Priority Setting for the Children's Health Insurance Program Reauthorization Act (CHIPRA) Pediatric Quality Measures Program, 75469-75471 [2010-30262]

Download as PDF Federal Register / Vol. 75, No. 232 / Friday, December 3, 2010 / Notices Sunshine Act Meeting TIME AND DATE: December 8, 2010–10 a.m. 800 North Capitol Street, NW., First Floor Hearing Room, Washington, DC. STATUS: Part of the meeting will be in Open Session and the remainder of the meeting will be in Closed Session. MATTERS TO BE CONSIDERED: PLACE: Open Session 1. Staff Update on Cruise West. 2. Initiative to Modernize Commission Rules of Practice and Procedure. Closed Session 1. Fact Finding No. 27: Complaints or Inquiries from Individual Shippers of Household Goods or Private Automobiles—Discussion of the Fact Finding Officer’s Interim Report. 2. Fact Finding Investigation No. 26: Vessel Capacity and Equipment Availability in the United States Export and Import Liner Trades— Discussion of the Fact Finding Officer’s Final Report. 3. Petition No. P1–01: Petition of Hainan P O Shipping Co., Ltd., for an Exemption from the First Sentence of Section 9(c) of the Shipping Act. 4. Staff Briefing and Discussion Regarding Passenger Vessel Financial Responsibility. CONTACT PERSON FOR MORE INFORMATION: Karen V. Gregory, Secretary, (202) 523– 5725. [FR Doc. 2010–30438 Filed 12–1–10; 11:15 am] BILLING CODE 6730–01–P FEDERAL RESERVE SYSTEM mstockstill on DSKH9S0YB1PROD with NOTICES Change in Bank Control Notices; Acquisitions of Shares of a Bank or Bank Holding Company The notificants listed below have applied under the Change in Bank Control Act (12 U.S.C. 1817(j)) and 225.41 of the Board’s Regulation Y (12 CFR 225.41) to acquire shares of a bank or bank holding company. The factors that are considered in acting on the notices are set forth in paragraph 7 of the Act (12 U.S.C. 1817(j)(7)). The notices are available for immediate inspection at the Federal Reserve Bank indicated. The notices also will be available for inspection at the offices of the Board of Governors. Interested persons may express their views in writing to the Reserve Bank indicated for that notice or to the offices VerDate Mar<15>2010 16:09 Dec 02, 2010 Jkt 223001 A. Federal Reserve Bank of San Francisco (Kenneth Binning, Vice President, Applications and Enforcement) 101 Market Street, San Francisco, California 94105–1579: 1. BOTC Holdings LLC, Lightyear Fund II, L.P.; Lightyear Co-Invest Partnership II, L.P.; Lightyear Fund II GP, L.P.; Lightyear Fund II GP Holdings, LLC; Marron & Associates, LLC; Chestnut Venture Holdings, LLC; Donald B. Marron; Lightyear Capital LLC and Lightyear Capital II, LLC, all of New York, New York; to acquire voting shares of Cascade Bancorp, and thereby indirectly acquire voting shares of The Bank of the Cascades, both of Bend, Oregon. Governors not later than December 30, 2010. A. Federal Reserve Bank of Richmond (A. Linwood Gill, III, Vice President) 701 East Byrd Street, Richmond, Virginia 23261–4528: 1. Old Line Bancshares, Inc., Bowie, Maryland; to acquire 100 percent of the voting shares of Maryland Bankcorp, Inc., and thereby indirectly acquire voting shares of Maryland Bank & Trust Company, National Association, both of Lexington Park, Maryland. Board of Governors of the Federal Reserve System, November 30, 2010. Robert deV. Frierson, Deputy Secretary of the Board. Board of Governors of the Federal Reserve System, November 30, 2010. Robert deV. Frierson, Deputy Secretary of the Board. DEPARTMENT OF HEALTH AND HUMAN SERVICES [FR Doc. 2010–30361 Filed 12–2–10; 8:45 am] Agency for Healthcare Research and Quality of the Board of Governors. Comments must be received not later than December 20, 2010. FEDERAL MARITIME COMMISSION 75469 BILLING CODE 6210–01–P FEDERAL RESERVE SYSTEM Formations of, Acquisitions by, and Mergers of Bank Holding Companies The companies listed in this notice have applied to the Board for approval, pursuant to the Bank Holding Company Act of 1956 (12 U.S.C. 1841 et seq.) (BHC Act), Regulation Y (12 CFR part 225), and all other applicable statutes and regulations to become a bank holding company and/or to acquire the assets or the ownership of, control of, or the power to vote shares of a bank or bank holding company and all of the banks and nonbanking companies owned by the bank holding company, including the companies listed below. The applications listed below, as well as other related filings required by the Board, are available for immediate inspection at the Federal Reserve Bank indicated. The application also will be available for inspection at the offices of the Board of Governors. Interested persons may express their views in writing on the standards enumerated in the BHC Act (12 U.S.C. 1842(c)). If the proposal also involves the acquisition of a nonbanking company, the review also includes whether the acquisition of the nonbanking company complies with the standards in section 4 of the BHC Act (12 U.S.C. 1843). Unless otherwise noted, nonbanking activities will be conducted throughout the United States. Unless otherwise noted, comments regarding each of these applications must be received at the Reserve Bank indicated or the offices of the Board of PO 00000 Frm 00019 Fmt 4703 Sfmt 4703 [FR Doc. 2010–30362 Filed 12–2–10; 8:45 am] BILLING CODE 6210–01–P Priority Setting for the Children’s Health Insurance Program Reauthorization Act (CHIPRA) Pediatric Quality Measures Program Agency for Healthcare Research and Quality, HHS. ACTION: Request for public comments. AGENCY: Section 401(a) of the Children’s Health Insurance Program Reauthorization Act of 2009 (Pub. L. 111–3) amended title Xl of the Social Security Act by inserting after section 1139 the new section 1139A, ‘‘Child Health Quality Measures.’’: Subsection 1139A(b), ‘‘Advancing and Improving Pediatric Quality Measures,’’ directs the Secretary to establish a pediatric quality measures program to: improve and strengthen the initial core child health care quality measures established by the Secretary under section 1139A(a); expand on existing pediatric quality measures used by public and private health care purchasers and advance the development of new quality measures; and increase the portfolio of evidencebased, consensus pediatric quality measures available to public and private purchasers of children’s healthcare services, providers, and consumers. Section 1139A(b)(3) requires the Secretary to consult with a broad range of stakeholders to set these priorities. To meet the requirement for extensive stakeholder consultation, we are seeking general public comment on these draft priorities, and asking the public to identify additional priorities as needed. DATES: Comments on this notice must be received by January 14, 2010. The SUMMARY: E:\FR\FM\03DEN1.SGM 03DEN1 mstockstill on DSKH9S0YB1PROD with NOTICES 75470 Federal Register / Vol. 75, No. 232 / Friday, December 3, 2010 / Notices public comment period will close on January 14, 2010 at 5 p.m. EST. Any comments received after the close of the comment period will not be considered. ADDRESSES: You may submit comments by any of the following methods: 1. Electronic Mail—CHIPRAquality measures@AHRQ.hhs.gov. 2. Mail—Agency for Healthcare Research and Quality, Attention: Office of Extramural Research, Education, and Priority Populations-Public Comment, CHIPRA PQMP Priorities, 540 Gaither Rd., Rockville, MD 20850. Comments cannot be sent by facsimile transmission, because of staff and resource limitations. Please note that all submissions may be posted without change to http://www.AHRQ.gov/chipra, including any personal information provided. FOR FURTHER INFORMATION CONTACT: Denise Dougherty, PhD, Senior Advisor, Child Health and Quality Improvement, Office of Extramural Research, Education, and Priority Populations, Agency for Healthcare Research and Quality, 540 Gaither Rd., Rockville, MD. 301–427–1868. Denise.dougherty@ahrq.hhs.gov. For information regarding this Notice, please contact: CHIPRAquality measures@AHRQ.hhs.gov. SUPPLEMENTARY INFORMATION: On February 4, 2009, the Congress enacted the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009 (Pub. L. 111–3)., Section 401(a) of the legislation amended title XI of the Social Security Act (the Act) to establish section 1139A (42 U.S.C. 1320b-9a). Subsection 1139A(b)(E) requires the Secretary to consult with a wide spectrum of national stakeholders to identify gaps in existing pediatric quality measures and establish priorities for development and advancement of such measures. The Secretary delegated CHIPRA implementation to the Centers for Medicare & Medicaid Services (CMS). A ‘‘Memorandum of Understanding ‘‘was entered into with the Agency for Healthcare Research and Quality (AHRQ), by which AHRQ would conduct several activities in Title IV. These included the identification of an initial, recommended core set of children’s healthcare quality measures for voluntary use by Medicaid and CHIP programs and establishment of the Pediatric Quality Measures Program (PQMP), both in collaboration with CMS. Pediatric Quality Measures Program (PQMP). The PQMP was required to be established by January 1, 2011, and authorized to award grants and contracts. The PQMP will consist of 7– VerDate Mar<15>2010 16:09 Dec 02, 2010 Jkt 223001 9 cooperative agreement awards to successful applicants to HS11–001 (http://grants.nih.gov/grants/guide/rfafiles/RFA–HS–11–001.html), and a contract award to a CHIPRA Coordinating and Technical Assistance Center (http://www.ahrg.gov/chipra/ #CTAC), both supervised by AHRQ and CMS. As required by CHIPRA, successful applicants will work on priorities for measurement methods and topics set by HHS and informed by the input of multiple stakeholders. Multi-stakeholder consultation. Section 1139A(b)(3) requires a consultation process for establishing priorities for the pediatric quality measures program that requires consultation with multiple stakeholders, as follows: ‘‘ * * * the Secretary shall consult with: ‘‘(A) States; (B) pediatricians, children’s hospitals, and other primary and specialized pediatric health care professionals (including members of the allied health professions) who specialize in the care and treatment of children, particularly children with special physical, mental and developmental health care needs; (C) dental professionals, including pediatric dental professionals; (D) health care providers that furnish primary health care to children and families who live in urban and rural medically underserved communities or who are members of distinct population sub-groups at heightened risk for poor health outcomes; (E) national organizations representing children, including children with disabilities and children with chronic conditions; (F) national organizations representing consumers and purchasers of children’s health care; (G) national organizations and individuals with expertise in pediatric health quality measurement; and (H) voluntary consensus standards setting organizations and other organizations involved in the advancement of evidencebased measures of health care.’’ Measure topics: Section 1139A(b)(2)(E) requires that the improved core measure sets include (but not necessarily be limited to) the following topics and types of healthcare quality measures: ‘‘(A) The duration of children’s health insurance coverage over a 12-month time period. ‘‘(B) The availability and effectiveness of a full range of— ‘‘(i) preventive services, treatments, and services for acute conditions, including services to promote healthy birth, prevent and treat premature birth, and detect the presence or risk of physical or mental conditions that could adversely affect growth and development; and ‘‘(ii) treatments to correct or ameliorate the effects of physical and mental conditions, including chronic conditions, in infants, PO 00000 Frm 00020 Fmt 4703 Sfmt 4703 young children, school-age children, and adolescents. ‘‘(C) The availability of care in a range of ambulatory and inpatient health care settings in which such care is furnished. ‘‘(D) The types of measures that, taken together, can be used to estimate the overall national quality of health care for children, including children with special needs, and to perform comparative analyses of pediatric health care quality and racial, ethnic, and socioeconomic disparities in child health and health care for children. CHIPRA Section 1139A(b)(2)) requires that the measures developed under the pediatric quality measures program shall, at a minimum, be: ‘‘(A) evidence-based and, where appropriate, risk adjusted; ‘‘(B) designed to identify and eliminate racial and ethnic disparities in child health and the provision of health care; ‘‘(C) designed to ensure that the data required for such measures is collected and reported in a standard format that permits comparison of quality and data at a State, plan, and provider level; ‘‘(D) periodically updated; and ‘‘(E) responsive to the child health needs, services, and domains of health care quality described in clauses (i), (ii), and (iii) of subsection (a)(6)(A). Definition of healthcare quality measure. For purposes of this notice, a healthcare quality measure is defined as a mechanism that enables a user to quantify the quality of a selected aspect of care by comparing it to a criterion (adapted from http:// www.qualitymeasures.AHRQ.gov/ resources/measure use.aspx). Definition of healthcare quality. An Institute of Medicine Committee on a Future Vision for the National Healthcare Quality and Disparities Reports has recently updated the IOM recommended framework for assessing and improving quality so that 6 components of quality care are identified (safety, timeliness, effectiveness, patient/familycenteredness, access, efficiency), as well as 2 crosscutting dimensions (equity and value), three types of care (preventive care, acute treatment, and chronic condition management), and two additional elements (care coordination, health systems infrastructure capabilities). (http:// iom.edu/Reports/2010/FutureDirections-for-the-National-HealthcareQuality-and-Disparities-Reports.aspx). We adopt this framework for purposes of this public notice. Prior work to identify priorities for the POMP. The first phase of CHIPRA required a process for developing recommendations for an initial core set of quality measures for voluntary use by Medicaid and CHIP programs. As E:\FR\FM\03DEN1.SGM 03DEN1 mstockstill on DSKH9S0YB1PROD with NOTICES Federal Register / Vol. 75, No. 232 / Friday, December 3, 2010 / Notices discussed in the Federal Register Notice and background paper that accompanied the public posting of the initial, recommended core set (http:// www.ahrq.gov/chip/ chipraact.htm#Core), not all CHIPRA criteria were able to be met for the initial core set. Public comments on the initial, recommended core set, and an expert meeting on measure criteria for the CHIPRA PQMP (http:// www.AHRQ.gov/chipra/#Expert) provided additional insights into potential priorities for the PQMP. The combination of these efforts and events led to the identification of the following potential priorities for measure enhancement and development of new measures: 1. Development or enhancement of methods to: a. Standardize measures across all payers, programs, and providers, public and private, as appropriate, to ensure that comparisons are valid. b. Assess disparities in quality by race, ethnicity, socioeconomic status, geographic region and residence, and special health care needs, for example by developing new measurement methods or enhancing existing measurement methods. c. Adjust for risk by enrollment duration. d. Stratify or adjust for risk by depth and breadth of coverage. e. Stratify or adjust for risk by medical conditions, including severity and acuity. f. Capitalize on current and coming investments in health information technology (e.g., patient and procedure registries, electronic health records, health information exchanges, interoperability), including meaningful use criteria under the American Recovery and Reinvestment Act (ARRA). g. Increase State programs’ and CMS’s ability to rely on non-Medicaid and CHIP data sources through improvement in public health sector measurement (e.g., birth certificate data; immunization surveys). h. Come to consensus on the meaning and application of ‘‘evidence-based’’ in the context of healthcare quality measurement for children. i. Incorporate patient and family perspectives into measurement to increase understandability. 2. Development or enhancement of measures in key topic areas: a. Most integrated healthcare settings. b. Availability of services. c. Duration of enrollment as a standalone measure. d. Measures of the content (quality) of care now typically measured as broad VerDate Mar<15>2010 16:09 Dec 02, 2010 Jkt 223001 utilization categories (e.g., prenatal, postpartum, newborn care (including breastfeeding support), well-child and adolescent well-care visits, screening services, and follow-up visits for chronic conditions and related medications). e. Specific care settings and conditions: i. Perinatal care (e.g., family planning clinics, obstetric and gynecological care, birth centers). ii. Quality of mental/behavioral health and substance abuse services, including prevention and treatment services, across all settings. iii. Quality of care in settings beyond traditional medical care settings (e.g., for screening, diagnostic services and therapies). iv. Inpatient settings (including specialty inpatient settings). v. Specialty care for child conditions and diseases. vi. Care transitions for patients transitioning within and across health care settings. vii. Additional measures related to family experiences of care (e.g., child or adolescent self-reports; perinatal experiences of care; inpatient experiences) viii. Health outcome measures (e.g., measures of patient and population health or other outcomes of healthcare).2 ix. Structural measures (e.g., measures of system design features that are causally linked to improved healthcare processes and outcomes). Those submitting comments are encouraged to include a summary of evidence for the readiness of a topic for quality measurement and the importance of a topic or method. Additional background information may be attached. Commenters may wish to address these issues using the following questions. Commenters may also wish to include in their comments a summary score based on a scale of 1–5, where 1 is a high score, 3 is a medium score, and 5 is a low score. Validity/Underlying Scientific Soundness: To what extent is there a demonstrated causal relationship between the element of quality to be measured (as a structure, process, or health outcome of healthcare delivery) and another element of the healthcare delivery system (e.g., structure and process; process and outcome). Commenters may wish to use as a guide to assessing underlying scientific soundness the method and criteria used by the AHRQ National Advisory Council Subcommittee on Children’s Healthcare Quality Measures for Medicaid and CHIP, where appropriate PO 00000 Frm 00021 Fmt 4703 Sfmt 4703 75471 http://www.AHRQ.gov/chipra/ corebackground/ corebacktab.htm#note5). Importance: Importance has several dimensions: • To what extent is the topic important to children’s health outcomes, family functioning, or societal functioning, including but not necessarily limited to high monetary costs of poor quality healthcare to children, families, or Society? • To what extent is the topic important to reducing disparities in the quality of care for particular racial and ethnic groups of children, socioeconomic groups, geographically underserved groups, and children with special healthcare needs? • To what extent is the topic important as a sentinel measure that could have spillover effects to the rest of the children’s healthcare delivery system? • To what extent is the proposed methodology important for addressing current shortcoming of healthcare quality measurement? We strongly encourage comments to be as succinct as possible (250 words or less per topic, with additional supporting data allowed). 3. Collection of Information Requirements This voluntary request 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 (44 U.S.C. 35). 4. Regulatory Impact Analysis As this notice does not meet the significance criteria of Executive Order 12866, it was not reviewed by the Office of Management and Budget. Dated: November 24, 2010. Carolyn M. Clancy, AHRQ Director. [FR Doc. 2010–30262 Filed 12–2–10; 8:45 am] BILLING CODE 4160–90–M DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary Delisting Agency for Healthcare Research and Quality, HHS. ACTION: Notice of Delisting. AGENCY: E:\FR\FM\03DEN1.SGM 03DEN1

Agencies

[Federal Register Volume 75, Number 232 (Friday, December 3, 2010)]
[Notices]
[Pages 75469-75471]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-30262]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality


Priority Setting for the Children's Health Insurance Program 
Reauthorization Act (CHIPRA) Pediatric Quality Measures Program

AGENCY: Agency for Healthcare Research and Quality, HHS.

ACTION: Request for public comments.

-----------------------------------------------------------------------

SUMMARY: Section 401(a) of the Children's Health Insurance Program 
Reauthorization Act of 2009 (Pub. L. 111-3) amended title Xl of the 
Social Security Act by inserting after section 1139 the new section 
1139A, ``Child Health Quality Measures.'': Subsection 1139A(b), 
``Advancing and Improving Pediatric Quality Measures,'' directs the 
Secretary to establish a pediatric quality measures program to: improve 
and strengthen the initial core child health care quality measures 
established by the Secretary under section 1139A(a); expand on existing 
pediatric quality measures used by public and private health care 
purchasers and advance the development of new quality measures; and 
increase the portfolio of evidence-based, consensus pediatric quality 
measures available to public and private purchasers of children's 
healthcare services, providers, and consumers. Section 1139A(b)(3) 
requires the Secretary to consult with a broad range of stakeholders to 
set these priorities. To meet the requirement for extensive stakeholder 
consultation, we are seeking general public comment on these draft 
priorities, and asking the public to identify additional priorities as 
needed.

DATES: Comments on this notice must be received by January 14, 2010. 
The

[[Page 75470]]

public comment period will close on January 14, 2010 at 5 p.m. EST. Any 
comments received after the close of the comment period will not be 
considered.

ADDRESSES: You may submit comments by any of the following methods:
    1. Electronic Mail_CHIPRAqualitymeasures@AHRQ.hhs.gov.
    2. Mail--Agency for Healthcare Research and Quality, Attention: 
Office of Extramural Research, Education, and Priority Populations-
Public Comment, CHIPRA PQMP Priorities, 540 Gaither Rd., Rockville, MD 
20850.
    Comments cannot be sent by facsimile transmission, because of staff 
and resource limitations. Please note that all submissions may be 
posted without change to http://www.AHRQ.gov/chipra, including any 
personal information provided.

FOR FURTHER INFORMATION CONTACT: 
    Denise Dougherty, PhD, Senior Advisor, Child Health and Quality 
Improvement, Office of Extramural Research, Education, and Priority 
Populations, Agency for Healthcare Research and Quality, 540 Gaither 
Rd., Rockville, MD. 301-427-1868. Denise.dougherty@ahrq.hhs.gov.
    For information regarding this Notice, please contact: 
CHIPRAqualitymeasures@AHRQ.hhs.gov.

SUPPLEMENTARY INFORMATION: On February 4, 2009, the Congress enacted 
the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 
2009 (Pub. L. 111-3)., Section 401(a) of the legislation amended title 
XI of the Social Security Act (the Act) to establish section 1139A (42 
U.S.C. 1320b-9a). Subsection 1139A(b)(E) requires the Secretary to 
consult with a wide spectrum of national stakeholders to identify gaps 
in existing pediatric quality measures and establish priorities for 
development and advancement of such measures. The Secretary delegated 
CHIPRA implementation to the Centers for Medicare & Medicaid Services 
(CMS). A ``Memorandum of Understanding ``was entered into with the 
Agency for Healthcare Research and Quality (AHRQ), by which AHRQ would 
conduct several activities in Title IV. These included the 
identification of an initial, recommended core set of children's 
healthcare quality measures for voluntary use by Medicaid and CHIP 
programs and establishment of the Pediatric Quality Measures Program 
(PQMP), both in collaboration with CMS.
    Pediatric Quality Measures Program (PQMP). The PQMP was required to 
be established by January 1, 2011, and authorized to award grants and 
contracts. The PQMP will consist of 7-9 cooperative agreement awards to 
successful applicants to HS11-001 (http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-11-001.html), and a contract award to a CHIPRA 
Coordinating and Technical Assistance Center (http://www.ahrg.gov/chipra/#CTAC), both supervised by AHRQ and CMS. As required by CHIPRA, 
successful applicants will work on priorities for measurement methods 
and topics set by HHS and informed by the input of multiple 
stakeholders.
    Multi-stakeholder consultation. Section 1139A(b)(3) requires a 
consultation process for establishing priorities for the pediatric 
quality measures program that requires consultation with multiple 
stakeholders, as follows:

    `` * * * the Secretary shall consult with:
    ``(A) States;
    (B) pediatricians, children's hospitals, and other primary and 
specialized pediatric health care professionals (including members 
of the allied health professions) who specialize in the care and 
treatment of children, particularly children with special physical, 
mental and developmental health care needs;
    (C) dental professionals, including pediatric dental 
professionals;
    (D) health care providers that furnish primary health care to 
children and families who live in urban and rural medically 
underserved communities or who are members of distinct population 
sub-groups at heightened risk for poor health outcomes;
    (E) national organizations representing children, including 
children with disabilities and children with chronic conditions;
    (F) national organizations representing consumers and purchasers 
of children's health care;
    (G) national organizations and individuals with expertise in 
pediatric health quality measurement; and
    (H) voluntary consensus standards setting organizations and 
other organizations involved in the advancement of evidence-based 
measures of health care.''

    Measure topics: Section 1139A(b)(2)(E) requires that the improved 
core measure sets include (but not necessarily be limited to) the 
following topics and types of healthcare quality measures:

    ``(A) The duration of children's health insurance coverage over 
a 12-month time period.
    ``(B) The availability and effectiveness of a full range of--
    ``(i) preventive services, treatments, and services for acute 
conditions, including services to promote healthy birth, prevent and 
treat premature birth, and detect the presence or risk of physical 
or mental conditions that could adversely affect growth and 
development; and
    ``(ii) treatments to correct or ameliorate the effects of 
physical and mental conditions, including chronic conditions, in 
infants, young children, school-age children, and adolescents.
    ``(C) The availability of care in a range of ambulatory and 
inpatient health care settings in which such care is furnished.
    ``(D) The types of measures that, taken together, can be used to 
estimate the overall national quality of health care for children, 
including children with special needs, and to perform comparative 
analyses of pediatric health care quality and racial, ethnic, and 
socioeconomic disparities in child health and health care for 
children.

    CHIPRA Section 1139A(b)(2)) requires that the measures developed 
under the pediatric quality measures program shall, at a minimum, be:

    ``(A) evidence-based and, where appropriate, risk adjusted;
    ``(B) designed to identify and eliminate racial and ethnic 
disparities in child health and the provision of health care;
    ``(C) designed to ensure that the data required for such 
measures is collected and reported in a standard format that permits 
comparison of quality and data at a State, plan, and provider level;
    ``(D) periodically updated; and
    ``(E) responsive to the child health needs, services, and 
domains of health care quality described in clauses (i), (ii), and 
(iii) of subsection (a)(6)(A).

    Definition of healthcare quality measure. For purposes of this 
notice, a healthcare quality measure is defined as a mechanism that 
enables a user to quantify the quality of a selected aspect of care by 
comparing it to a criterion (adapted from http://www.qualitymeasures.AHRQ.gov/resources/measure use.aspx).
    Definition of healthcare quality. An Institute of Medicine 
Committee on a Future Vision for the National Healthcare Quality and 
Disparities Reports has recently updated the IOM recommended framework 
for assessing and improving quality so that 6 components of quality 
care are identified (safety, timeliness, effectiveness, patient/family-
centeredness, access, efficiency), as well as 2 crosscutting dimensions 
(equity and value), three types of care (preventive care, acute 
treatment, and chronic condition management), and two additional 
elements (care coordination, health systems infrastructure 
capabilities). (http://iom.edu/Reports/2010/Future-Directions-for-the-National-Healthcare-Quality-and-Disparities-Reports.aspx). We adopt 
this framework for purposes of this public notice.
    Prior work to identify priorities for the POMP. The first phase of 
CHIPRA required a process for developing recommendations for an initial 
core set of quality measures for voluntary use by Medicaid and CHIP 
programs. As

[[Page 75471]]

discussed in the Federal Register Notice and background paper that 
accompanied the public posting of the initial, recommended core set 
(http://www.ahrq.gov/chip/chipraact.htm#Core), not all CHIPRA criteria 
were able to be met for the initial core set. Public comments on the 
initial, recommended core set, and an expert meeting on measure 
criteria for the CHIPRA PQMP (http://www.AHRQ.gov/chipra/#Expert) 
provided additional insights into potential priorities for the PQMP. 
The combination of these efforts and events led to the identification 
of the following potential priorities for measure enhancement and 
development of new measures:
    1. Development or enhancement of methods to:
    a. Standardize measures across all payers, programs, and providers, 
public and private, as appropriate, to ensure that comparisons are 
valid.
    b. Assess disparities in quality by race, ethnicity, socioeconomic 
status, geographic region and residence, and special health care needs, 
for example by developing new measurement methods or enhancing existing 
measurement methods.
    c. Adjust for risk by enrollment duration.
    d. Stratify or adjust for risk by depth and breadth of coverage.
    e. Stratify or adjust for risk by medical conditions, including 
severity and acuity.
    f. Capitalize on current and coming investments in health 
information technology (e.g., patient and procedure registries, 
electronic health records, health information exchanges, 
interoperability), including meaningful use criteria under the American 
Recovery and Reinvestment Act (ARRA).
    g. Increase State programs' and CMS's ability to rely on non-
Medicaid and CHIP data sources through improvement in public health 
sector measurement (e.g., birth certificate data; immunization 
surveys).
    h. Come to consensus on the meaning and application of ``evidence-
based'' in the context of healthcare quality measurement for children.
    i. Incorporate patient and family perspectives into measurement to 
increase understandability.
    2. Development or enhancement of measures in key topic areas:
    a. Most integrated healthcare settings.
    b. Availability of services.
    c. Duration of enrollment as a standalone measure.
    d. Measures of the content (quality) of care now typically measured 
as broad utilization categories (e.g., prenatal, postpartum, newborn 
care (including breastfeeding support), well-child and adolescent well-
care visits, screening services, and follow-up visits for chronic 
conditions and related medications).
    e. Specific care settings and conditions:
    i. Perinatal care (e.g., family planning clinics, obstetric and 
gynecological care, birth centers).
    ii. Quality of mental/behavioral health and substance abuse 
services, including prevention and treatment services, across all 
settings.
    iii. Quality of care in settings beyond traditional medical care 
settings (e.g., for screening, diagnostic services and therapies).
    iv. Inpatient settings (including specialty inpatient settings).
    v. Specialty care for child conditions and diseases.
    vi. Care transitions for patients transitioning within and across 
health care settings.
    vii. Additional measures related to family experiences of care 
(e.g., child or adolescent self-reports; perinatal experiences of care; 
inpatient experiences)
    viii. Health outcome measures (e.g., measures of patient and 
population health or other outcomes of healthcare).\2\
    ix. Structural measures (e.g., measures of system design features 
that are causally linked to improved healthcare processes and 
outcomes).
    Those submitting comments are encouraged to include a summary of 
evidence for the readiness of a topic for quality measurement and the 
importance of a topic or method. Additional background information may 
be attached. Commenters may wish to address these issues using the 
following questions. Commenters may also wish to include in their 
comments a summary score based on a scale of 1-5, where 1 is a high 
score, 3 is a medium score, and 5 is a low score.
    Validity/Underlying Scientific Soundness: To what extent is there a 
demonstrated causal relationship between the element of quality to be 
measured (as a structure, process, or health outcome of healthcare 
delivery) and another element of the healthcare delivery system (e.g., 
structure and process; process and outcome). Commenters may wish to use 
as a guide to assessing underlying scientific soundness the method and 
criteria used by the AHRQ National Advisory Council Subcommittee on 
Children's Healthcare Quality Measures for Medicaid and CHIP, where 
appropriate http://www.AHRQ.gov/chipra/corebackground/corebacktab.htm#note5).
    Importance: Importance has several dimensions:
     To what extent is the topic important to children's health 
outcomes, family functioning, or societal functioning, including but 
not necessarily limited to high monetary costs of poor quality 
healthcare to children, families, or Society?
     To what extent is the topic important to reducing 
disparities in the quality of care for particular racial and ethnic 
groups of children, socioeconomic groups, geographically underserved 
groups, and children with special healthcare needs?
     To what extent is the topic important as a sentinel 
measure that could have spillover effects to the rest of the children's 
healthcare delivery system?
     To what extent is the proposed methodology important for 
addressing current shortcoming of healthcare quality measurement?
    We strongly encourage comments to be as succinct as possible (250 
words or less per topic, with additional supporting data allowed).

3. Collection of Information Requirements

    This voluntary request 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 (44 U.S.C. 35).

4. Regulatory Impact Analysis

    As this notice does not meet the significance criteria of Executive 
Order 12866, it was not reviewed by the Office of Management and 
Budget.

    Dated: November 24, 2010.
Carolyn M. Clancy,
AHRQ Director.
[FR Doc. 2010-30262 Filed 12-2-10; 8:45 am]
BILLING CODE 4160-90-M