Attachment B - 60 day FRN

147

Federal Register / Vol. 76, No. 1 / Monday, January 3, 2011 / Notices
Dated: December 28, 2010.
Mirtha Beadle,
Deputy Director, Office of Minority Health,
Office of the Assistant Secretary for Health,
Office of the Secretary, U.S. Department of
Health and Human Services.

community-level responses to surges in
demand, but it remains a difficult task.
While there is extensive research on
managing collaborations during times of
extraordinary pressure where response
to surge takes precedence over other
activities, less is known about
developing and maintaining integrated
collaborations during periods where the
system must respond to unusual surge
but also continue the routine provision
of health care. In particular, studies
have not explored how these
collaborations can build on sustainable
relationships between a broad range of
stakeholders (including primary care
providers) in communities with
different market structures and different
degrees of investment in public health.
This study aims to generate
information about the role of
community-based collaborations in
disaster preparedness that the CDC can
use to develop its programs guiding and
supporting these collaborations. This
project will explore barriers and
facilitators to coordination on surge
response in ten communities, eight of
which have been studied longitudinally
since the mid-1990s as part of the
Center for Studying Health System
Change’s (HSC’s) Community Tracking
Study (CTS). Interviews of local
healthcare stakeholders will be
conducted at 10 sites.
Interviews will be conducted at a total
of 63 organizations over the two years
of this project. Within each of the ten
communities studied, two emergency
practitioner respondents (one from a
safety-net hospital and one from a nonsafety-net hospital), two primary care
providers (one from a large practice and
one from a small practice) and two local
preparedness experts (one from the
County or local public health agency,
and one coordinator or collaboration
leader) will be interviewed. In three
sites (Phoenix, Greenville and Seattle)
an additional respondent will be
identified from an outlying rural area to
offer the perspective of providers in
those communities. There is no cost to
respondents except their time.

be received within 60 days of this
notice.
Proposed Project
Healthcare System Surge Capacity at
the Community Level—New—National
Center for Emerging and Zoonotic
Infectious Diseases, (NCEZID), Centers
for Disease Control and Prevention,
(CDC).

[FR Doc. 2010–33084 Filed 12–30–10; 8:45 am]
BILLING CODE 4150–29–P

DEPARTMENT OF HEALTH AND
HUMAN SERVICES

Background and Brief Description
The Healthcare Preparedness Activity,
Division of Healthcare Quality
Promotion (DHQP) at the Centers for
Disease Control and Prevention (CDC)
works with other Federal agencies, State
governments, medical societies and
other public and private organizations
to promote collaboration amongst
healthcare partners, and to integrate
healthcare preparedness into Federal,
State and local public health
preparedness planning. The goal of the
Activity is to help local communities’
healthcare delivery and public health
sectors effectively and efficiently
prepare for and respond to urgent and
emergent threats.
Surge is defined as a marked increase
in demand for resources such as
personnel, space and material. Health
care providers manage both routine
surge (predictable fluctuations in
demand associated with the weekly
calendar, for example) as well as
unusual surge (larger fluctuations in
demand caused by rarer events such as
pandemic influenza). Except in
extraordinary cases, providers are
expected to manage surge while
adhering to their existing standards for
quality and patient safety. Currently,
health care organizations are expected
to prepare for and respond to surges in
demand ranging from a severe
catastrophe (for example, a nuclear
detonation) to more common, less
severe events (for example, a worsethan-usual influenza season). The
Centers for Disease Control and
Prevention (CDC) and Federal agencies
have dedicated considerable funding
and technical assistance towards
developing and coordinating

Centers for Disease Control and
Prevention
[60Day–11–11BM]

Proposed Data Collections Submitted
for Public Comment and
Recommendations
In compliance with the requirement
of Section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995 for
opportunity for public comment on
proposed data collection projects, the
Centers for Disease Control and
Prevention (CDC) will publish periodic
summaries of proposed projects. To
request more information on the
proposed projects or to obtain a copy of
the data collection plans and
instruments, call 404–639–5960 and
send comments to Carol E. Walker,
Acting CDC Reports Clearance Officer,
1600 Clifton Road, MS–D74, Atlanta,
GA 30333 or send an e-mail to
omb@cdc.gov.
Comments are invited on: (a) Whether
the proposed collection of information
is necessary for the proper performance
of the functions of the agency, including
whether the information shall have
practical utility; (b) the accuracy of the
agency’s estimate of the burden of the
proposed collection of information; (c)
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
on respondents, including through the
use of automated collection techniques
or other forms of information
technology. Written comments should

ESTIMATED ANNUALIZED BURDEN HOURS

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Emergency Department: Private, non-safety net ............................................
Emergency Department: Public/safety net ......................................................
Primary Care: Larger practice .........................................................................
Primary Care: Solo/2 physician practice .........................................................
Preparedness: Public/Department of Health ...................................................
Preparedness: Health care preparedness coordinator/collaboration leader ...
Rural (Greenville, Phoenix, Seattle only: Clinician-leader at rural site (ED or
PC) ...............................................................................................................

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Number of
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Respondent category

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Total burden
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10
10
10
10
10

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1
1
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1

1
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1

10
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148

Federal Register / Vol. 76, No. 1 / Monday, January 3, 2011 / Notices
ESTIMATED ANNUALIZED BURDEN HOURS—Continued
Respondent category

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

Dated: December 27, 2010.
Carol E. Walker,
Acting Reports Clearance Officer, Centers for
Disease Control and Prevention.
[FR Doc. 2010–33128 Filed 12–30–10; 8:45 am]
BILLING CODE P

DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–2321–N]
RIN 0938–AQ44

Medicaid Program; Final FY 2009 and
Preliminary FY 2011 Disproportionate
Share Hospital Allotments, and Final
FY 2009 and Preliminary FY 2011
Institutions for Mental Diseases
Disproportionate Share Hospital Limits
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice.
AGENCY:

This notice announces the
final Federal share disproportionate
share hospital (DSH) allotments for
Federal FY (FY) 2009 and the
preliminary Federal share DSH
allotments for FY 2011. This notice also
announces the final FY 2009 and the
preliminary FY 2011 limitations on
aggregate DSH payments that States may
make to institutions for mental disease
and other mental health facilities. In
addition, this notice includes
background information describing the
methodology for determining the
amounts of States’ FY DSH allotments.
DATES: Effective Date: This notice is
effective March 4, 2011. The final
allotments and limitations set forth in
this notice are effective for the fiscal
years specified.
FOR FURTHER INFORMATION CONTACT:
Richard Strauss, (410) 786–2019.
SUPPLEMENTARY INFORMATION:
SUMMARY:

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I. Background
A. Disproportionate Share Hospital
Allotments for Federal FY 2003
Under section 1923(f)(3) of the Social
Security Act (the Act), States’ Federal
fiscal year (FY) 2003 disproportionate
share hospital (DSH) allotments were
calculated by increasing the amounts of

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Jkt 223001

Number of
respondents

Number of responses per
respondent

Average burden response
(in hours)

........................

........................

........................

the FY 2002 allotments for each State
(as specified in the chart, entitled ‘‘DSH
Allotment (in millions of dollars)’’,
contained in section 1923(f)(2) of the
Act) by the percentage change in the
Consumer Price Index for all Urban
Consumers (CPI–U) for the prior fiscal
year. The allotment, determined in this
way, is subject to the limitation that an
increase to a State’s DSH allotment for
a FY cannot result in the DSH allotment
exceeding the greater of the State’s DSH
allotment for the previous FY or 12
percent of the State’s total medical
assistance expenditures for the
allotment year (this is referred to as the
12 percent limit).
Most States’ actual FY 2002
allotments were determined in
accordance with the provisions of
section 1923(f)(4) of the Act which
allowed for a special DSH calculation
rule for FY 2001 and FY 2002. However,
as indicated previously, the calculation
of States’ FY 2003 allotments was not
based on the actual FY 2002 DSH
allotments; rather, section 1923(f)(3) of
the Act requires that the States’ FY 2003
allotments be determined using the
amount of the States’ FY 2002
allotments specified in the chart in
section 1923(f)(2) of the Act. The
exception to this is the calculation of
the FY 2003 DSH allotments for certain
‘‘Low-DSH States’’ (defined in section
1923(f)(5) of the Act). Under the LowDSH State provision, there is a special
calculation methodology for the LowDSH States only. Under this
methodology, the FY 2003 allotments
were determined by increasing States’
actual FY 2002 DSH allotments, rather
than their FY 2002 allotments specified
in the chart in section 1923(f)(2) of the
Act, by the percentage change in the
CPI–U for the previous fiscal year.
B. DSH Allotments for FY 2004
Section 1001(a) of the Medicare
Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA) (Pub.
L. 108–173, enacted on December 8,
2003) amended section 1923(f)(3) of the
Act to provide for a ‘‘Special, Temporary
Increase In Allotments On A One-Time,
Non-Cumulative Basis.’’ Under this
provision, States’ FY 2004 DSH
allotments were determined by
increasing their FY 2003 allotments by
16 percent, and the FY DSH allotment

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amounts so determined were not subject
to the 12 percent limit.
C. DSH Allotments for Non-Low DSH
States for FY 2005, and FYs Thereafter
Under the methodology contained in
section 1923(f)(3)(C) of the Act, as
amended by section 1001(a)(2) of the
MMA, the non-Low-DSH States’ DSH
allotments for FY 2005 and subsequent
FYs continue at the same level as the
States’ DSH allotments for FY 2004 until
a ‘‘fiscal year specified’’ occurs. The
fiscal year specified is the first FY for
which the Secretary estimates that a
State’s DSH allotment equals (or no
longer exceeds) the DSH allotment as
would have been determined under the
statute in effect before the enactment of
the MMA. We determine whether the
fiscal year specified has occurred under
a special parallel process. Specifically,
under this parallel process, a ‘‘parallel’’
DSH allotment is determined for FYs
after 2003 by increasing the State’s DSH
allotment for the previous FY by the
percentage change in the CPI–U for the
prior FY, subject to the 12 percent limit.
This is the methodology as would
otherwise have been applied under
section 1923(f)(3)(A) of the Act,
notwithstanding the application of the
provisions of MMA. The fiscal year
specified, is the FY in which the
parallel DSH allotment calculated under
this special parallel process equals or
exceeds the FY 2004 DSH allotment, as
determined under the MMA provisions.
Once the fiscal year specified occurs for
a State, that State’s FY DSH allotment
will be calculated by increasing the
State’s previous actual FY DSH
allotment (which would be equal to the
FY 2004 DSH allotment) by the
percentage change in the CPI–U for the
previous FY, subject to the 12 percent
limit. The following example illustrates
how the FY DSH allotment would be
calculated for FYs after FY 2004.
Example—In this example, we are
determining the parallel FY 2009 DSH
allotment. A State’s actual FY 2003 DSH
allotment is $100 million. Under the MMA,
this State’s actual FY 2004 DSH allotment
would be $116 million ($100 million
increased by 16 percent). The State’s DSH
allotment for FY 2005 and subsequent FYs
would continue at the $116 million FY 2004
DSH allotment for FYs following FY 2004
until the fiscal year specified occurs. Under
the separate parallel process, we determine

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