficiaries in physician settings by supporting provider use of and
participation in the CMS physician value modifier program and
coordinating community driven projects that advance efforts to achieve
better care at lower costs. The QIN-QIOs will improve healthcare by
identifying gaps and opportunities for improvement in quality,
efficiency, and care coordination. The QIOs shall be called upon to
assist hospitals, PPS-exempt Cancer Hospitals (PCHs), Inpatient
Psychiatric Facilities (IPFs), Ambulatory Surgical Centers (ASCs) and
physicians (as defined in section 1861(r) of the Act) in improving the
quality and efficiency of care through outreach and education about
CMS' hospital and physician value based payment programs, quality
reporting
[[Page 46833]]
programs, Physician Feedback Reporting Program, and the use of the
quality and cost measure information contained in the confidential
quality and resource use reports.
QIN-QIO-Proposed Projects That Advance Efforts for Better Care at Lower
Cost (See Section D.2 in Attachment J.1, QIN-QIO Task Order No. 001)
We will use SIPs to support QIN-QIOs in their respective services
areas to work with communities to improve healthcare quality and
efficiencies. Specifically, SIPs are initiatives, efforts, and programs
rooted in the QIN-QIO area. SIPs are recommended to us, through the
QIN-QIO, by community advocates, organizers, and groups engaged with
local health issues. The SIP is intended to address health issues that
the community finds acute but is less visible at a national-level.
Evaluation criteria and standards will be developed for each SIP.
Quality Improvement Initiatives (See Section E.1 in Attachment J.1,
QIN-QIO Task Order No. 001)
The purpose of this Task is to improve the quality of health care
for Medicare beneficiaries by providing technical assistance to
providers and practitioners. The QIN-QIO will improve healthcare
quality by assisting providers and/or practitioners in identifying the
root cause of a concern, developing a framework in which to address the
concern, and improving a process or system based on their analyses. A
Quality Improvement Initiative (QII) is any formal activity designed to
serve as a catalyst and support for quality improvement that uses
proven methodologies to achieve these improvements. The improvements
may relate to safety, healthcare, health and value and involve
providers, practitioners, beneficiaries, and/or communities. A QII may
consist of system-wide and/or non-system-wide changes and may be based
on a single, confirmed concern or multiple confirmed concerns.
Additionally, the QIN-QIO will collaborate with the Beneficiary and
Family Centered Care-QIO to improve Beneficiary (``Patient'') and
Family Engagement in healthcare quality improvement efforts and
actively supporting projects aimed at shared decision-making with
beneficiaries, families, and caregivers and families. QIIs may also be
based upon or responsive to referrals made by other contractors in the
QIO Program.
III. Evaluation of the Tasks
The QIN-QIO's performance will be evaluated based on achievement
associated with the Tasks in each awarded Task Order and as described
in Sections C.5, G.22 and G.29 of the QIN-QIO Base Contract and the
QIN-QIO Statement of Work (including Attachments J.1 and other
Attachments for measures and targets).
If a QIN-QIO is not tasked to work on a specific Task or an area
under a Task, the QIN-QIO will not be evaluated under that particular
area. Any Special Innovation Project that the QIN-QIO may carry out
will be evaluated separately and will not be considered in the overall
performance evaluation criteria.
We will conduct monitoring activities throughout the course of the
contract and will act upon findings as necessary. We will monitor, at
least quarterly, the QIN-QIO's performance relative to contract
requirements and targets as well as milestones and progress toward
successfully implementing plans and programs for each of the individual
states/territories of the QIN-QIO's service area, as well as the
aggregate, in the Task Award.
Information used for these monitoring purposes includes but is not
limited to:
Deliverables submitted by the QIN-QIO to CMS in accordance
with the Schedule of Deliverables;
Data for measures indicated in Attachment J.1(b);
Data from the QIN-QIO's Continuous Internal Quality
Improvement Program;
Other data submitted by QIN-QIOs as required by CMS;
Additional information gathered by email, telephone,
video, or in-person visits.
Plans and programs against which progress will be monitored include
but are not limited to:
Plan & Program Monitoring
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Base contract or task order 001 Section(s) Brief description
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Base Contract............................ C.6.1.1..................... Comprehensive Strategic Plan.
Task Order 001........................... A.1.1....................... Comprehensive Strategic Plan.
Base Contract............................ C.6.1.2..................... Integrated Communications Plan.
Task Order 001........................... A.1.3....................... Integrated Communications Plan.
Base Contract............................ C.6.1.3..................... Task Order Work Plan.
Base Contract............................ C.6.4.2..................... Recruitment.
Base Contract............................ C.6.4.3..................... Provider and Practitioner Recruitment.
Base Contract............................ C.6.4.4..................... Beneficiary (``Patient'') and Family Engagement.
Base Contract............................ C.6.4.5..................... Partner and Stakeholder Recruitment and Collaboration.
Base Contract............................ C.6.4.6..................... Sustainability Plan.
Task Order 001........................... A.1.2....................... Management Plan.
Task Order 001........................... A.1.6....................... Continuous Internal Quality Improvement Program.
All Task Orders from Task 001 forward.... All Sections................ Task Order 001, Excellence in Operations and Quality Improvement and all
subsequent Task Orders as specified.
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QIN-QIOs shall cooperate with the Contracting Officer
Representative (COR) on all our monitoring processes and address any
concerns identified by the COR. We will take appropriate contract
action (for example, providing warning for the need for adjustment,
instituting a formal correction plan, terminating an activity, or
recommending early termination of a contract because of failure to meet
contract timelines or performance as specified in the contract). This
means that the QIO shall comply with the Base Contract, all Task
Orders, Schedules of Deliverables, Evaluation Measures Tables, and any
subsequent modifications (including HCQIS Memorandums) issued by CMS.
Additionally, there will be multiple periods of evaluation under
this contract. The first evaluation will occur at the end of the 12th
month of the contract. Subsequent evaluations will
[[Page 46834]]
occur at the end of the 24, 36, 48 and 54th months of the contract. The
evaluations will be based on the most recent data available to us. The
performance results of the evaluation at each evaluation period (that
is, 12, 24, 36, 48 and 54th months) will be used, in addition to
ongoing monitoring activities, to determine the QIO's performance on
the overall contract.
Annual and 54th Month Evaluation
Annual and the 54th month contract evaluation will determine if the
QIN-QIO has met the performance evaluation criteria as specified in the
Task areas of the Base Contract. The annual and 54th month evaluation
criteria are found in Section J, Attachment J.1(b), Evaluation Measures
Table of the QIN-QIO SOW. Attachment J.1(b) includes the following
measures, by Task:
B.1. Improving Cardiac Health
[cir] Percentage of patients whose blood pressure was adequately
controlled.
[cir] Percentage of patients who are screened about tobacco use at
least one time within 24 months.
[cir] Percentage of patients identified as tobacco users who are
provided with cessation counseling intervention.
B.2. Everyone with Diabetes Counts
[cir] Percentage of clinical outcome data for Medicare
beneficiaries who complete DSME classes through EDC. Clinical outcomes
are: HbA1c, Lipids, Eye Exam, Blood Pressure and Weight.
[cir] Percentage of physician practices recruited to participate in
EDC.
[cir] Percentage of New Beneficiaries Completing DSME.
B.3. (Reserved)
B.4. Meaningful Use of HIT and Collaborating With RECs
[cir] Percentage of recruited EPs, EHs and CAHs using certified EHR
technology (CEHRT) with signed agreements within each state or
territory.
[cir] Percentage of recruited EPs, EHs and CAHs using CEHRT
receiving technical assistance within each state or territory.
[cir] Percentage of recruited practitioners/providers attending
QIO's educational sessions and the Learning and Action Network.
[cir] Percentage of recruited EPs, EHs and CAHs that received
Technical Assistance (TA) that meet EHR Incentive Programs clinical
quality measures reporting requirements post TA within each state or
territory.
[cir] Percentage of recruited practitioners/providers working to
establish an electronic connection with beneficiaries/family
representative.
C.1. Reducing Healthcare-Acquired Infections (HAIs) in
Hospitals
[cir] CLABSI Standardized Infection Ratio.
[cir] CAUTI Standardized Infection Ratio.
[cir] Urinary Catheter Utilization Rate.
[cir] CDI Standardized Infection Rate.
[cir] Recruitment of non-ICU and ICU units in acute care facilities
to participate in HAI projects.
C.2. Reducing Healthcare-Acquired Conditions in Nursing Homes
[cir] Rate of reduction in percentage of residents who received
antipsychotic medications.
[cir] Percentage of long-stay residents with improved mobility.
[cir] Percentage of One-Star Category Target Number recruited for
Collaborative I.
[cir] Sum of Percentages of One-Star Category Target Number
recruited for Collaboratives I and II.
[cir] Percentage of Recruitment Target Number recruited for
Collaborative I.
[cir] Sum of percentages of Recruitment Target Number recruited for
Collaboratives I and II.
[cir] NNHQCC Quality Composite Measure Score.
C.3. Coordination of Care
[cir] Percentage of interventions implemented (for a minimum of 6
months) that show improvement (for a minimum of 5 interventions across
the region annually).
[cir] Percentage of 30-day readmissions per 1,000 Fee-for-Service
(FFS) beneficiaries in region-wide coalition.
[cir] Percentage of admissions per 1,000 FFS beneficiaries in
region-wide coalition.
[cir] Percentage of region-wide readmissions per 1,000 FFS
beneficiaries.
[cir] Percentage of adverse drug events per 1,000 screened
beneficiaries.
[cir] Increased community tenure in region-wide coalition.
``Community tenure'' is defined as the number of days beneficiaries
spend in their home setting.
D.1. Quality Improvement through Physician Value-Based
Modifiers
[cir] Percentage of eligible physicians/physician groups attending
QIO-convened forums related to the Value Modifier (VM) Program.
[cir] Percentage of eligible physicians/physician groups that
demonstrate improvement in quality-of-care measures (per Quality and
Resource Use Reports) after receiving TA from QIOs.
[cir] Percentage of eligible ASCs that demonstrate improvement in
quality-of-care measures (per Ambulatory Surgical Center Quality
Reporting) after receiving TA from QIOs.
[cir] Percentage of eligible IPFs that demonstrate improvement in
quality-of-care measures (per Inpatient Psychiatric Facility Quality
Reporting) after receiving TA from QIOs.
[cir] Percentage of eligible CAHs that demonstrate improvement in
quality-of-care measures (per Inpatient Quality Reporting or Outpatient
Quality Reporting (OQR)) after receiving TA from QIOs.
[cir] Percentage of eligible PCHs that demonstrate improvement in
quality-of-care measures (per PPS-Exempt Cancer Hospital Quality
Reporting) after receiving TA from QIOs.
[cir] Performance period median national measure rate on OQR
measure as posted on Hospital Compare.
[cir] Percentage of eligible physicians/physician groups actively
participating in VM that require technical assistance for electronic
submission (Physician Quality Reporting System) and are successful in
subsequent submissions.
[cir] Percentage of eligible physicians/eligible physician groups
receiving payment adjustments through VM.
E.1. Technical Assistance--Quality Improvement Initiatives
(QIIs)
[cir] Percentage of QIIs initiated within 30 days of the receipt of
the applicable referral or request for QII technical assistance.
[cir] Percentage of QIIs successfully resolved.
Achievement within each of the Tasks for each Task Order will be
evaluated on an individual basis for appropriate contract action.
Though, in general, evaluation of each Task will relate only to that
area, we reserve the right to take appropriate contract action in the
event of failure in multiple Task areas.
Overall Contract Evaluation
The results of the annual (12, 24, 36, 48th month) and 54th month
evaluation periods, in addition to ongoing monitoring activities, will
be used to determine how each QIN-QIO performed on the overall
contract. Annual and 54th Month Evaluation Criteria are specifically
defined in Attachment J-1(b) of the QIN-QIO SOW; the criteria for
evaluating each deliverable under the contract and Task
[[Page 46835]]
Order No. 001 are identified in Attachment J.1(a) Schedule of
Deliverables of the 11th SOW. Further, as indicated in Sections G.22
and G.29, the Contracting Officer will use the Contractor Performance
Assessment Reporting System (CPARS) criteria in performing evaluations:
Quality, Schedule/Timeliness, Cost/Price Control, Business Relations,
Management, and Small Business. Performance on the evaluation criteria
defined in Attachment J-1(b) will be considered for assessment of the
Quality sub-factor for the CPARS assessment.
If we choose, we may notify the QIN-QIO of the intention not to
renew the QIN-QIO contract, and inform the QIN-QIO of the QIN-QIO's
rights under the current statute. Any failure at one or more of the
annual or 54th month evaluations for any Task may result in the QIN-QIO
receiving an adverse performance evaluation. Further, failure may
impact on the QIN-QIO's ability to continue similar work in or
eligibility for future QIO Program awards.
We reserve the right at any point, prior to the notification of our
intention not to continue the option for a Task and/or to renew the
contract, to revise measures or adjust the expected minimum thresholds
for satisfactory performance or remove criteria from a Task evaluation
protocol for any reason, including, but not limited to, data gathered
based on experience with the amount of improvement achieved during the
contract cycle or in pilot projects currently in progress, information
gathered through evaluation of the QIN-QIO performance overall, or any
unforeseen circumstances. Further, in accordance with standard contract
procedures, we reserve the right at any time to discontinue all or part
of one or more tasks for one or more states or territories in the QIN
area or any other part of this contract regardless of QIN-QIO
performance on the Task.
Rounding Rules
The rounding of results to assess the minimum performance criteria
indicated in Section J, Attachment J.1(b) uses the following rules.
1. Interim Calculations
We will not round the interim results of calculations used to
produce results. (For example, we will not round the results from steps
used to calculate the criteria or result). For example, we will not
first round baseline and re-measurement rates for the calculation of
relative improvement.
2. Percentages/Proportions/Rates
Use conventional rounding ``round half up.'' For example, to round
from the hundredth to the tenth digit, round using the tie-break rule
of ``half-up.'' 5.45 will become 5.5 whereas 5.44 will become 5.4.
Apply conventional rounding to one digit beyond that used to specify
the criteria (for example, for whole numbers, to the tenths place). For
example, for a criterion expressed as 5 percent, 4.46 percent rounds to
4.5 percent and 4.44 percent rounds to 4.4 percent.
3. Integers
For discrete numbers of units required for improvement, round to
the more favorable (typically lower) integer with a minimum of one. We
note that this method is applied selectively to special cases as
indicated in Section J, Attachment J.1(b). This method is more than a
rounding rule. We calculate a minimum performance target using the
minimum performance criteria and the size of the re-measurement
criteria. For example, for a minimum criteria of 95 percent and a re-
measurement denominator of 10, 10 x 0.95 = 9.5, which is rounded down
(the more favorable direction) to 9. For this example, if CMS specified
use of the integer rounding rule for this measure, the minimum
performance criteria of 95 percent would be met by achieving at least 9
cases given a re-measurement denominator count of size 10. If we do not
specifically indicate that the integer rounding rule applied to this
measure, the percentage rounding rule would be used.
III. Collection of Information Requirements
This document does not impose information collection and
recordkeeping requirements. Consequently, it need not be reviewed by
the Office of Management and Budget under the authority of the
Paperwork Reduction Act of 1995.
IV. Response to Comments
Because of the large number of public comments we normally receive
on Federal Register documents, we are not able to acknowledge or
respond to them individually. We will consider all comments we receive
by the date and time specified in the DATES section of this preamble,
and, when we proceed with a subsequent document, we will respond to the
comments in the preamble to that document.
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: June 3, 2014.
Marilyn Tavenner,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2014-18901 Filed 8-8-14; 8:45 am]
BILLING CODE 4120-01-P