On August 25, 2009, the HHS Office for Civil Rights (OCR) published a direct final rule adjusting for inflation the maximum civil money penalty amounts for violations of the confidentiality provisions of the November 21, 2008 Patient Safety and Quality Improvement Rule. The inflation adjustment is being made to comply with the Federal Civil Penalties Inflation Adjustment Act of 1990, and is effective November 23, 2009. The OCR is using direct final rulemaking for this action because it expects no significant adverse comment on the rule. If adverse comment is received by September 24, 2009 on a companion proposed rule, OCR will withdraw the direct final rule.