81 FR 5448 - Medicaid Program; Final FY 2013 and Preliminary FY 2015 Disproportionate Share Hospital Allotments, and Final FY 2013 and Preliminary FY 2015 Institutions for Mental Diseases Disproportionate Share Hospital Limits
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services Federal Register Volume 81, Issue 21 (February 2, 2016)
Centers for Medicare & Medicaid Services
Federal Register Volume 81, Issue 21 (February 2, 2016)
| Page Range | 5448-5463 | |
| FR Document | 2016-01836 |
[Federal Register Volume 81, Number 21 (Tuesday, February 2, 2016)] [Notices] [Pages 5448-5463] From the Federal Register Online [www.thefederalregister.org] [FR Doc No: 2016-01836] ----------------------------------------------------------------------- DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-2398-N] RIN 0983-ZB24 Medicaid Program; Final FY 2013 and Preliminary FY 2015 Disproportionate Share Hospital Allotments, and Final FY 2013 and Preliminary FY 2015 Institutions for Mental Diseases Disproportionate Share Hospital Limits AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice. ----------------------------------------------------------------------- SUMMARY: This notice announces the final federal share disproportionate share hospital (DSH) allotments for federal fiscal year (FY) 2013 and the preliminary federal share DSH allotments for FY 2015. This notice also announces the final FY 2013 and the preliminary FY 2015 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: This notice is effective March 3, 2016. The final allotments and limitations set forth in this notice are effective for the fiscal years specified. FOR FURTHER INFORMATION CONTACT: Stuart Goldstein, (410) 786-0694 and Richard Cuno, (410) 786-1111. SUPPLEMENTARY INFORMATION: I. Background A. Fiscal Year DSH Allotments A state's federal fiscal year (FY) disproportionate share hospital (DSH) allotment represents the aggregate limit on the federal share amount of the state's payments to DSH hospitals in the state for the FY. The amount of such allotment is determined in accordance with the provisions of section 1923(f)(3) of the Social Security Act (the Act). Under such provisions, in general a state's FY DSH allotment is calculated by increasing the amount of its DSH allotment for the preceding FY by the percentage change in the Consumer Price Index for all Urban Consumers (CPI-U) for the previous FY. The Affordable Care Act amended Medicaid DSH provisions, adding section 1923(f)(7) of the Act which would have required reductions to states' FY DSH allotments beginning with FY 2014, the calculation of which was described in the Disproportionate Share Hospital Payment Reduction final rule published in the September 18, 2013 Federal Register (78 FR 57293). Under the DSH reduction methodology, first, each state's unreduced FY DSH allotment would have been calculated in accordance with the provisions of section 1923(f) of the Act, excluding section 1923(f)(7) of the Act; then, the reduction amount for each state would have been determined under the provisions of section 1923(f)(7) of the Act and implementing regulations at 42 CFR 447.294; and, finally, the net FY DSH allotment for each state would have been determined by subtracting the DSH reduction amount for the state from its unreduced FY 2014 DSH allotment. The reductions under section 1923(f)(7) of the Act were most recently delayed and modified by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) (Pub. L. 114-10), enacted on April 16, 2015. The reductions of states' fiscal year DSH allotments under section 1923(f)(7) of the Act that were applicable to FY 2017 were repealed, and are instead scheduled to begin in FY 2018 at modified levels. MACRA also extended DSH allotment reductions through 2025. Because there is no reduction to DSH allotments for FY 2015 under section 1923(f)(7) of the Act, this notice contains only the state- specific preliminary FY 2015 DSH allotments, as calculated under the statute without application of the reductions that would have otherwise been imposed. This notice also provides information on the calculation of such FY DSH allotments, the calculation of the states' IMD DSH limits, and the amounts of states' preliminary FY 2015 IMD DSH limits. B. Determination of Fiscal Year DSH Allotments Generally, in accordance with the methodology specified under section 1923(f)(3) of the Act, a state's FY DSH allotment is calculated by increasing the amount of its DSH allotment for the preceding FY by the percentage change in the CPI-U for the previous FY. Also in accordance with section 1923(f)(3) of the Act, a state's DSH allotment for a FY 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). Furthermore, under section 1923(h) of the Act, federal financial participation [[Page 5449]] (FFP) for DSH payments to institutions for mental diseases (IMDs) and other mental health facilities is limited to state-specific aggregate amounts. Under this provision, the aggregate limit for DSH payments to IMDs and other mental health facilities is the lesser of a state's FY 1995 total computable (state and federal share) IMD and other mental health facility DSH expenditures applicable to the state's FY 1995 DSH allotment (as reported on the Form CMS-64 as of January 1, 1997), or the amount equal to the product of the state's current year total computable DSH allotment and the applicable percentage specified in section 1902(h) of the Act (the applicable percentage is the IMD share of DSH total computable expenditures as of FY 1995). In general, we determine states' DSH allotments for a FY and the IMD DSH limits for the same FY using the most recent available estimates of or actual medical assistance expenditures, including DSH expenditures in their Medicaid programs and the most recent available change in the CPI-U used for the FY in accordance with the methodology prescribed in the statute. The indicated estimated or actual expenditures are obtained from states for each relevant FY from the most recent available quarterly Medicaid budget reports (Form CMS-37) or quarterly Medicaid expenditure reports (Form CMS-64), respectively, submitted by the states. For example, as part of the initial determination of a state's FY DSH allotment (referred to as the preliminary DSH allotments) that is determined before the beginning of the FY for which the DSH allotments and IMD DSH limits are being determined, we use estimated expenditures for the FY obtained from the August submission of the CMS-37 submitted by states prior to the beginning of the FY; such estimated expenditures are subject to update and revision during the FY before such actual expenditure data become available. We also use the most recent available estimated CPI-U percentage change that is available before the beginning of the FY for determining the states' preliminary FY DSH allotments; such estimated CPI-U percentage change is subject to update and revision during the FY before the actual CPI-U percentage change becomes available. In determining the final DSH allotments and IMD DSH limits for a FY we use the actual expenditures for the FY and actual CPI-U percentage change for the previous FY. II. Provisions of the Notice A. Calculation of the Final FY 2013 Federal Share State DSH Allotments and the Preliminary FY 2015 Federal Share State DSH Allotments 1. Final FY 2013 Federal Share State DSH Allotments Addendum 1 to this notice provides the states' final FY 2013 DSH allotments determined in accordance with section 1923(f)(3) of the Act. As described in the background section of this notice, in general, the DSH allotment for a FY is calculated by increasing the FY DSH allotment for the preceding FY by the CPI-U increase for the previous fiscal year. For purposes of calculating the states' final FY 2013 DSH allotments, the preceding final fiscal year DSH allotments (for FY 2012) were published in the July 26, 2013 Federal Register (78 FR 45217). For purposes of calculating the states' final FY 2013 DSH allotments we are using the actual Medicaid expenditures for FY 2013. Finally, for purposes of calculating the states' final FY 2013 DSH allotments, the applicable historical percentage change in the CPI-U for the previous FY (FY 2012) was 2.4 percent; we note that this is the same as the estimated 2.4 percentage change in the CPI-U for FY 2012 that was available and used in the calculation of the preliminary FY 2013 DSH allotments which were published in the July 26, 2013 Federal Register (78 FR 45217). 2. Calculation of the Preliminary FY 2015 Federal Share State DSH Allotments Addendum 2 to this notice provides the preliminary FY 2015 DSH allotments determined in accordance with section 1923(f)(3) of the Act. The preliminary FY 2015 DSH allotments contained in this notice were determined based on the most recent available estimates from states of their FY 2015 total computable Medicaid expenditures. Also, the preliminary FY 2015 allotments contained in this notice were determined by increasing the preliminary FY 2014 DSH allotments as contained in the notice published in the February 28, 2014 Federal Register (79 FR 11436) by 1.6 percent, representing the most recent available estimate of the percentage increase in the CPI-U for FY 2014 (the previous FY to FY 2015). We will publish states' final FY 2015 DSH allotments in future notices based on the states' four quarterly Medicaid expenditure reports (Form CMS-64) for FY 2015 available following the end of FY 2015 and the actual change in the CPI-U for FY 2014. B. Calculation of the Final FY 2013 and Preliminary FY 2015 IMD DSH Limits Section 1923(h) of the Act specifies the methodology to be used to establish the limits on the amount of DSH payments that a state can make to IMDs and other mental health facilities. FFP is not available for IMD or DSH payments that exceed the IMD limits. In this notice, we are publishing the final FY 2013 and the preliminary FY 2015 IMD DSH Limits determined in accordance with the provisions discussed above. Addendums 3 and 4 to this notice detail each state's final FY 2013 and preliminary FY 2015 IMD DSH Limit, respectively, determined in accordance with section 1923(h) of the Act. III. Collection of Information Requirements This notice does not impose any new or revised information collection or recordkeeping requirements. The requirements and burden associated with form CMS-37 (OMB control number 0938-1265) and form CMS-64 (OMB control number 0938-1265) are unaffected by this notice. As it pertains to the content of this notice, CMS-37 and CMS-64 are not subject to formal Office of Management and Budget review under the authority of the Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et seq.). IV. Regulatory Impact Statement We have examined the impact of this notice as required by Executive Order 12866 on Regulatory Planning and Review (September 1993), the Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96-354), section 1102(b) of the Act, section 202 of the Unfunded Mandates Reform Act of 1995 (March 22, 1995; Pub. L. 104-4), Executive Order 13132 on Federalism (August 4, 1999) and the Congressional Review Act (5 U.S.C. 804(2)). Executive Order 12866 directs agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). A regulatory impact analysis (RIA) must be prepared for major rules with economically significant effects ($100 million or more in any 1 year). This notice reaches the $100 million economic threshold and thus is considered a major rule under the Congressional Review Act. The final FY 2013 DSH allotments being published in this notice are equal [[Page 5450]] to the preliminary FY 2013 DSH allotments published in the July 26, 2013 Federal Register (78 FR 45217). This is due to the actual percentage change in the CPI-U for FY 2012 used in the calculation of the final FY 2013 allotments (2.4 percent) being equal to the estimated percentage change in the CPI-U for FY 2012 used in the calculation of the preliminary FY 2013 allotments (2.4 percent). The final FY 2013 IMD DSH limits being published in this notice are also equal to the preliminary FY 2013 IMD DSH limits published in the July 26, 2013 Federal Register (78 FR 45217). Since the final FY 2013 DSH allotments were equal to the preliminary FY 2013 DSH allotments, the associated FY 2013 IMD DSH limits also remained the same. The preliminary FY 2015 DSH allotments being published in this notice are about $240 million more than the preliminary FY 2014 DSH allotments published in the February 28, 2014 Federal Register (79 FR 11436). The increase in the DSH allotments is due to the application of the statutory formula for calculating DSH allotments under which the prior fiscal year allotments are increased by the percentage increase in the CPI-U for the prior fiscal year. The preliminary FY 2015 IMD DSH limits being published in this notice are about $14 million more than the preliminary FY 2014 IMD DSH limits published in the February 28, 2014 Federal Register (79 FR 11436). The increase in the IMD DSH limits is because the DSH allotment for a FY is a factor in the determination of the IMD DSH limit for the FY. Since the preliminary FY 2015 DSH allotments are greater than the preliminary FY 2014 DSH allotments, the associated preliminary FY 2015 IMD DSH limits for some states also increased. The RFA requires agencies to analyze options for regulatory relief of small businesses, if a rule has a significant impact on a substantial number of small entities. For purposes of the RFA, small entities include small businesses, nonprofit organizations, and small governmental jurisdictions. Most hospitals and most other providers and suppliers are small entities, either by nonprofit status or by having revenues of less than $7.5 million to $38.5 million in any 1 year. Individuals and states are not included in the definition of a small entity. We are not preparing an analysis for the RFA because the Secretary has determined that this notice will not have significant economic impact on a substantial number of small entities. Specifically, any impact on providers is due to the effect of the various controlling statutes; providers are not impacted as a result of the independent regulatory action in publishing this notice. The purpose of the notice is to announce the latest distributions as required by the statute. In addition, section 1102(b) of the Act requires us to prepare a regulatory impact analysis if a rule may have a significant impact on the operations of a substantial number of small rural hospitals. This analysis must conform to the provisions of section 604 of the RFA. For purposes of section 1102(b) of the Act, we define a small rural hospital as a hospital that is located outside of a Core-Based Statistical Area for Medicaid payment regulations and has fewer than 100 beds. We are not preparing analysis for section 1102(b) of the Act because the Secretary has determined that this notice will not have a significant impact on the operations of a substantial number of small rural hospitals. The Medicaid statute specifies the methodology for determining the amounts of states' DSH allotments and IMD DSH limits; and as described previously, the application of the methodology specified in statute results in the decreases or increases in states' DSH allotments and IMD DSH limits for the applicable FYs. The statute applicable to these allotments and limits does not apply to the determination of the amounts of DSH payments made to specific DSH hospitals; rather, these allotments and limits represent an overall limit on the total of such DSH payments. In this regard, we do not believe that this notice will have a significant economic impact on a substantial number of small entities. Section 202 of the Unfunded Mandates Reform Act of 1995 also requires that agencies assess anticipated costs and benefits before issuing any rule whose mandates require spending in any 1 year of $100 million in 1995 dollars, updated annually for inflation. In 2015, that is approximately $144 million. This notice will have no consequential effect on state, local, or tribal governments, in the aggregate, or on the private sector. Executive Order 13132 establishes certain requirements that an agency must meet when it issues a proposed rule (and subsequent final rule) that imposes substantial direct requirement costs on state and local governments, preempts state law, or otherwise has Federalism implications. Since this notice does not impose any costs on state or local governments, the requirements of E.O. 13132 are not applicable. A. Alternatives Considered The methodologies for determining the states' fiscal year DSH allotments and IMD DSH Limits, as reflected in this notice, were established in accordance with the methodologies and formula for determining states' allotments as specified in the statute. This notice does not put forward any further discretionary administrative policies for determining such allotments. B. Accounting Statement As required by OMB Circular A-4 (available at http://www.whitehouse.gov/omb/circulars/a004/a-4.pdf), in the Table 1, we have prepared an accounting statement showing the classification of the estimated expenditures associated with the provisions of this notice. Table 1 provides our best estimate of the change (decrease) in the federal share of states' Medicaid DSH payments resulting from the application of the provisions of the Medicaid statute relating to the calculation of states' FY DSH allotments and the increase in the FY DSH allotments from FY 2014 to FY 2015. Table 1--Accounting Statement: Classification of Estimated Expenditures, From the FY 2014 to FY 2015 [In millions] ------------------------------------------------------------------------ Category Transfers ------------------------------------------------------------------------ Annualized Monetized Transfers............ $240. From Whom To Whom? Federal Government to States. ------------------------------------------------------------------------ Congressional Review Act This proposed regulation is subject to the Congressional Review Act provisions of the Small Business Regulatory Enforcement Fairness Act of 1996 (5 U.S.C. 801 et seq.) and has been transmitted to the Congress and the Comptroller General for review. In accordance with the provisions of Executive Order 12866, this notice was reviewed by the Office of Management and Budget. Dated: December 3, 2015. Andrew M. Slavitt, Acting Administrator, Centers for Medicare & Medicaid Services. Dated: January 20, 2016. Sylvia M. Burwell, Secretary, Department of Health and Human Services. [[Page 5451]] Key to Addendum 1--Final DSH Allotments for FY 2013 [The Final FY 2013 DSH Allotments for the NON-Low DSH States are presented in the top section of this addendum, and the Final FY 2013 DSH Allotments for the Low-DSH States are presented in the bottom section of this addendum] ------------------------------------------------------------------------ Column Description ------------------------------------------------------------------------ Column A................. State. Column B................. FY 2013 FMAPs. This column contains the States' FY 2013 Federal Medical Assistance Percentages. Column C................. Prior FY (2012) DSH Allotments This column contains the States' prior FY 2012 DSH Allotments. Column D................. Prior FY (2012) DSH Allotments (Col C) x (100 percent + Percentage Increase in CPIU): 102.4 percent. This column contains the amount in Column C increased by 1 plus the percentage increase in the CPI-U for the prior FY (102.4 percent). Column E................. FY 2013 TC MAP Exp. Including DSH. This column contains the amount of the States' FY 2013 total computable (TC) medical assistance expenditures including DSH expenditures. Column F................. FY 2013 TC DSH Expenditures. This column contains the amount of the States' FY 2013 total computable DSH expenditures. Column G................. FY 2013 TC MAP Exp. Net of DSH. This column contains the amount of the States' FY 2013 total computable medical assistance expenditures net of DSH expenditures, calculated as the amount in Column E minus the amount in Column F. Column H................. 12 percent Amount. This column contains the amount of the ``12 percent limit'' in Federal share, determined in accordance with the provisions of section 1923(f)(3) of the Act. Column I................. Greater of FY 2012 Allotment or 12 percent Limit. This column contains the greater of the State's prior FY (FY 2012) DSH allotment or the amount of the 12 percent Limit, determined as the maximum of the amount in Column C or Column H Column J................. FY 2013 DSH Allotment. This column contains the States' final FY 2013 DSH allotments, determined as the minimum of the amount in Column I or Column D. For states with ``na'' in Columns I or D, refer to the footnotes in the addendum. ------------------------------------------------------------------------ [[Page 5452]] Addendum 1--Final DSH Allotments for FY 2013 ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Prior FY (2012) DSH allotment FY 2013 TC MAP FY 2013 TC MAP ``12% Amount'' = Greater of Col H FY 2013 DSH State FY 2013 FMAPs Prior FY (2012) (Col C) x 100% + Exp. including FY 2013 TC DSH EXP. net of DSH Col G x .12/(1- or Col C (12% allotment MIN (percent) DSH allotments Pct increase in DSH expenditures Col E-F .12/Col B)* (in limit, FY 2012 Col I, Col D CPIU: 102.4% FS) Allotment) A B C D E F G H I J ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ALABAMA...................................................... 68.53 $315,520,769 $323,093,267 $4,999,646,843 $470,923,104 $4,528,723,739 $658,807,935 $658,807,935 $323,093,267 ARIZONA...................................................... 65.68 103,890,985 106,384,369 8,437,380,837 173,082,813 8,264,298,024 1,213,410,792 1,213,410,792 106,384,369 CALIFORNIA................................................... 50.00 1,124,844,365 1,151,840,630 61,425,894,719 2,119,710,409 59,306,184,310 9,364,134,365 9,364,134,365 1,151,840,630 COLORADO..................................................... 50.00 94,912,751 97,190,657 5,048,193,724 194,191,858 4,854,001,866 766,421,347 766,421,347 97,190,657 CONNECTICUT.................................................. 50.00 205,216,760 210,141,962 6,415,388,481 272,860,246 6,142,528,235 969,872,879 969,872,879 210,141,962 DISTRICT OF COLUMBIA......................................... 70.00 62,847,632 64,355,975 2,275,681,171 56,387,767 2,219,293,404 321,414,907 321,414,907 64,355,975 FLORIDA...................................................... 58.08 205,216,760 210,141,962 18,411,438,180 335,009,637 18,076,428,543 2,734,059,817 2,734,059,817 210,141,962 GEORGIA...................................................... 65.56 275,760,021 282,378,262 8,887,641,041 429,964,548 8,457,676,493 1,242,312,033 1,242,312,033 282,378,262 ILLINOIS..................................................... 50.00 220,608,017 225,902,609 15,493,580,784 447,072,185 15,046,508,599 2,375,764,516 2,375,764,516 225,902,609 INDIANA...................................................... 67.16 219,325,413 224,589,223 7,930,553,510 337,536,579 7,593,016,931 1,109,384,374 1,109,384,374 224,589,223 KANSAS....................................................... 56.51 42,325,957 43,341,780 2,544,769,057 76,622,785 2,468,146,272 376,027,713 376,027,713 43,341,780 KENTUCKY..................................................... 70.55 148,782,151 152,352,923 5,726,056,802 216,263,666 5,509,793,136 796,685,033 796,685,033 152,352,923 LOUISIANA/1.................................................. na na na na na na na na 731,960,000 MAINE........................................................ 62.57 107,738,799 110,324,530 2,826,874,563 37,489,437 2,789,385,126 414,155,018 414,155,018 110,324,530 MARYLAND..................................................... 50.00 78,238,890 80,116,623 7,688,146,740 134,340,816 7,553,805,924 1,192,706,199 1,192,706,199 80,116,623 MASSACHUSETTS................................................ 50.00 312,955,559 320,466,492 12,999,170,453 0 12,999,170,453 2,052,500,598 2,052,500,598 320,466,492 MICHIGAN..................................................... 66.39 271,912,207 278,438,100 12,308,409,960 387,951,247 11,920,458,713 1,746,054,614 1,746,054,614 278,438,100 MISSISSIPPI.................................................. 73.43 156,477,779 160,233,246 4,708,563,005 217,999,554 4,490,563,451 644,132,328 644,132,328 160,233,246 MISSOURI..................................................... 61.37 486,107,200 497,773,773 8,863,322,084 703,393,659 8,159,928,425 1,217,196,210 1,217,196,210 497,773,773 NEVADA....................................................... 59.74 47,456,375 48,595,328 1,797,228,664 81,373,600 1,715,855,064 257,658,605 257,658,605 48,595,328 NEW HAMPSHIRE................................................ 50.00 164,274,500 168,217,088 1,188,634,372 40,923,914 1,147,710,458 181,217,441 181,217,441 168,217,088 NEW JERSEY................................................... 50.00 660,541,446 676,394,441 10,480,866,440 1,298,115,161 9,182,751,279 1,449,908,097 1,449,908,097 676,394,441 NEW YORK..................................................... 50.00 1,648,147,103 1,687,702,633 52,489,778,879 3,423,365,423 49,066,413,456 7,747,328,440 7,747,328,440 1,687,702,633 NORTH CAROLINA............................................... 65.51 302,694,721 309,959,394 11,721,921,735 617,376,633 11,104,545,102 1,631,378,246 1,631,378,246 309,959,394 OHIO......................................................... 63.58 416,846,544 426,850,861 16,628,494,101 649,120,744 15,979,373,357 2,363,633,714 2,363,633,714 426,850,861 PENNSYLVANIA................................................. 54.28 575,889,532 589,710,881 20,922,389,122 847,055,684 20,075,333,438 3,092,778,900 3,092,778,900 589,710,881 RHODE ISLAND................................................. 51.26 66,695,447 68,296,138 1,909,141,351 129,846,057 1,779,295,294 278,777,412 278,777,412 68,296,138 SOUTH CAROLINA............................................... 70.43 336,042,444 344,107,463 4,690,094,944 457,173,209 4,232,921,735 612,270,432 612,270,432 344,107,463 TENNESSEE/2.................................................. na na na na na na na na 53,100,000 TEXAS........................................................ 59.30 981,192,634 1,004,741,257 27,752,018,303 226,747,941 27,525,270,362 4,141,011,076 4,141,011,076 1,004,741,257 VERMONT...................................................... 56.04 23,086,886 23,640,971 1,452,095,084 37,448,781 1,414,646,303 216,013,021 216,013,021 23,640,971 VIRGINIA..................................................... 50.00 89,892,713 92,050,138 7,218,485,856 186,468,433 7,032,017,423 1,110,318,540 1,110,318,540 92,050,138 WASHINGTON................................................... 50.00 189,825,503 194,381,315 7,805,501,929 366,733,930 7,438,767,999 1,174,542,316 1,174,542,316 194,381,315 WEST VIRGINIA................................................ 72.04 69,260,656 70,922,912 3,007,417,198 75,434,137 2,931,983,061 422,158,680 422,158,680 70,922,912 ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Total.................................................... 0.00 10,004,528,519 10,244,637,203 366,054,779,932 15,047,983,957 351,006,795,975 53,874,035,598 53,874,035,598 11,029,697,203 ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- LOW DSH STATES ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ALASKA....................................................... 50.00 20,901,012 21,402,636 1,340,719,400 21,706,474 1,319,012,926 208,265,198.84 208,265,199 21,402,636 ARKANSAS..................................................... 70.17 44,262,980 45,325,292 4,156,350,929 61,000,000 4,095,350,929 592,822,640 592,822,640 45,325,292 DELAWARE..................................................... 55.67 9,289,338 9,512,282 1,557,544,100 10,874,669 1,546,669,431 236,601,110 236,601,110 9,512,282 HAWAII....................................................... 51.86 10,000,000 10,240,000 1,586,220,307 24,971,280 1,561,249,027 243,752,256.52 243,752,257 10,240,000 IDAHO........................................................ 71.00 16,866,254 17,271,044 1,641,925,393 23,708,980 1,618,216,413 233,681,421.00 233,681,421 17,271,044 IOWA......................................................... 59.59 40,408,349 41,378,149 3,622,873,642 54,606,370 3,568,267,272 536,162,337 536,162,337 41,378,149 MINNESOTA.................................................... 50.00 76,637,045 78,476,334 8,781,239,289 46,287,099 8,734,952,190 1,379,202,977 1,379,202,977 78,476,334 MONTANA...................................................... 66.00 11,646,847 11,926,371 996,801,715 17,703,206 979,098,509 143,601,115 143,601,115 11,926,371 NEBRASKA..................................................... 55.76 29,036,347 29,733,219 1,790,372,947 45,313,162 1,745,059,785 266,831,445 266,831,445 29,733,219 NEW MEXICO................................................... 69.07 20,901,012 21,402,636 3,280,561,202 25,164,146 3,255,397,056 472,788,382 472,788,382 21,402,636 NORTH DAKOTA................................................. 52.27 9,801,133 10,036,360 775,035,726 1,265,931 773,769,795 120,521,323 120,521,323 10,036,360 OKLAHOMA..................................................... 64.00 37,157,353 38,049,129 4,481,944,280 41,759,650 4,440,184,630 655,781,115 655,781,115 38,049,129 OREGON....................................................... 62.44 46,446,693 47,561,414 5,070,815,864 76,536,235 4,994,279,629 741,894,100 741,894,100 47,561,414 SOUTH DAKOTA................................................. 56.19 11,332,733 11,604,719 758,090,042 1,441,151 756,648,891 115,454,450 115,454,450 11,604,719 UTAH......................................................... 69.61 20,129,695 20,612,808 2,087,187,059 28,794,708 2,058,392,351 298,457,958 298,457,958 20,612,808 WISCONSIN.................................................... 59.74 96,998,597 99,326,563 7,034,898,860 581,325 7,034,317,535 1,056,296,932 1,056,296,932 99,326,563 WYOMING...................................................... 50.00 232,233 237,807 546,576,901 463,560 546,113,341 86,228,422 86,228,422 237,807 -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- [[Page 5453]] Total Low DSH States..................................... 0.00 502,047,621 514,096,764 49,509,157,656 482,177,946 49,026,979,710 7,388,343,182 7,388,343,182 514,096,763 -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Total................................................ 0.00 10,506,576,140 10,758,733,967 415,563,937,588 15,530,161,903 400,033,775,685 61,262,378,780 61,262,378,780 11,543,793,966 ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- \1\ FY 2013 DSH allotment for Louisiana determined under the provisions of section 1903(f)(3)(C) and (D) of the Act. \2\ Tennessee's DSH allotments are determined under section 1923(f)(6)(A)(v)(II) of the Act. Under this provision, Tennessee's DSH payments for FY 2013 are limited to $53,100,000. \3\ Beginning FY 2013, under section 1923(f)(6)(B)(II) of the Act, Hawaii's DSH allotments are determined as for low-DSH states. This means its allotments are determined as for all States, by increasing the previous fiscal year allotment by the CPIU for the previous fiscal year. [[Page 5454]] Key to Addendum 2--Preliminary DSH Allotments for FY 2015 [The Preliminary FY 2015 DSH Allotments for the NON-Low DSH States are presented in the top section of this addendum, and the Preliminary FY 2015 DSH Allotments for the Low-DSH States are presented in the bottom section of this addendum] ------------------------------------------------------------------------ Column Description ------------------------------------------------------------------------ Column A................. State. Column B................. FY 2015 FMAPs. This column contains the States' FY 2015 Federal Medical Assistance Percentages. Column C................. Prior FY (2014) DSH Allotments. This column contains the States' prior FY 2014 DSH Allotments Column D................. Prior FY (2014) DSH Allotments (Col C) x (100 percent + Percentage Increase in CPIU): 101.6 percent. This column contains the amount in Column C increased by 1 plus the estimated percentage increase in the CPI-U for the prior FY (101.6 percent). Column E................. FY 2015 TC MAP Exp. Including DSH. This column contains the amount of the States' projected FY 2015 total computable (TC) medical assistance expenditures including DSH expenditures. Column F................. FY 2015 TC DSH Expenditures. This column contains the amount of the States' projected FY 2015 total computable DSH expenditures. Column G................. FY 2015 TC MAP Exp. Net of DSH. This column contains the amount of the States' projected FY 2015 total computable medical assistance expenditures net of DSH expenditures, calculated as the amount in Column E minus the amount in Column F. Column H................. 12 percent Amount. This column contains the amount of the ``12 percent limit'' in Federal share, determined in accordance with the provisions of section 1923(f)(3) of the Act. Column I................. Greater of FY 2014 Allotment or 12 percent Limit. This column contains the greater of the State's prior FY (FY 2014) DSH allotment or the amount of the 12 percent Limit, determined as the maximum of the amount in Column C or Column H. Column J................. FY 2015 DSH Allotment. This column contains the States' preliminary FY 2015 DSH allotments, determined as the minimum of the amount in Column I or Column D. For states with ``na'' in Columns I or D, refer to the footnotes in the addendum. ------------------------------------------------------------------------ [[Page 5455]] Addendum 2--Preliminary DSH Allotments for FY 2015 ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Prior FY (2014) DSH Allotment FY 2015 TC MAP FY 2015 TC MAP ``12% Amount'' = Greater of Col H FY 2015 DSH State FY 2015 FMAPs Prior FY (2014) (Col C) x 100% + Exp. Including FY 2015 TC DSH EXP. Net Of DSH Col G x .12/(1- or Col C (12% Allotment Min Col (percent) DSH allotments Pct increase in DSH \4\ Expenditures \4\ Col E-F .12/Col B)* (in Limit, FY 2014 I, Col D CPIU: 101.6% FS) allotment) A B C D E F G H I J ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ALABAMA...................................................... 68.99 $327,939,666 $333,186,701 $5,727,646,000 $507,528,000 $5,220,118,000 $758,313,966 $758,313,966 $333,186,701 ARIZONA...................................................... 68.46 107,980,135 109,707,817 11,262,757,000 167,012,000 11,095,745,000 1,614,483,959 1,614,483,959 109,707,817 CALIFORNIA................................................... 50.00 1,169,118,239 1,187,824,131 96,031,140,000 597,609,000 95,433,531,000 15,068,452,263 15,068,452,263 1,187,824,131 COLORADO..................................................... 51.01 98,648,517 100,226,893 6,927,502,000 204,899,000 6,722,603,000 1,054,867,918 1,054,867,918 100,226,893 CONNECTICUT.................................................. 50.00 213,294,091 216,706,796 7,094,230,000 125,646,000 6,968,584,000 1,100,302,737 1,100,302,737 216,706,796 DISTRICT OF COLUMBIA......................................... 70.00 65,321,315 66,366,456 2,630,681,000 37,174,000 2,593,507,000 375,611,359 375,611,359 66,366,456 FLORIDA...................................................... 59.72 213,294,091 216,706,796 22,430,097,000 362,102,000 22,067,995,000 3,314,083,809 3,314,083,809 216,706,796 GEORGIA...................................................... 66.94 286,613,936 291,199,759 9,915,707,000 434,725,000 9,480,982,000 1,386,218,278 1,386,218,278 291,199,759 ILLINOIS..................................................... 50.76 229,291,148 232,959,806 19,753,482,000 456,614,000 19,296,868,000 3,032,535,665 3,032,535,665 232,959,806 INDIANA...................................................... 66.52 227,958,061 231,605,390 10,719,730,000 474,987,000 10,244,743,000 1,499,956,649 1,499,956,649 231,605,390 KANSAS....................................................... 56.63 43,991,907 44,695,778 3,161,490,000 74,228,000 3,087,262,000 470,082,851 470,082,851 44,695,778 KENTUCKY..................................................... 69.94 154,638,217 157,112,428 8,903,447,000 241,000,000 8,662,447,000 1,254,784,004 1,254,784,004 157,112,428 LOUISIANA \1\................................................ 62.05 731,960,000 743,671,360 7,995,712,000 551,048,000 7,444,664,000 1,107,551,811 1,107,551,811 743,671,360 MAINE........................................................ 61.88 111,979,398 113,771,068 2,565,931,000 38,566,000 2,527,365,000 376,247,024 376,247,024 113,771,068 MARYLAND..................................................... 50.00 81,318,372 82,619,466 11,133,665,000 92,859,000 11,040,806,000 1,743,285,158 1,743,285,158 82,619,466 MASSACHUSETTS................................................ 50.00 325,273,489 330,477,865 16,287,567,000 0 16,287,567,000 2,571,721,105 2,571,721,105 330,477,865 MICHIGAN..................................................... 65.54 282,614,672 287,136,507 16,050,268,000 322,351,000 15,727,917,000 2,310,364,618 2,310,364,618 287,136,507 MISSISSIPPI.................................................. 73.58 162,636,745 165,238,933 5,362,441,000 228,204,000 5,134,237,000 736,168,545 736,168,545 165,238,933 MISSOURI..................................................... 63.45 505,240,380 513,324,226 9,641,725,000 713,722,000 8,928,003,000 1,321,240,327 1,321,240,327 513,324,226 NEVADA....................................................... 64.36 49,324,258 50,113,446 2,848,030,000 78,128,000 2,769,902,000 408,565,835 408,565,835 50,113,446 NEW HAMPSHIRE................................................ 50.00 170,740,344 173,472,190 1,816,048,000 76,097,000 1,739,951,000 274,729,105 274,729,105 173,472,190 NEW JERSEY................................................... 50.00 686,540,358 697,525,004 14,214,233,000 1,213,776,000 13,000,457,000 2,052,703,737 2,052,703,737 697,525,004 NEW YORK..................................................... 50.00 1,713,018,172 1,740,426,463 68,512,267,000 5,326,800,000 63,185,467,000 9,976,652,684 9,976,652,684 1,740,426,463 NORTH CAROLINA............................................... 65.88 314,608,785 319,642,526 12,482,232,000 411,389,000 12,070,843,000 1,771,107,209 1,771,107,209 319,642,526 OHIO......................................................... 62.64 433,253,624 440,185,682 21,305,059,000 0 21,305,059,000 3,162,438,142 3,162,438,142 440,185,682 PENNSYLVANIA................................................. 51.82 598,556,544 608,133,449 24,679,963,000 787,072,000 23,892,891,000 3,731,179,141 3,731,179,141 608,133,449 RHODE ISLAND................................................. 50.00 69,320,580 70,429,709 3,117,756,000 142,487,000 2,975,269,000 469,779,316 469,779,316 70,429,709 SOUTH CAROLINA............................................... 70.64 349,269,075 354,857,380 5,636,583,000 494,437,000 5,142,146,000 743,331,228 743,331,228 354,857,380 TENNESSEE \2\................................................ na na na na na na na na 53,100,000 TEXAS........................................................ 58.05 1,019,812,376 1,036,129,374 35,894,535,000 2,630,047,000 33,264,488,000 5,031,931,019 5,031,931,019 1,036,129,374 VERMONT \5\.................................................. 56.21 23,995,586 24,379,515 1,577,599,000 37,449,000 1,540,150,000 234,983,483 234,983,483 24,379,515 VIRGINIA..................................................... 50.00 93,430,890 94,925,784 8,689,637,000 193,862,000 8,495,775,000 1,341,438,158 1,341,438,158 94,925,784 WASHINGTON................................................... 50.03 197,297,035 200,453,788 12,536,442,000 405,243,000 12,131,199,000 1,915,089,832 1,915,089,832 200,453,788 WEST VIRGINIA................................................ 71.35 71,986,756 73,138,544 3,631,855,000 71,987,000 3,559,868,000 513,556,694 513,556,694 73,138,544 ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Total.................................................... ................. 11,130,266,762 11,308,351,030 490,537,457,000 17,499,048,000 473,038,409,000 72,723,757,629 72,723,757,629 11,361,451,030 -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- LOW DSH STATES ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ALASKA....................................................... 50.00 21,723,676 22,071,255 1,661,590,000 21,894,000 1,639,696,000 258,899,368.42 258,899,368 22,071,255 ARKANSAS..................................................... 70.88 46,005,171 46,741,254 6,070,657,000 65,820,000 6,004,837,000 867,437,867 867,437,867 46,741,254 DELAWARE..................................................... 53.63 9,654,966 9,809,445 1,549,168,000 24,248,000 1,524,920,000 235,738,053 235,738,053 9,809,445 HAWAII \3\................................................... 52.23 10,393,600 10,559,898 1,951,834,000 0 1,951,834,000 304,084,384.25 304,084,384 10,559,898 IDAHO........................................................ 71.75 17,530,110 17,810,592 2,009,716,000 24,470,000 1,985,246,000 286,074,779.25 286,074,779 17,810,592 IOWA......................................................... 55.54 41,998,821 42,670,802 4,714,183,000 34,688,000 4,679,495,000 716,304,508 716,304,508 42,670,802 MINNESOTA.................................................... 50.00 79,653,479 80,927,935 11,849,443,000 154,792,000 11,694,651,000 1,846,523,842 1,846,523,842 80,927,935 MONTANA...................................................... 65.90 12,105,267 12,298,951 1,030,146,000 1,896,000 1,028,250,000 150,860,872 150,860,872 12,298,951 NEBRASKA..................................................... 53.27 30,179,217 30,662,084 2,053,612,000 42,720,000 2,010,892,000 311,471,433 311,471,433 30,662,084 NEW MEXICO................................................... 69.65 21,723,676 22,071,255 4,758,998,000 31,196,000 4,727,802,000 685,428,779 685,428,779 22,071,255 NORTH DAKOTA................................................. 50.00 10,186,905 10,349,895 1,155,141,000 1,735,000 1,153,406,000 182,116,737 182,116,737 10,349,895 OKLAHOMA..................................................... 62.30 38,619,866 39,237,784 5,404,554,000 58,140,000 5,346,414,000 794,628,053 794,628,053 39,237,784 OREGON....................................................... 64.06 48,274,835 49,047,232 8,294,293,000 81,136,000 8,213,157,000 1,212,757,981 1,212,757,981 49,047,232 SOUTH DAKOTA................................................. 51.64 11,778,790 11,967,251 857,827,000 1,613,000 856,214,000 133,849,317 133,849,317 11,967,251 UTAH......................................................... 70.56 20,922,000 21,256,752 2,276,646,000 31,390,000 2,245,256,000 324,641,933 324,641,933 21,256,752 WISCONSIN.................................................... 58.27 100,816,461 102,429,524 8,016,231,000 166,265,000 7,849,966,000 1,186,300,027 1,186,300,027 102,429,524 WYOMING...................................................... 50.00 241,374 245,236 596,915,000 476,000 596,439,000 94,174,579 94,174,579 245,236 -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- [[Page 5456]] Total Low DSH States..................................... ................. 521,808,214 530,157,145 64,250,954,000 742,479,000 63,508,475,000 9,591,292,512 9,591,292,512 530,157,145 -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Total................................................ ................. 11,652,074,976 11,838,508,176 554,788,411,000 18,241,527,000 536,546,884,000 82,315,050,141 82,315,050,141 11,891,608,175 ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- \1\ Louisiana's FY 2015 DSH allotment is determined under the provisions of section 1923(f)(3)(C) and (D) of the Act. \2\ Tennessee's DSH allotment for FY 2015 determined under section 1923(f)(6)(A)(vi) of the Act \3\ Beginning FY 2013, under section 1923(f)(6)(B)(II) of the Act, Hawaii's DSH allotment for a fiscal year is determined as for low-DSH states. This means Hawaii's DSH allotment for a fiscal year is determined as for all States, by increasing the previous fiscal year allotment by the percentage increase in the CPIU for the previous fiscal year. \4\ Expenditures based on the amounts reported by States on the Form CMS-37. \5\ FMAP for Vermont for FY 2015 determined in accordance with section 1905(z)(1)(A) of the Act. [[Page 5457]] Key to Addendum 3--Final IMD DSH Limits for FY 2013 [The final FY 2013 IMD DSH Limits for the Non-Low DSH States are presented in the top section of this addendum and the preliminary FY 2013 IMD DSH Limits for the Low-DSH States are presented in the bottom section of the addendum] ------------------------------------------------------------------------ Column Description ------------------------------------------------------------------------ Column A................. State. Column B................. Inpatient Hospital Services FY 95 DSH Total Computable This column contains the States' total computable FY 1995 inpatient hospital DSH expenditures as reported on the Form CMS-64. Column C................. IMD and Mental Health Services FY 95 DSH Total Computable. This column contains the total computable FY 1995 mental health facility DSH expenditures as reported on the Form CMS- 64 as of January 1, 1997. Column D................. Total Inpatient Hospital & IMD & Mental Health FY 95 DSH Total Computable, Col. B + C. This column contains the total computation of all inpatient hospital DSH expenditures and mental health facility DSH expenditures for FY 1995 as reported on the Form CMS-64 as of January 1, 1997 (representing the sum of Column B and Column C). Column E................. Applicable Percentage, Col. C/D. This column contains the ``applicable percentage'' representing the total Computable FY 1995 mental health facility DSH expenditures divided by total computable all inpatient hospital and mental health facility DSH expenditures for FY 1995 (the amount in Column C divided by the amount in Column D) Per section 1923(h)(2)(A)(ii)(III) of the Act, for FYs after FY 2002, the applicable percentage can be no greater than 33 percent. Column F................. FY 2013 Federal Share DSH Allotment This column contains the states' FY 2013 DSH allotments from Column J Addendum 1. Column G................. FY 2013 FMAP. Column H................. FY 2013 DSH Allotments in Total Computable, Col. F/G. This column contains states' FY 2013 total computable DSH allotment (determined as Column F/Column G). Column I................. Applicable Percentage Applied to FY 2013 Allotments in TC, Col E x Col H. This column contains the applicable percentage of FY 2012 total computable DSH allotment (calculated as the percentage in Column E multiplied by the amount in Column H). Column J................. FY 2013 TC IMD DSH Limit. Lesser of Col. I or C. This column contains the total computable FY 2013 TC IMD DSH Limit equal to the lesser of the amount in Column I or Column C. Column K................. FY 2013 IMD DSH Limit in Federal Share, Col. G x J. This column contains the FY 2013 Federal Share IMD DSH limit determined by converting the total computable FY 2013 IMD DSH Limit from Column J into a federal share amount by multiplying it by the FY 2013 FMAP in Column G. ------------------------------------------------------------------------ [[Page 5458]] Addendum 3--Final IMD DSH Limits for FY 2013 ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Applicable Inpatient IMD And mental Total inpatient percentage FY 2013 TC Hospital health services & IMD & mental Applicable FY 2013 FY 2013 applied to FY IMD Limit FY 2013 IMD MMA LOW State services FY 95 FY 95 DSH health FY 95 DSH percent FY 2013 FMAPs Allotments in TC 2013 (Lesser Of Limit In FS DSH DSH Total Total total Col C/D Allotment In FS (percent) Col F/G allotments in Col I or Col Col G x J Status computable computable computable Col B (percent) TC Col E x C) + C Col H A B C D E F G H I J K L ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ALABAMA................................................... $413,006,229 $4,451,770 $417,457,999 1.07 $323,093,267 68.53 471,462,523 $5,027,674 $4,451,770 $3,050,798 N/A ARIZONA................................................... 93,916,100 28,474,900 122,391,000 23.27 106,384,369 65.68 161,973,765 37,684,035 28,474,900 18,702,314 N/A CALIFORNIA................................................ 2,189,879,543 1,555,919 2,191,435,462 0.07 1,151,840,630 50.00 2,303,681,260 1,635,614 1,555,919 777,960 N/A COLORADO.................................................. 173,900,441 594,776 174,495,217 0.34 97,190,657 50.00 194,381,314 662,559 594,776 297,388 N/A CONNECTICUT............................................... 303,359,275 105,573,725 408,933,000 25.82 210,141,962 50.00 420,283,924 108,504,179 105,573,725 52,786,863 N/A DISTRICT OF COLUMBIA...................................... 39,532,234 6,545,136 46,077,370 14.20 64,355,975 70.00 91,937,107 13,059,358 6,545,136 4,581,595 N/A FLORIDA................................................... 184,468,014 149,714,986 334,183,000 33.00 210,141,962 58.08 361,814,673 119,398,842 119,398,842 69,346,847 N/A GEORGIA................................................... 407,343,557 0 407,343,557 0.00 282,378,262 65.56 430,717,300 0 0 0 N/A ILLINOIS.................................................. 315,868,508 89,408,276 405,276,784 22.06 225,902,609 50.00 451,805,218 99,672,933 89,408,276 44,704,138 N/A INDIANA................................................... 79,960,783 153,566,302 233,527,085 33.00 224,589,223 67.16 334,409,206 110,355,038 110,355,038 74,114,444 N/A KANSAS.................................................... 11,587,208 76,663,508 88,250,716 33.00 43,341,780 56.51 76,697,540 25,310,188 25,310,188 14,302,787 N/A KENTUCKY.................................................. 158,804,908 37,443,073 196,247,981 19.08 152,352,923 70.55 215,950,281 41,202,167 37,443,073 26,416,088 N/A LOUISIANA................................................. 1,078,512,169 132,917,149 1,211,429,318 10.97 731,960,000 65.51 1,117,325,599 122,592,157 122,592,157 80,310,122 N/A MAINE..................................................... 99,957,958 60,958,342 160,916,300 33.00 110,324,530 62.57 176,321,768 58,186,183 58,186,183 36,407,095 N/A MARYLAND.................................................. 22,226,467 120,873,531 143,099,998 33.00 80,116,623 50.00 160,233,246 52,876,971 52,876,971 26,438,486 N/A MASSACHUSETTS............................................. 469,653,946 105,635,054 575,289,000 18.36 320,466,492 50.00 640,932,984 117,688,658 105,635,054 52,817,527 N/A MICHIGAN.................................................. 133,258,800 304,765,552 438,024,352 33.00 278,438,100 66.39 419,397,650 138,401,225 138,401,225 91,884,573 N/A MISSISSIPPI............................................... 182,608,033 0 182,608,033 0.00 160,233,246 73.43 218,212,238 0 0 0 N/A MISSOURI.................................................. 521,946,524 207,234,618 729,181,142 28.42 497,773,773 61.37 811,102,775 230,516,896 207,234,618 127,179,885 N/A NEVADA.................................................... 73,560,000 0 73,560,000 0.00 48,595,328 59.74 81,344,707 0 0 0 N/A NEW HAMPSHIRE............................................. 92,675,916 94,753,948 187,429,864 33.00 168,217,088 50.00 336,434,176 111,023,278 94,753,948 47,376,974 N/A NEW JERSEY................................................ 736,742,539 357,370,461 1,094,113,000 32.66 676,394,441 50.00 1,352,788,882 441,861,843 357,370,461 178,685,231 N/A NEW YORK.................................................. 2,418,869,368 605,000,000 3,023,869,368 20.01 1,687,702,633 50.00 3,375,405,266 675,333,468 605,000,000 302,500,000 N/A NORTH CAROLINA............................................ 193,201,966 236,072,627 429,274,593 33.00 309,959,394 65.51 473,148,212 156,138,910 156,138,910 102,286,600 N/A OHIO...................................................... 535,731,956 93,432,758 629,164,714 14.85 426,850,861 63.58 671,360,272 99,698,919 93,432,758 59,404,548 N/A PENNSYLVANIA.............................................. 388,207,319 579,199,682 967,407,001 33.00 589,710,881 54.28 1,086,423,878 358,519,880 358,519,880 194,604,591 N/A RHODE ISLAND.............................................. 108,503,167 2,397,833 110,901,000 2.16 68,296,138 51.26 133,234,760 2,880,720 2,397,833 1,229,129 N/A SOUTH CAROLINA............................................ 366,681,364 72,076,341 438,757,705 16.43 344,107,463 70.43 488,580,808 80,260,965 72,076,341 50,763,367 N/A TENNESSEE................................................. 0 0 0 0.00 53,100,000 66.13 80,296,386 0 0 0 N/A TEXAS..................................................... 1,220,515,401 292,513,592 1,513,028,993 19.33 1,004,741,257 59.30 1,694,336,015 327,565,642 292,513,592 173,460,560 N/A VERMONT................................................... 19,979,252 9,071,297 29,050,549 31.23 23,640,971 56.04 42,185,887 13,172,925 9,071,297 5,083,555 N/A VIRGINIA.................................................. 129,313,480 7,770,268 137,083,748 5.67 92,050,138 50.00 184,100,276 10,435,289 7,770,268 3,885,134 N/A WASHINGTON................................................ 171,725,815 163,836,435 335,562,250 33.00 194,381,315 50.00 388,762,630 128,291,668 128,291,668 64,145,834 N/A WEST VIRGINIA............................................. 66,962,606 18,887,045 85,849,651 22.00 70,922,912 72.04 98,449,350 21,658,997 18,887,045 13,606,227 N/A ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Total................................................. 13,402,460,846 4,118,758,904 17,521,219,750 .......... 11,029,697,203 ......... 19,545,491,877 3,709,617,180 3,410,261,852 1,921,150,660 ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- LOW DSH STATES ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ALASKA.................................................... $2,506,827 $17,611,765 $20,118,592 33.00 $21,402,636 50.00 $42,805,272 $14,125,740 $14,125,740 $7,062,870 LOW DSH ARKANSAS.................................................. 2,422,649 819,351 3,242,000 25.27 45,325,292 70.17 64,593,547 16,324,734 819,351 574,939 LOW DSH DELAWARE.................................................. 0 7,069,000 7,069,000 33.00 9,512,282 55.67 17,086,909 5,638,680 5,638,680 3,139,053 LOW DSH HAWAII.................................................... 0 0 0 0.00 10,240,000 51.86 19,745,469 0 0 0 LOW DSH IDAHO..................................................... 2,081,429 0 2,081,429 0.00 17,271,044 71.00 24,325,414 0 0 0 LOW DSH IOWA...................................................... 12,011,250 0 12,011,250 0.00 41,378,149 59.59 69,438,075 0 0 0 LOW DSH MINNESOTA................................................. 24,240,000 5,257,214 29,497,214 17.82 78,476,334 50.00 156,952,668 27,973,278 5,257,214 2,628,607 LOW DSH MONTANA................................................... 237,048 0 237,048 0.00 11,926,371 66.00 18,070,259 0 0 0 LOW DSH NEBRASKA.................................................. 6,449,102 1,811,337 8,260,439 21.93 29,733,219 55.76 53,323,563 11,692,713 1,811,337 1,010,002 LOW DSH NEW MEXICO................................................ 6,490,015 254,786 6,744,801 3.78 21,402,636 69.07 30,986,877 1,170,535 254,786 175,981 LOW DSH NORTH DAKOTA.............................................. 214,523 988,478 1,203,001 33.00 10,036,360 52.27 19,200,995 6,336,328 988,478 516,677 LOW DSH OKLAHOMA.................................................. 20,019,969 3,273,248 23,293,217 14.05 38,049,129 64.00 59,451,764 8,354,379 3,273,248 2,094,879 LOW DSH [[Page 5459]] OREGON.................................................... 11,437,908 19,975,092 31,413,000 33.00 47,561,414 62.44 76,171,387 25,136,558 19,975,092 12,472,447 LOW DSH SOUTH DAKOTA.............................................. 321,120 751,299 1,072,419 33.00 11,604,719 56.19 20,652,641 6,815,372 751,299 422,155 LOW DSH UTAH...................................................... 3,621,116 934,586 4,555,702 20.51 20,612,808 69.61 29,611,849 6,074,765 934,586 650,565 LOW DSH WISCONSIN................................................. 6,609,524 4,492,011 11,101,535 33.00 99,326,563 59.74 166,264,752 54,867,368 4,492,011 2,683,527 LOW DSH WYOMING................................................... 0 0 0 0.00 237,807 50.00 475,614 0 0 0 LOW DSH ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Total Low DSH States.................................. 98,662,480 63,238,167 161,900,647 .......... 514,096,763 ......... 869,157,055 184,510,449 58,321,822 33,431,702 ........ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Total................................................. 13,501,123,326 4,181,997,071 17,683,120,397 .......... 11,543,793,966 ......... 20,414,648,932 3,894,127,630 3,468,583,674 1,954,582,362 ........ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- [[Page 5460]] Key to Addendum 4--Preliminary IMD DSH Limits for FY 2015 [The preliminary FY 2015 IMD DSH Limits for the Non-Low DSH States are presented in the top section of this addendum and the preliminary FY 2015 IMD DSH Limits for the Low-DSH States are presented in the bottom section of the addendum] ------------------------------------------------------------------------ Column Description ------------------------------------------------------------------------ Column A................. State. Column B................. Inpatient Hospital Services FY 95 DSH Total Computable. This column contains the States' total computable FY 1995 inpatient hospital DSH expenditures as reported on the Form CMS-64. Column C................. IMD and Mental Health Services FY 95 DSH Total Computable. This column contains the total computable FY 1995 mental health facility DSH expenditures as reported on the Form CMS- 64 as of January 1, 1997. Column D................. Total Inpatient Hospital & IMD & Mental Health FY 95 DSH Total Computable, Col. B + C. This column contains the total computation of all inpatient hospital DSH expenditures and mental health facility DSH expenditures for FY 1995 as reported on the Form CMS-64 as of January 1, 1997 (representing the sum of Column B and Column C). Column E................. Applicable Percentage, Col. C/D. This column contains the ``applicable percentage'' representing the total Computable FY 1995 mental health facility DSH expenditures divided by total computable all inpatient hospital and mental health facility DSH expenditures for FY 1995 (the amount in Column C divided by the amount in Column D) Per section 1923(h)(2)(A)(ii)(III) of the Act, for FYs after FY 2002, the applicable percentage can be no greater than 33 percent. Column F................. FY 2015 Federal Share DSH Allotment. This column contains the states' preliminary FY 2015 DSH allotments from Column J Addendum 1. Column G................. FY 2015 FMAP. Column H................. FY 2015 DSH Allotments in Total Computable, Col. F/G. This column contains states' FY 2015 total computable DSH allotment (determined as Column F/Column G). Column I................. Applicable Percentage Applied to FY 2015 Allotments in TC, Col E x Col H. This column contains the applicable percentage of FY 2014 total computable DSH allotment (calculated as the percentage in Column E multiplied by the amount in Column H). Column J................. FY 2015 TC IMD DSH Limit. Lesser of Col. I or C. This column contains the total computable FY 2015 TC IMD DSH Limit equal to the lesser of the amount in Column I or Column C. Column K................. FY 2015 IMD DSH Limit in Federal Share, Col. G x J. This column contains the FY 2015 Federal Share IMD DSH limit determined by converting the total computable FY 2015 IMD DSH Limit from Column J into a federal share amount by multiplying it by the FY 2015 FMAP in Column G. ------------------------------------------------------------------------ [[Page 5461]] Addendum 4--Preliminary IMD DSH Limits for FY 2015 ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Applicable Inpatient Total inpatient & percentage hospital IMD and mental IMD & mental Applicable FY 2015 FY 2015 applied to FY FY 2015 TC IMD FY 2015 TC IMD MMA LOW State services FY 95 health services health FY 95 DSH percent FY 2015 allotment FMAPs allotments in TC 2015 Limit (Lesser limit in FS DSH DSH total FY 95 DSH total total computable Col C/D in FS (percent) Col. F/G allotments in Of Col I or Col G x J Status computable computable Col B + C TC Col E x Col C) Col H A B C D E F G H I J K L ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ALABAMA................................................... $413,006,229 $4,451,770 $417,457,999 1.07 $333,186,701 68.99 $482,949,269 $5,150,169 $4,451,770 $3,071,276 N/A ARIZONA................................................... 93,916,100 28,474,900 122,391,000 23.27 109,707,817 68.46 160,250,974 37,283,219 28,474,900 19,493,917 N/A CALIFORNIA................................................ 2,189,879,543 1,555,919 2,191,435,462 0.07 1,187,824,131 50.00 2,375,648,262 1,686,710 1,555,919 777,960 N/A COLORADO.................................................. 173,900,441 594,776 174,495,217 0.34 100,226,893 51.01 196,484,793 669,729 594,776 303,395 N/A CONNECTICUT............................................... 303,359,275 105,573,725 408,933,000 25.82 216,706,796 50.00 433,413,592 111,893,849 105,573,725 52,786,863 N/A DISTRICT OF COLUMBIA...................................... 39,532,234 6,545,136 46,077,370 14.20 66,366,456 70.00 94,809,223 13,467,332 6,545,136 4,581,595 N/A FLORIDA................................................... 184,468,014 149,714,986 334,183,000 33.00 216,706,796 59.72 362,871,393 119,747,560 119,747,560 71,513,243 N/A GEORGIA................................................... 407,343,557 0 407,343,557 0.00 291,199,759 66.94 435,016,073 0 0 0 N/A ILLINOIS.................................................. 315,868,508 89,408,276 405,276,784 22.06 232,959,806 50.76 458,943,668 101,247,749 89,408,276 45,383,641 N/A INDIANA................................................... 79,960,783 153,566,302 233,527,085 33.00 231,605,390 66.52 348,174,068 114,897,442 114,897,442 76,429,779 N/A KANSAS.................................................... 11,587,208 76,663,508 88,250,716 33.00 44,695,778 56.63 78,925,972 26,045,571 26,045,571 14,749,607 N/A KENTUCKY.................................................. 158,804,908 37,443,073 196,247,981 19.08 157,112,428 69.94 224,638,873 42,859,905 37,443,073 26,187,685 N/A LOUISIANA................................................. 1,078,512,169 132,917,149 1,211,429,318 10.97 743,671,360 62.05 1,198,503,400 131,498,927 131,498,927 81,595,084 N/A MAINE..................................................... 99,957,958 60,958,342 160,916,300 33.00 113,771,068 61.88 183,857,576 60,673,000 60,673,000 37,544,452 N/A MARYLAND.................................................. 22,226,467 120,873,531 143,099,998 33.00 82,619,466 50.00 165,238,932 54,528,848 54,528,848 27,264,424 N/A MASSACHUSETTS............................................. 469,653,946 105,635,054 575,289,000 18.36 330,477,865 50.00 660,955,730 121,365,252 105,635,054 52,817,527 N/A MICHIGAN.................................................. 133,258,800 304,765,552 438,024,352 33.00 287,136,507 65.54 438,108,799 144,575,904 144,575,904 94,755,047 N/A MISSISSIPPI............................................... 182,608,033 0 182,608,033 0.00 165,238,933 73.58 224,570,444 0 0 0 N/A MISSOURI.................................................. 521,946,524 207,234,618 729,181,142 28.42 513,324,226 63.45 809,021,633 229,925,432 207,234,618 131,490,365 N/A NEVADA.................................................... 73,560,000 0 73,560,000 0.00 50,113,446 64.36 77,864,273 0 0 0 N/A NEW HAMPSHIRE............................................. 92,675,916 94,753,948 187,429,864 33.00 173,472,190 50.00 346,944,380 114,491,645 94,753,948 47,376,974 N/A NEW JERSEY................................................ 736,742,539 357,370,461 1,094,113,000 32.66 697,525,004 50.00 1,395,050,008 455,665,607 357,370,461 178,685,231 N/A NEW YORK.................................................. 2,418,869,368 605,000,000 3,023,869,368 20.01 1,740,426,463 50.00 3,480,852,926 696,430,885 605,000,000 302,500,000 N/A NORTH CAROLINA............................................ 193,201,966 236,072,627 429,274,593 33.00 319,642,526 65.88 485,189,019 160,112,376 160,112,376 105,482,034 N/A OHIO...................................................... 535,731,956 93,432,758 629,164,714 14.85 440,185,682 62.64 702,722,992 104,356,372 93,432,758 58,526,280 N/A PENNSYLVANIA.............................................. 388,207,319 579,199,682 967,407,001 33.00 608,133,449 51.82 1,173,549,689 387,271,397 387,271,397 200,684,038 N/A RHODE ISLAND.............................................. 108,503,167 2,397,833 110,901,000 2.16 70,429,709 50.00 140,859,418 3,045,575 2,397,833 1,198,917 N/A SOUTH CAROLINA............................................ 366,681,364 72,076,341 438,757,705 16.43 354,857,380 70.64 502,346,234 82,522,262 72,076,341 50,914,727 N/A TENNESSEE*................................................ 0 0 0 0.00 53,100,000 64.99 81,704,878 0 0 0 N/A TEXAS..................................................... 1,220,515,401 292,513,592 1,513,028,993 19.33 1,036,129,374 58.05 1,784,891,256 345,072,669 292,513,592 169,804,140 N/A VERMONT**................................................. 19,979,252 9,071,297 29,050,549 31.23 24,379,515 56.21 43,372,202 13,543,363 9,071,297 5,098,976 N/A VIRGINIA.................................................. 129,313,480 7,770,268 137,083,748 5.67 94,925,784 50.00 189,851,568 10,761,287 7,770,268 3,885,134 N/A WASHINGTON................................................ 171,725,815 163,836,435 335,562,250 33.00 200,453,788 50.03 400,667,176 132,220,168 132,220,168 66,149,750 N/A WEST VIRGINIA............................................. 66,962,606 18,887,045 85,849,651 22.00 73,138,544 71.35 102,506,719 22,551,624 18,887,045 13,475,907 N/A ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Total................................................. 13,402,460,846 4,118,758,904 17,521,219,750 .......... 11,361,451,030 ......... 20,240,755,414 3,845,561,828 3,471,761,983 1,944,527,968 ........ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- LOW DSH STATES ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ALASKA.................................................... 2,506,827 17,611,765 20,118,592 33.00 22,071,255 50.00 44,142,510 14,567,028 14,567,028 7,283,514 LOW DSH ARKANSAS.................................................. 2,422,649 819,351 3,242,000 25.27 46,741,254 70.88 65,944,207 16,666,086 819,351 580,756 LOW DSH DELAWARE.................................................. 0 7,069,000 7,069,000 33.00 9,809,445 53.63 18,290,966 6,036,019 6,036,019 3,237,117 LOW DSH HAWAII.................................................... 0 0 0 0.00 10,559,898 52.23 20,218,070 0 0 0 LOW DSH IDAHO..................................................... 2,081,429 0 2,081,429 0.00 17,810,592 71.75 24,823,125 0 0 0 LOW DSH IOWA...................................................... 12,011,250 0 12,011,250 0.00 42,670,802 55.54 76,828,956 0 0 0 LOW DSH MINNESOTA................................................. 24,240,000 5,257,214 29,497,214 17.82 80,927,935 50.00 161,855,870 28,847,163 5,257,214 2,628,607 LOW DSH MONTANA................................................... 237,048 0 237,048 0.00 12,298,951 65.90 18,663,052 0 0 0 LOW DSH [[Page 5462]] NEBRASKA.................................................. 6,449,102 1,811,337 8,260,439 21.93 30,662,084 53.27 57,559,760 12,621,620 1,811,337 964,899 LOW DSH NEW MEXICO................................................ 6,490,015 254,786 6,744,801 3.78 22,071,255 69.65 31,688,808 1,197,050 254,786 177,458 LOW DSH NORTH DAKOTA.............................................. 214,523 988,478 1,203,001 33.00 10,349,895 50.00 20,699,790 6,830,931 988,478 494,239 LOW DSH OKLAHOMA.................................................. 20,019,969 3,273,248 23,293,217 14.05 39,237,784 62.30 62,981,997 8,850,460 3,273,248 2,039,234 LOW DSH OREGON.................................................... 11,437,908 19,975,092 31,413,000 33.00 49,047,232 64.06 76,564,521 25,266,292 19,975,092 12,796,044 LOW DSH SOUTH DAKOTA.............................................. 321,120 751,299 1,072,419 33.00 11,967,251 51.64 23,174,382 7,647,546 751,299 387,971 LOW DSH UTAH...................................................... 3,621,116 934,586 4,555,702 20.51 21,256,752 70.56 30,125,782 6,180,197 934,586 659,444 LOW DSH WISCONSIN................................................. 6,609,524 4,492,011 11,101,535 33.00 102,429,524 58.27 175,784,321 58,008,826 4,492,011 2,617,495 LOW DSH WYOMING................................................... 0 0 0 0.00 245,236 50.00 490,472 0 0 0 LOW DSH ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Total Low DSH States.................................. 98,662,480 63,238,167 161,900,647 .......... 530,157,145 ......... 909,836,589 192,719,219 59,160,449 33,866,778 ........ Total............................................. 13,501,123,326 4,181,997,071 17,683,120,397 .......... 11,891,608,175 ......... 21,150,592,003 4,038,281,047 3,530,922,432 1,978,394,746 ........ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- * Tennessee's DSH allotment for FY 2015 determined under section 1923(f)(6)(A)(vi) of the Act. ** Vermont's FMAP for FY 2015 determined in accordance with section 1905(z)(1)(A) of the Act [[Page 5463]] [FR Doc. 2016-01836 Filed 2-1-16; 8:45 am] BILLING CODE 4120-01-P
![5448 Federal Register / Vol. 81, No. 21 / Tuesday, February 2, 2016 / Notices
Friday of each week from 8:30 a.m. to DEPARTMENT OF HEALTH AND was described in the Disproportionate
4 p.m. To schedule an appointment to HUMAN SERVICES Share Hospital Payment Reduction final
view public comments, phone 1–800– rule published in the September 18,
743–3951. Centers for Medicare & Medicaid 2013 Federal Register (78 FR 57293).
Services Under the DSH reduction methodology,
FOR FURTHER INFORMATION CONTACT: Lisa first, each state’s unreduced FY DSH
Marie Gomez, (410) 786–1175. [CMS–2398–N]
allotment would have been calculated
SUPPLEMENTARY INFORMATION: On RIN 0983–ZB24 in accordance with the provisions of
December 31, 2015, we published a section 1923(f) of the Act, excluding
Medicaid Program; Final FY 2013 and section 1923(f)(7) of the Act; then, the
request for information in the Federal Preliminary FY 2015 Disproportionate
Register (80 FR 81824) entitled, reduction amount for each state would
Share Hospital Allotments, and Final have been determined under the
‘‘Request for Information: Certification FY 2013 and Preliminary FY 2015 provisions of section 1923(f)(7) of the
Frequency and Requirements for the Institutions for Mental Diseases Act and implementing regulations at 42
Reporting of Quality Measures Under Disproportionate Share Hospital Limits CFR 447.294; and, finally, the net FY
CMS Programs’’ (referred to in this DSH allotment for each state would
document as ‘‘the December 31 RFI’’). AGENCY: Centers for Medicare &
Medicaid Services (CMS), HHS. have been determined by subtracting the
That request for information seek public DSH reduction amount for the state
comment regarding several items related ACTION: Notice. from its unreduced FY 2014 DSH
to the certification of health information allotment.
SUMMARY: This notice announces the
technology (IT), including electronic The reductions under section
final federal share disproportionate
health records (EHR) products used for 1923(f)(7) of the Act were most recently
share hospital (DSH) allotments for
reporting to certain CMS quality delayed and modified by the Medicare
federal fiscal year (FY) 2013 and the
reporting programs such as, but not Access and CHIP Reauthorization Act of
preliminary federal share DSH
limited to, the Hospital Inpatient 2015 (MACRA) (Pub. L. 114–10),
allotments for FY 2015. This notice also
Quality Reporting (IQR) Program and enacted on April 16, 2015. The
announces the final FY 2013 and the
the Physician Quality Reporting System reductions of states’ fiscal year DSH
preliminary FY 2015 limitations on
(PQRS). In addition, it requested allotments under section 1923(f)(7) of
aggregate DSH payments that states may the Act that were applicable to FY 2017
feedback on how often to require make to institutions for mental disease
recertification, the number of clinical were repealed, and are instead
and other mental health facilities. In scheduled to begin in FY 2018 at
quality measures (CQMs) a certified addition, this notice includes modified levels. MACRA also extended
Health IT Module should be required to background information describing the DSH allotment reductions through 2025.
certify to, and testing of certified Health methodology for determining the Because there is no reduction to DSH
IT Module(s). amounts of states’ FY DSH allotments. allotments for FY 2015 under section
We have received inquiries from DATES: This notice is effective March 3, 1923(f)(7) of the Act, this notice
stakeholders regarding the 30-day 2016. The final allotments and contains only the state-specific
comment period to submit comments limitations set forth in this notice are preliminary FY 2015 DSH allotments, as
regarding the December 31 RFI. The effective for the fiscal years specified. calculated under the statute without
stakeholders stated that they need FOR FURTHER INFORMATION CONTACT: application of the reductions that would
additional time to respond to the Stuart Goldstein, (410) 786–0694 and have otherwise been imposed. This
questions posed in the December 31 Richard Cuno, (410) 786–1111. notice also provides information on the
RFI. Since we requested the public’s SUPPLEMENTARY INFORMATION: calculation of such FY DSH allotments,
comments on several options, we the calculation of the states’ IMD DSH
I. Background limits, and the amounts of states’
believe that it is important to allow
ample time for the public to prepare A. Fiscal Year DSH Allotments preliminary FY 2015 IMD DSH limits.
their comments. Therefore, we have A state’s federal fiscal year (FY) B. Determination of Fiscal Year DSH
decided to extend the comment period disproportionate share hospital (DSH) Allotments
for an additional 15 days. This allotment represents the aggregate limit Generally, in accordance with the
document announces the extension of on the federal share amount of the methodology specified under section
the public comment period to February state’s payments to DSH hospitals in the 1923(f)(3) of the Act, a state’s FY DSH
16, 2016. state for the FY. The amount of such allotment is calculated by increasing the
Dated: January 28, 2016. allotment is determined in accordance amount of its DSH allotment for the
with the provisions of section 1923(f)(3) preceding FY by the percentage change
Andrew M. Slavitt,
of the Social Security Act (the Act). in the CPI–U for the previous FY. Also
Acting Administrator, Centers for Medicare Under such provisions, in general a in accordance with section 1923(f)(3) of
& Medicaid Services. state’s FY DSH allotment is calculated the Act, a state’s DSH allotment for a FY
[FR Doc. 2016–01937 Filed 2–1–16; 8:45 am] by increasing the amount of its DSH is subject to the limitation that an
BILLING CODE 4120–01–P allotment for the preceding FY by the increase to a state’s DSH allotment for
percentage change in the Consumer a FY cannot result in the DSH allotment
Price Index for all Urban Consumers exceeding the greater of the state’s DSH
wgreen on DSK2VPTVN1PROD with NOTICES
(CPI–U) for the previous FY. allotment for the previous FY or 12
The Affordable Care Act amended percent of the state’s total medical
Medicaid DSH provisions, adding assistance expenditures for the
section 1923(f)(7) of the Act which allotment year (this is referred to as the
would have required reductions to 12 percent limit).
states’ FY DSH allotments beginning Furthermore, under section 1923(h) of
with FY 2014, the calculation of which the Act, federal financial participation
VerDate Sep<11>2014 15:21 Feb 01, 2016 Jkt 238001 PO 00000 Frm 00031 Fmt 4703 Sfmt 4703 E:\FR\FM\02FEN1.SGM 02FEN1](https://thefederalregister.org/doc/81_FR_5469/page/1.svg)
![5450 Federal Register / Vol. 81, No. 21 / Tuesday, February 2, 2016 / Notices
to the preliminary FY 2013 DSH any impact on providers is due to the requirements of E.O. 13132 are not
allotments published in the July 26, effect of the various controlling statutes; applicable.
2013 Federal Register (78 FR 45217). providers are not impacted as a result of
A. Alternatives Considered
This is due to the actual percentage the independent regulatory action in
change in the CPI–U for FY 2012 used publishing this notice. The purpose of The methodologies for determining
in the calculation of the final FY 2013 the notice is to announce the latest the states’ fiscal year DSH allotments
allotments (2.4 percent) being equal to distributions as required by the statute. and IMD DSH Limits, as reflected in this
the estimated percentage change in the In addition, section 1102(b) of the Act notice, were established in accordance
CPI–U for FY 2012 used in the requires us to prepare a regulatory with the methodologies and formula for
calculation of the preliminary FY 2013 impact analysis if a rule may have a determining states’ allotments as
allotments (2.4 percent). The final FY significant impact on the operations of specified in the statute. This notice does
2013 IMD DSH limits being published a substantial number of small rural not put forward any further
in this notice are also equal to the hospitals. This analysis must conform to discretionary administrative policies for
preliminary FY 2013 IMD DSH limits the provisions of section 604 of the determining such allotments.
published in the July 26, 2013 Federal RFA. For purposes of section 1102(b) of
B. Accounting Statement
Register (78 FR 45217). Since the final the Act, we define a small rural hospital
FY 2013 DSH allotments were equal to as a hospital that is located outside of As required by OMB Circular A–4
the preliminary FY 2013 DSH a Core-Based Statistical Area for (available at http://
allotments, the associated FY 2013 IMD Medicaid payment regulations and has www.whitehouse.gov/omb/circulars/
DSH limits also remained the same. fewer than 100 beds. We are not a004/a-4.pdf), in the Table 1, we have
The preliminary FY 2015 DSH preparing analysis for section 1102(b) of prepared an accounting statement
allotments being published in this the Act because the Secretary has showing the classification of the
notice are about $240 million more than determined that this notice will not estimated expenditures associated with
the preliminary FY 2014 DSH have a significant impact on the the provisions of this notice. Table 1
allotments published in the February operations of a substantial number of provides our best estimate of the change
28, 2014 Federal Register (79 FR small rural hospitals. (decrease) in the federal share of states’
11436). The increase in the DSH The Medicaid statute specifies the Medicaid DSH payments resulting from
allotments is due to the application of methodology for determining the the application of the provisions of the
the statutory formula for calculating amounts of states’ DSH allotments and Medicaid statute relating to the
DSH allotments under which the prior IMD DSH limits; and as described calculation of states’ FY DSH allotments
fiscal year allotments are increased by previously, the application of the and the increase in the FY DSH
the percentage increase in the CPI–U for methodology specified in statute results allotments from FY 2014 to FY 2015.
the prior fiscal year. The preliminary FY in the decreases or increases in states’
2015 IMD DSH limits being published DSH allotments and IMD DSH limits for TABLE 1—ACCOUNTING STATEMENT:
in this notice are about $14 million the applicable FYs. The statute CLASSIFICATION OF ESTIMATED EX-
more than the preliminary FY 2014 IMD applicable to these allotments and limits PENDITURES, FROM THE FY 2014 TO
DSH limits published in the February does not apply to the determination of FY 2015
28, 2014 Federal Register (79 FR the amounts of DSH payments made to
[In millions]
11436). The increase in the IMD DSH specific DSH hospitals; rather, these
limits is because the DSH allotment for allotments and limits represent an Category Transfers
a FY is a factor in the determination of overall limit on the total of such DSH
the IMD DSH limit for the FY. Since the payments. In this regard, we do not Annualized Monetized $240.
preliminary FY 2015 DSH allotments believe that this notice will have a Transfers.
are greater than the preliminary FY 2014 significant economic impact on a From Whom To Federal Government
DSH allotments, the associated substantial number of small entities. Whom? to States.
preliminary FY 2015 IMD DSH limits Section 202 of the Unfunded
for some states also increased. Mandates Reform Act of 1995 also Congressional Review Act
The RFA requires agencies to analyze requires that agencies assess anticipated This proposed regulation is subject to
options for regulatory relief of small costs and benefits before issuing any the Congressional Review Act
businesses, if a rule has a significant rule whose mandates require spending provisions of the Small Business
impact on a substantial number of small in any 1 year of $100 million in 1995 Regulatory Enforcement Fairness Act of
entities. For purposes of the RFA, small dollars, updated annually for inflation. 1996 (5 U.S.C. 801 et seq.) and has been
entities include small businesses, In 2015, that is approximately $144 transmitted to the Congress and the
nonprofit organizations, and small million. This notice will have no Comptroller General for review.
governmental jurisdictions. Most consequential effect on state, local, or In accordance with the provisions of
hospitals and most other providers and tribal governments, in the aggregate, or Executive Order 12866, this notice was
suppliers are small entities, either by on the private sector. reviewed by the Office of Management
nonprofit status or by having revenues Executive Order 13132 establishes and Budget.
of less than $7.5 million to $38.5 certain requirements that an agency
million in any 1 year. Individuals and must meet when it issues a proposed Dated: December 3, 2015.
states are not included in the definition rule (and subsequent final rule) that Andrew M. Slavitt,
of a small entity. We are not preparing imposes substantial direct requirement Acting Administrator, Centers for Medicare
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an analysis for the RFA because the costs on state and local governments, & Medicaid Services.
Secretary has determined that this preempts state law, or otherwise has Dated: January 20, 2016.
notice will not have significant Federalism implications. Since this Sylvia M. Burwell,
economic impact on a substantial notice does not impose any costs on Secretary, Department of Health and Human
number of small entities. Specifically, state or local governments, the Services.
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![Federal Register / Vol. 81, No. 21 / Tuesday, February 2, 2016 / Notices 5451
KEY TO ADDENDUM 1—FINAL DSH ALLOTMENTS FOR FY 2013
[The Final FY 2013 DSH Allotments for the NON-Low DSH States are presented in the top section of this addendum, and the Final FY 2013
DSH Allotments for the Low-DSH States are presented in the bottom section of this addendum]
Column Description
Column A .......... State.
Column B .......... FY 2013 FMAPs.
This column contains the States’ FY 2013 Federal Medical Assistance Percentages.
Column C ......... Prior FY (2012) DSH Allotments
This column contains the States’ prior FY 2012 DSH Allotments.
Column D ......... Prior FY (2012) DSH Allotments (Col C) × (100 percent + Percentage Increase in CPIU): 102.4 percent.
This column contains the amount in Column C increased by 1 plus the percentage increase in the CPI–U for the prior FY
(102.4 percent).
Column E .......... FY 2013 TC MAP Exp. Including DSH.
This column contains the amount of the States’ FY 2013 total computable (TC) medical assistance expenditures including
DSH expenditures.
Column F .......... FY 2013 TC DSH Expenditures.
This column contains the amount of the States’ FY 2013 total computable DSH expenditures.
Column G ......... FY 2013 TC MAP Exp. Net of DSH.
This column contains the amount of the States’ FY 2013 total computable medical assistance expenditures net of DSH ex-
penditures, calculated as the amount in Column E minus the amount in Column F.
Column H ......... 12 percent Amount.
This column contains the amount of the ‘‘12 percent limit’’ in Federal share, determined in accordance with the provisions of
section 1923(f)(3) of the Act.
Column I ........... Greater of FY 2012 Allotment or 12 percent Limit.
This column contains the greater of the State’s prior FY (FY 2012) DSH allotment or the amount of the 12 percent Limit, de-
termined as the maximum of the amount in Column C or Column H
Column J .......... FY 2013 DSH Allotment.
This column contains the States’ final FY 2013 DSH allotments, determined as the minimum of the amount in Column I or
Column D.
For states with ‘‘na’’ in Columns I or D, refer to the footnotes in the addendum.
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![5454 Federal Register / Vol. 81, No. 21 / Tuesday, February 2, 2016 / Notices
KEY TO ADDENDUM 2—PRELIMINARY DSH ALLOTMENTS FOR FY 2015
[The Preliminary FY 2015 DSH Allotments for the NON-Low DSH States are presented in the top section of this addendum, and the Preliminary
FY 2015 DSH Allotments for the Low-DSH States are presented in the bottom section of this addendum]
Column Description
Column A .......... State.
Column B .......... FY 2015 FMAPs.
This column contains the States’ FY 2015 Federal Medical Assistance Percentages.
Column C ......... Prior FY (2014) DSH Allotments.
This column contains the States’ prior FY 2014 DSH Allotments
Column D ......... Prior FY (2014) DSH Allotments (Col C) × (100 percent + Percentage Increase in CPIU): 101.6 percent.
This column contains the amount in Column C increased by 1 plus the estimated percentage increase in the CPI–U for the
prior FY (101.6 percent).
Column E .......... FY 2015 TC MAP Exp. Including DSH.
This column contains the amount of the States’ projected FY 2015 total computable (TC) medical assistance expenditures in-
cluding DSH expenditures.
Column F .......... FY 2015 TC DSH Expenditures.
This column contains the amount of the States’ projected FY 2015 total computable DSH expenditures.
Column G ......... FY 2015 TC MAP Exp. Net of DSH.
This column contains the amount of the States’ projected FY 2015 total computable medical assistance expenditures net of
DSH expenditures, calculated as the amount in Column E minus the amount in Column F.
Column H ......... 12 percent Amount.
This column contains the amount of the ‘‘12 percent limit’’ in Federal share, determined in accordance with the provisions of
section 1923(f)(3) of the Act.
Column I ........... Greater of FY 2014 Allotment or 12 percent Limit.
This column contains the greater of the State’s prior FY (FY 2014) DSH allotment or the amount of the 12 percent Limit, de-
termined as the maximum of the amount in Column C or Column H.
Column J .......... FY 2015 DSH Allotment.
This column contains the States’ preliminary FY 2015 DSH allotments, determined as the minimum of the amount in Column I
or Column D.
For states with ‘‘na’’ in Columns I or D, refer to the footnotes in the addendum.
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![Federal Register / Vol. 81, No. 21 / Tuesday, February 2, 2016 / Notices 5457
KEY TO ADDENDUM 3—FINAL IMD DSH LIMITS FOR FY 2013
[The final FY 2013 IMD DSH Limits for the Non-Low DSH States are presented in the top section of this addendum and the preliminary FY 2013
IMD DSH Limits for the Low-DSH States are presented in the bottom section of the addendum]
Column Description
Column A .......... State.
Column B .......... Inpatient Hospital Services FY 95 DSH Total Computable
This column contains the States’ total computable FY 1995 inpatient hospital DSH expenditures as reported on the Form
CMS–64.
Column C ......... IMD and Mental Health Services FY 95 DSH Total
Computable. This column contains the total computable FY 1995 mental health facility DSH expenditures as reported on the
Form CMS–64 as of January 1, 1997.
Column D ......... Total Inpatient Hospital & IMD & Mental Health FY 95 DSH Total
Computable, Col. B + C. This column contains the total computation of all inpatient hospital DSH expenditures and mental
health facility DSH expenditures for FY 1995 as reported on the Form CMS–64 as of January 1, 1997 (representing the
sum of Column B and Column C).
Column E .......... Applicable Percentage, Col. C/D.
This column contains the ‘‘applicable percentage’’ representing the total Computable FY 1995 mental health facility DSH ex-
penditures divided by total computable all inpatient hospital and mental health facility DSH expenditures for FY 1995 (the
amount in Column C divided by the amount in Column D) Per section 1923(h)(2)(A)(ii)(III) of the Act, for FYs after FY 2002,
the applicable percentage can be no greater than 33 percent.
Column F .......... FY 2013 Federal Share DSH Allotment
This column contains the states’ FY 2013 DSH allotments from Column J Addendum 1.
Column G ......... FY 2013 FMAP.
Column H ......... FY 2013 DSH Allotments in Total Computable, Col. F/G.
This column contains states’ FY 2013 total computable DSH allotment (determined as Column F/Column G).
Column I ........... Applicable Percentage Applied to FY 2013 Allotments in TC, Col E × Col H.
This column contains the applicable percentage of FY 2012 total computable DSH allotment (calculated as the percentage in
Column E multiplied by the amount in Column H).
Column J .......... FY 2013 TC IMD DSH Limit. Lesser of Col.
I or C. This column contains the total computable FY 2013 TC IMD DSH Limit equal to the lesser of the amount in Column I
or Column C.
Column K .......... FY 2013 IMD DSH Limit in Federal Share, Col. G × J.
This column contains the FY 2013 Federal Share IMD DSH limit determined by converting the total computable FY 2013 IMD
DSH Limit from Column J into a federal share amount by multiplying it by the FY 2013 FMAP in Column G.
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![5460 Federal Register / Vol. 81, No. 21 / Tuesday, February 2, 2016 / Notices
KEY TO ADDENDUM 4—PRELIMINARY IMD DSH LIMITS FOR FY 2015
[The preliminary FY 2015 IMD DSH Limits for the Non-Low DSH States are presented in the top section of this addendum and the preliminary
FY 2015 IMD DSH Limits for the Low-DSH States are presented in the bottom section of the addendum]
Column Description
Column A .......... State.
Column B .......... Inpatient Hospital Services FY 95 DSH Total Computable.
This column contains the States’ total computable FY 1995 inpatient hospital DSH expenditures as reported on the Form
CMS–64.
Column C ......... IMD and Mental Health Services FY 95 DSH Total
Computable. This column contains the total computable FY 1995 mental health facility DSH expenditures as reported on the
Form CMS–64 as of January 1, 1997.
Column D ......... Total Inpatient Hospital & IMD & Mental Health FY 95 DSH Total
Computable, Col. B + C. This column contains the total computation of all inpatient hospital DSH expenditures and mental
health facility DSH expenditures for FY 1995 as reported on the Form CMS–64 as of January 1, 1997 (representing the
sum of Column B and Column C).
Column E .......... Applicable Percentage, Col. C/D.
This column contains the ‘‘applicable percentage’’ representing the total Computable FY 1995 mental health facility DSH ex-
penditures divided by total computable all inpatient hospital and mental health facility DSH expenditures for FY 1995 (the
amount in Column C divided by the amount in Column D) Per section 1923(h)(2)(A)(ii)(III) of the Act, for FYs after FY 2002,
the applicable percentage can be no greater than 33 percent.
Column F .......... FY 2015 Federal Share DSH Allotment.
This column contains the states’ preliminary FY 2015 DSH allotments from Column J Addendum 1.
Column G ......... FY 2015 FMAP.
Column H ......... FY 2015 DSH Allotments in Total Computable, Col. F/G.
This column contains states’ FY 2015 total computable DSH allotment (determined as Column F/Column G).
Column I ........... Applicable Percentage Applied to FY 2015 Allotments in TC, Col E x Col H.
This column contains the applicable percentage of FY 2014 total computable DSH allotment (calculated as the percentage in
Column E multiplied by the amount in Column H).
Column J .......... FY 2015 TC IMD DSH Limit. Lesser of Col.
I or C. This column contains the total computable FY 2015 TC IMD DSH Limit equal to the lesser of the amount in Column I
or Column C.
Column K .......... FY 2015 IMD DSH Limit in Federal Share, Col. G × J.
This column contains the FY 2015 Federal Share IMD DSH limit determined by converting the total computable FY 2015 IMD
DSH Limit from Column J into a federal share amount by multiplying it by the FY 2015 FMAP in Column G.
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![Federal Register / Vol. 81, No. 21 / Tuesday, February 2, 2016 / Notices 5463
[FR Doc. 2016–01836 Filed 2–1–16; 8:45 am] Health and Human Services, Attention: We will allow stakeholders 30 days
BILLING CODE 4120–01–P CMS–1661–NC, P.O. Box 8010, from the date of this notice to submit
Baltimore, MD 21244–8010. written comments. Comments received
Please allow sufficient time for mailed timely will be available for public
DEPARTMENT OF HEALTH AND comments to be received before the inspection as they are received,
HUMAN SERVICES close of the comment period. generally beginning approximately 3
3. By express or overnight mail. You weeks after publication of this notice, at
Centers for Medicare & Medicaid may send written comments to the the headquarters of the Centers for
Services following address only: Centers for Medicare & Medicaid Services, 7500
[CMS–1661–NC] Medicare & Medicaid Services, Security Boulevard, Baltimore,
Department of Health and Human Maryland 21244, Monday through
Medicare Program; Request for an Services, Attention: CMS–1661–NC, Friday of each week from 8:30 a.m. to
Exception to the Prohibition on Mail Stop C4–26–05, 7500 Security 4 p.m. To schedule an appointment to
Expansion of Facility Capacity Under Boulevard, Baltimore, MD 21244–1850. view public comments, please phone 1–
the Hospital Ownership and Rural 4. By hand or courier. Alternatively, 800–743–3951.
Provider Exceptions to the Physician you may deliver (by hand or courier) I. Background
Self-Referral Prohibition your written comments only to the
following addresses: Section 1877 of the Social Security
AGENCY: Centers for Medicare & Act (the Act), also known as the
a. For delivery in Washington, DC—
Medicaid Services (CMS), HHS. physician self-referral law—(1) prohibits
Centers for Medicare & Medicaid
ACTION: Notice with request for a physician from making referrals for
Services, Department of Health and
comment. Human Services, Room 445–G, Hubert certain ‘‘designated health services’’
H. Humphrey Building, 200 (DHS) payable by Medicare to an entity
SUMMARY: The Social Security Act (the with which he or she (or an immediate
Act) prohibits a physician-owned Independence Avenue SW.,
Washington, DC 20201. family member) has a financial
hospital from expanding its facility relationship (ownership or
capacity, unless the Secretary of the (Because access to the interior of the
Hubert H. Humphrey Building is not compensation), unless the requirements
Department of Health and Human of an applicable exception are satisfied;
Services (the Secretary) grants the readily available to persons without
Federal government identification, and (2) prohibits the entity from filing
hospital’s request for an exception to claims with Medicare (or billing another
that prohibition after considering input commenters are encouraged to leave
their comments in the CMS drop slots individual, entity, or third party payer)
on the hospital’s request from for those DHS furnished as a result of a
individuals and entities in the located in the main lobby of the
building. A stamp-in clock is available prohibited referral.
community where the hospital is Section 1877(d)(2) of the Act provides
located. The Centers for Medicare & for persons wishing to retain a proof of
an exception for physician ownership or
Medicaid Services (CMS) has received a filing by stamping in and retaining an
investment interests in rural providers
request from a physician-owned extra copy of the comments being filed.)
(the ‘‘rural provider exception’’). In
hospital for an exception to the b. For delivery in Baltimore, MD—
order for an entity to qualify for the
prohibition against expansion of facility Centers for Medicare & Medicaid rural provider exception, the DHS must
capacity. This notice solicits comments Services, Department of Health and be furnished in a rural area (as defined
on the request from individuals and Human Services, 7500 Security in section 1886(d)(2) of the Act) and
entities in the community in which the Boulevard, Baltimore, MD 21244–1850. substantially all the DHS furnished by
physician-owned hospital is located. If you intend to deliver your the entity must be furnished to
Community input may inform our comments to the Baltimore address, call individuals residing in a rural area.
determination regarding whether the telephone number (410) 786–9994 in Section 1877(d)(3) of the Act provides
requesting hospital qualifies for an advance to schedule your arrival with an exception, known as the hospital
exception to the prohibition against one of our staff members. ownership exception, for physician
expansion of facility capacity. Comments erroneously mailed to the ownership or investment interests held
DATES: Comment Date: To be assured
addresses indicated as appropriate for in a hospital located outside of Puerto
consideration, comments must be hand or courier delivery may be delayed Rico, provided that the referring
received at one of the addresses and received after the comment period. physician is authorized to perform
provided below, no later than 5 p.m. on FOR FURTHER INFORMATION CONTACT: services at the hospital and the
March 3, 2016. POH-ExceptionRequests@cms.hhs.gov. ownership or investment interest is in
ADDRESSES: In commenting, please refer SUPPLEMENTARY INFORMATION: the hospital itself (and not merely in a
to file code CMS–1661–NC. Because of subdivision of the hospital).
Inspection of Public Comments Section 6001(a)(3) of the Patient
staff and resource limitations, we cannot
accept comments by facsimile (FAX) All comments received before the Protection and Affordable Care Act
transmission. close of the comment period are (Pub. L. 111–148) as amended by the
You may submit comments in one of available for viewing by the public, Health Care and Education
four ways (please choose only one of the including any personally identifiable or Reconciliation Act of 2010 (Pub. L. 111–
ways listed): confidential business information that is 152) (hereafter referred to together as
1. Electronically. You may submit included in a comment. We post all ‘‘the Affordable Care Act’’) amended the
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electronic comments on this regulation comments received before the close of rural provider and hospital ownership
to http://www.regulations.gov. Follow the comment period on the following exceptions to the physician self-referral
the ‘‘Submit a comment’’ instructions. Web site as soon as possible after they prohibition to impose additional
2. By regular mail. You may mail have been received: http:// restrictions on physician ownership and
written comments to the following www.regulations.gov. Follow the search investment in hospitals and rural
address only: Centers for Medicare & instructions on that Web site to view providers. Since March 23, 2010, a
Medicaid Services, Department of public comments. physician-owned hospital that seeks to
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Document Created: 2016-02-02 00:31:59
Document Modified: 2016-02-02 00:31:59
| Category | Regulatory Information | |
| Collection | Federal Register | |
| sudoc Class | AE 2.7: GS 4.107: AE 2.106: | |
| Publisher | Office of the Federal Register, National Archives and Records Administration | |
| Section | Notices | |
| Action | Notice. | |
| Dates | This notice is effective March 3, 2016. The final allotments and limitations set forth in this notice are effective for the fiscal years specified. | |
| Contact | Stuart Goldstein, (410) 786-0694 and Richard Cuno, (410) 786-1111. | |
| FR Citation | 81 FR 5448 | |
| RIN Number | 0983-ZB24 |
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