82 FR 51259 - Medicaid Program; Final FY 2015 and Preliminary FY 2017 Disproportionate Share Hospital Allotments, and Final FY 2015 and Preliminary FY 2017 Institutions for Mental Diseases Disproportionate Share Hospital Limits
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services Federal Register Volume 82, Issue 212 (November 3, 2017)
Centers for Medicare & Medicaid Services
Federal Register Volume 82, Issue 212 (November 3, 2017)
| Page Range | 51259-51274 | |
| FR Document | 2017-23933 |
[Federal Register Volume 82, Number 212 (Friday, November 3, 2017)] [Notices] [Pages 51259-51274] From the Federal Register Online [www.thefederalregister.org] [FR Doc No: 2017-23933] [[Page 51259]] ----------------------------------------------------------------------- DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-2409-N] RIN 0938-ZB43 Medicaid Program; Final FY 2015 and Preliminary FY 2017 Disproportionate Share Hospital Allotments, and Final FY 2015 and Preliminary FY 2017 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) 2015 and the preliminary federal share DSH allotments for FY 2017. This notice also announces the final FY 2015 and the preliminary FY 2017 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 applicable December 4, 2017. The final allotments and limitations set forth in this notice are applicable 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 DSH 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 from FY 2014 through FY 2020, 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). Subsequent legislation, most recently by the Medicare Access and CHIP Reauthorization Act of 2015 (Pub. L. 114-10, enacted on April 16, 2015) (MACRA), delayed the start of these reductions until FY 2018. The proposed rule delineating the methodology for the calculation of DSH allotment reductions scheduled to begin in FY 2018 was published in the July 28, 2017 Federal Register (82 FR 35155). Because there are no reductions to DSH allotments for FY 2015 and FY 2017 under section 1923(f)(7) of the Act, as amended, this notice contains only the state-specific final FY 2015 DSH allotments and preliminary FY 2017 DSH allotments, as calculated under the statute without application of the reductions that would have been imposed under the Affordable Care Act provisions beginning with FY 2014. This notice also provides information on the calculation of such FY DSH allotments, the calculation of the states' institutions for mental diseases (IMDs) DSH limits, and the amounts of states' final FY 2015 IMD DSH limits and preliminary FY 2017 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 (FFP) for DSH payments to 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 1923(h) of the Act. 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 2015 Federal Share State DSH Allotments, and the Preliminary FY 2017 Federal Share State DSH Allotments 1. Final FY 2015 Federal Share State DSH Allotments Addendum 1 to this notice provides the states' final FY 2015 DSH allotments determined in accordance with section 1923(f)(3) of the Act. As described in the background section, 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 [[Page 51260]] calculating the states' final FY 2015 DSH allotments, the preceding final fiscal year DSH allotments (for FY 2014) were published in the October 26, 2016 Federal Register (81 FR 74432). For purposes of calculating the states' final FY 2015 DSH allotments we are using the actual Medicaid expenditures for FY 2015. Finally, for purposes of calculating the states' final FY 2015 DSH allotments, the applicable historical percentage change in the CPI-U for the previous FY (FY 2014) was 1.6 percent; we note that this is the same as the estimated 1.6 percentage change in the CPI-U for FY 2014 that was available and used in the calculation of the preliminary FY 2015 DSH allotments which were published in the February 2, 2016 Federal Register (81 FR 5448). 2. Calculation of the Preliminary FY 2017 Federal Share State DSH Allotments Addendum 2 to this notice provides the preliminary FY 2017 DSH allotments determined in accordance with section 1923(f)(3) of the Act. The preliminary FY 2017 DSH allotments contained in this notice were determined based on the most recent available estimates from states of their FY 2017 total computable Medicaid expenditures. Also, the preliminary FY 2017 allotments contained in this notice were determined by increasing the preliminary FY 2016 DSH allotments. The actual percentage increase in the CPI-U for FY 2016 was 0.9 percent (CMS originally published the preliminary FY 2016 DSH allotments in the October 26, 2016 Federal Register (81 FR74432)). We will publish states' final FY 2017 DSH allotments in a future notice based on the states' four quarterly Medicaid expenditure reports (Form CMS-64) for FY 2017 available following the end of FY 2017 utilizing the actual change in the CPI-U for FY 2016. B. Calculation of the Final FY 2015 and Preliminary FY 2017 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 DSH payments to IMDs or other mental health facilities that exceed the IMD DSH limits. In this notice, we are publishing the final FY 2015 and the preliminary FY 2017 IMD DSH limits determined in accordance with the provisions discussed above. Addendums 3 and 4 to this notice detail each state's final FY 2015 and preliminary FY 2017 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 or burden. While discussed in section I.B. of this notice and in Addendums 3 and 4, the requirements and burden associated with Form CMS-37 (OMB control number 0938-0101) and Form CMS-64 (OMB control number 0938-0067) are unaffected by this notice. Consequently, this notice, CMS-37, and CMS-64 are not subject to Office of Management and Budget review under the authority of the Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et seq.) associated with the publication of this notice. IV. Regulatory Impact Analysis 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 (Pub. L. 104-4, enacted on March 22, 1995) (UMRA `95), Executive Order 13132 on Federalism (August 4, 1999) and the Congressional Review Act (5 U.S.C. 804(2)), and Executive Order 13771 on Reducing Regulation and Controlling Regulatory Costs (January 30, 2017). 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 2015 DSH allotments being published in this notice are approximately $11 million more than the preliminary FY 2015 DSH allotments published in the February 2, 2016 Federal Register (81 FR 5448). The increase in the final FY 2015 DSH allotments is a result of being calculated by multiplying the actual increase in the CPI-U for 2014 by the final FY 2014 DSH allotments, while the preliminary FY 2015 DSH allotments were calculated by multiplying the estimated CPI-U for 2014 by the preliminary FY 2014 DSH allotments. Although the estimated and actual increase in the CPI-U remained the same at 1.6 percent, the preliminary FY 2014 DSH allotments were lower than the final FY 2014 DSH allotments and therefore the final FY 2015 DSH allotments are higher than the preliminary FY 2015 DSH allotments. The final FY 2015 IMD DSH limits being published in this notice are approximately $695,000 more than the preliminary FY 2015 IMD DSH limits published in the February 2, 2016 Federal Register (81 FR 5448). The increases in the IMD DSH limits are because the DSH allotment for a FY is a factor in the determination of the IMD DSH limit for the FY. Since the final FY 2015 DSH allotments were increased as compared to the preliminary FY 2015 DSH allotments, the associated FY 2015 IMD DSH limits for some states were also increased. The preliminary FY 2017 DSH allotments being published in this notice have been increased by approximately $118 million more than the preliminary FY 2016 DSH allotments published in the October 26, 2016 Federal Register (81 FR 74432). 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 2017 IMD DSH limits being published in this notice are approximately $5.5 million more than the preliminary FY 2016 IMD DSH limits published in the October 2, 2016 Federal Register (81 FR 74432). The increases in the IMD DSH limits are 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 2017 DSH allotments are greater than the preliminary FY 2016 DSH allotments, the associated preliminary FY 2017 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 $7.0 million to $34.5 million in any one 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 [[Page 51261]] 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 DSH allotments and IMD DSH limits, 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. For this reason, 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 2017, that threshold is approximately $148 million. This notice will have no consequential effect on spending by 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 promulgates 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 or otherwise have Federalism implications, the requirements of E.O. 13132 are not applicable. Executive Order 13771, titled ``Reducing Regulation and Controlling Regulatory Costs,'' was issued on January 30, 2017. It has been determined that this notice is a transfer rule and is not a regulatory action for the purposes of Executive Order 13771. 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 and limits as specified in statute. This notice does not put forward any further discretionary administrative policies for determining such allotments and limits, or otherwise. B. Accounting Statement As required by OMB Circular A-4 (available at http://www.whitehouse.gov/omb/circulars/a004/a-4.pdf), in 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 2016 to FY 2017. Table 1--Accounting Statement: Classification of Estimated Expenditures, From the FY 2016 to FY 2017 [In millions] ------------------------------------------------------------------------ Category Transfers ------------------------------------------------------------------------ Annualized Monetized Transfers............ $118. 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 October 11, 2017. Seema Verma, Administrator, Centers for Medicare & Medicaid Services. Dated October 27, 2017. Eric D. Hargan, Acting Secretary, Department of Health and Human Services. Key to Addendum 1--Final DSH Allotments for FY 2015 [The Final FY 2015 DSH Allotments for the NON-Low DSH States are presented in the top section of this addendum, and the Final 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 (100percent + Percentage Increase in CPIU): 101.6 percent. This column contains the amount in Column C increased by 1 plus the 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' 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' FY 2015 total computable DSH expenditures. Column G................. FY 2015 TC MAP Exp. Net of DSH. This column contains the amount of the States' 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. [[Page 51262]] Column J................. FY 2015 DSH Allotment. This column contains the States' final 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 51263]] Addendum 1--Final DSH Allotments for Fiscal Year: 2015 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Prior FY (2014) DSH allotment FY 2015 (Col C) x 100% + FY 2015 TC MAP FY 2015 TC MAP ``12% Amount'' = Greater of Col H FY 2015 DSH State FMAPs Prior FY (2014) Pct increase in Exp. including FY 2015 TC DSH EXP.net net OF DSH Col G x .12/(1- Or Col C (12% allotment MIN Col (percent) DSH allotments CPIU: DSH expenditures Col E-F .12/Col B)* (In Limit, FY 2014 I, Col D ------------------- FS) allotment) 101.6% ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ALABAMA...................... 68.99 $328,262,759 $333,514,963 $5,264,823,220 $482,949,270 $4,781,873,950 $694,651,308 $694,651,308 $333,514,963 ARIZONA...................... 68.46 108,086,519 109,815,903 10,617,725,498 171,078,470 10,446,647,028 1,520,037,100 1,520,037,100 109,815,903 CALIFORNIA................... 50.00 1,170,270,080 1,188,994,401 82,139,045,889 2,390,079,654 79,748,966,235 12,591,942,037 12,591,942,037 1,188,994,401 COLORADO..................... 51.01 98,745,708 100,325,639 7,301,119,320 196,484,794 7,104,634,526 1,114,813,865 1,114,813,865 100,325,639 CONNECTICUT.................. 50.00 213,504,233 216,920,301 7,183,360,060 129,030,409 7,054,329,651 1,113,841,524 1,113,841,524 216,920,301 DISTRICT OF COLUMBIA......... 70.00 65,385,671 66,431,842 2,369,871,903 36,875,089 2,332,996,814 337,882,297 337,882,297 66,431,842 FLORIDA...................... 59.72 213,504,233 216,920,301 21,320,462,370 358,797,341 20,961,665,029 3,147,939,570 3,147,939,570 216,920,301 GEORGIA...................... 66.94 286,896,314 291,486,655 9,664,791,833 435,016,070 9,229,775,763 1,349,489,311 1,349,489,311 291,486,655 ILLINOIS..................... 50.76 229,517,051 233,189,324 16,938,472,430 442,188,036 16,496,284,394 2,592,419,182 2,592,419,182 233,189,324 INDIANA...................... 66.52 228,182,651 231,833,573 9,249,771,996 232,141,314 9,017,630,682 1,320,292,281 1,320,292,281 231,833,573 KANSAS....................... 56.63 44,035,248 44,739,812 3,010,910,864 78,925,971 2,931,984,893 446,439,537 446,439,537 44,739,812 KENTUCKY..................... 69.94 154,790,570 157,267,219 9,423,467,372 226,627,736 9,196,839,636 1,332,192,539 1,332,192,539 157,267,219 LOUISIANA \1\................ 62.05 731,960,000 743,671,360 7,863,181,815 1,329,125,915 6,534,055,900 972,079,525 972,079,525 743,671,360 MAINE........................ 61.88 112,089,722 113,883,158 2,477,405,878 42,093,817 2,435,312,061 362,543,168 362,543,168 113,883,158 MARYLAND..................... 50.00 81,398,489 82,700,865 9,410,240,087 107,964,734 9,302,275,353 1,468,780,319 1,468,780,319 82,700,865 MASSACHUSETTS................ 50.00 325,593,956 330,803,459 15,378,247,995 0 15,378,247,995 2,428,144,420 2,428,144,420 330,803,459 MICHIGAN..................... 65.54 282,893,110 287,419,400 15,867,358,420 336,597,089 15,530,761,331 2,281,403,282 2,281,403,282 287,419,400 MISSISSIPPI.................. 73.58 162,796,978 165,401,730 5,136,317,498 224,546,417 4,911,771,081 704,270,444 704,270,444 165,401,730 MISSOURI..................... 63.45 505,738,153 513,829,963 9,518,489,904 680,860,006 8,837,629,898 1,307,866,162 1,307,866,162 513,829,963 NEVADA....................... 64.36 49,372,853 50,162,819 3,105,613,113 77,953,523 3,027,659,590 446,585,572 446,585,572 50,162,819 NEW HAMPSHIRE................ 50.00 170,908,561 173,643,098 1,716,225,884 108,694,387 1,607,531,497 253,820,763 253,820,763 173,643,098 NEW JERSEY................... 50.00 687,216,752 698,212,220 14,049,422,255 1,089,139,502 12,960,282,753 2,046,360,435 2,046,360,435 698,212,220 NEW YORK..................... 50.00 1,714,705,875 1,742,141,169 57,896,956,615 3,431,160,259 54,465,796,356 8,599,862,583 8,599,862,583 1,742,141,169 NORTH CAROLINA............... 65.88 314,918,744 319,957,444 13,212,668,475 531,329,898 12,681,338,577 1,860,682,818 1,860,682,818 319,957,444 OHIO......................... 62.64 433,680,475 440,619,363 21,423,012,674 686,937,454 20,736,075,220 3,077,980,454 3,077,980,454 440,619,363 PENNSYLVANIA................. 51.82 599,146,255 608,732,595 23,223,615,661 750,991,666 22,472,623,995 3,509,386,365 3,509,386,365 608,732,595 RHODE ISLAND................. 50.00 69,388,876 70,499,098 2,584,840,295 140,548,917 2,444,291,378 385,940,744 385,940,744 70,499,098 SOUTH CAROLINA............... 70.64 349,613,182 355,206,993 5,767,691,574 487,856,512 5,279,835,062 763,235,093 763,235,093 355,206,993 TENNESSEE \2\................ na na na na na na na na 53,100,000 TEXAS........................ 58.05 1,020,817,117 1,037,150,191 34,691,253,016 2,330,024,141 32,361,228,875 4,895,294,687 4,895,294,687 1,037,150,191 VERMONT \3\.................. 56.21 24,019,227 24,403,535 1,632,611,663 37,448,781 1,595,162,882 243,376,898 243,376,898 24,403,535 VIRGINIA..................... 50.00 93,522,940 95,019,307 8,032,760,161 20,698,074 8,012,062,087 1,265,062,435 1,265,062,435 95,019,307 WASHINGTON................... 50.03 197,491,416 200,651,279 10,494,138,618 362,580,070 10,131,558,548 1,599,416,905 1,599,416,905 200,651,279 WEST VIRGINIA................ 71.35 72,057,679 73,210,602 3,646,548,197 72,590,493 3,573,957,704 515,589,315 515,589,315 73,210,602 ------------------------------------------------------------------------------------------------------------------------------------------------------------------ TOTAL.................... 0.00 11,140,511,397 11,318,759,579 451,612,422,553 18,029,335,809 433,583,086,744 66,549,622,938 66,549,622,938 11,371,859,581 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ LOW DSH STATES ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ALASKA....................... 50.00 21,745,078 22,092,999 1,405,373,754 19,880,034 1,385,493,720 218,762,166.32 218,762,166 22,092,999 ARKANSAS..................... 70.88 46,050,497 46,787,305 5,469,511,577 64,862,196 5,404,649,381 780,736,851 780,736,851 46,787,305 DELAWARE..................... 53.63 9,664,479 9,819,111 1,860,130,571 14,439,649 1,845,690,922 285,326,171 285,326,171 9,819,111 HAWAII....................... 52.23 10,403,840 10,570,301 1,957,983,075 0 1,957,983,075 305,042,374.37 305,042,374 10,570,301 IDAHO........................ 71.75 17,547,381 17,828,139 1,715,448,736 24,187,617 1,691,261,119 243,711,434.89 243,711,435 17,828,139 IOWA......................... 55.54 42,040,199 42,712,842 4,476,316,992 47,094,445 4,429,222,547 677,994,544 677,994,544 42,712,842 MINNESOTA.................... 50.00 79,731,955 81,007,666 10,704,500,992 57,035,579 10,647,465,413 1,681,178,749 1,681,178,749 81,007,666 MONTANA...................... 65.90 12,117,193 12,311,068 1,132,392,709 18,620,317 1,113,772,392 163,408,387 163,408,387 12,311,068 NEBRASKA..................... 53.27 30,208,951 30,692,294 1,846,405,999 38,427,073 1,807,978,926 280,041,785 280,041,785 30,692,294 NEW MEXICO................... 69.65 21,745,078 22,092,999 4,920,345,001 22,732,973 4,897,612,028 710,047,551 710,047,551 22,092,999 NORTH DAKOTA................. 50.00 10,196,942 10,360,093 1,085,776,090 2,594,883 1,083,181,207 171,028,612 171,028,612 10,360,093 OKLAHOMA..................... 62.30 38,657,915 39,276,442 4,703,038,531 43,517,776 4,659,520,755 692,536,325 692,536,325 39,276,442 OREGON....................... 64.06 48,322,397 49,095,555 8,027,137,262 60,717,454 7,966,419,808 1,176,324,671 1,176,324,671 49,095,555 SOUTH DAKOTA................. 51.64 11,790,395 11,979,041 805,740,131 1,584,383 804,155,748 125,711,209 125,711,209 11,979,041 UTAH......................... 70.56 20,942,613 21,277,695 2,147,978,557 25,398,058 2,122,580,499 306,904,262 306,904,262 21,277,695 WISCONSIN.................... 58.27 100,915,788 102,530,441 7,893,501,866 31,421,346 7,862,080,520 1,188,130,794 1,188,130,794 102,530,441 WYOMING...................... 50.00 241,612 245,478 558,961,575 471,420 558,490,155 88,182,656 88,182,656 245,478 ------------------------------------------------------------------------------------------------------------------------------------------------------------------ [[Page 51264]] TOTAL LOW DSH STATES..... 0.00 522,322,313 530,679,470 60,710,543,418 472,985,203 60,237,558,215 9,095,068,543 9,095,068,543 530,679,469 ------------------------------------------------------------------------------------------------------------------------------------------------------------------ TOTAL................ 0.00 11,662,833,710 11,849,439,049 512,322,965,971 18,502,321,012 493,820,644,959 75,644,691,482 75,644,691,482 11,902,539,050 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ \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) of the Act. \3\ FMAP for Vermont for FY 2015 determined in accordance with section 1905(z)(1)(A) of the Act. [[Page 51265]] Key to Addendum 2: Preliminary DSH Allotments for FY 2017 [The Preliminary FY 2017 DSH Allotments for the NON-Low DSH States are presented in the top section of this addendum, and the Preliminary FY 2017 DSH Allotments for the Low-DSH States are presented in the bottom section of this addendum.] ------------------------------------------------------------------------ Column Description ------------------------------------------------------------------------ Column A................. State. Column B................. FY 2017 FMAPs. This column contains the States' FY 2017 Federal Medical Assistance Percentages. Column C................. Prior FY (2016) DSH Allotments. This column contains the States' prior preliminary FY 2016 DSH Allotments. Column D................. Prior FY (2016) DSH Allotments (Col C) x (100 percent + Percentage Increase in CPIU): 100.9 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 (100.9 percent). Column E................. FY 2017 TC MAP Exp. Including DSH. This column contains the amount of the States' projected FY 2017 total computable (TC) medical assistance expenditures including DSH expenditures. Column F................. FY 2017 TC DSH Expenditures. This column contains the amount of the States' projected FY 2017 total computable DSH expenditures. Column G................. FY 2017 TC MAP Exp. Net of DSH. This column contains the amount of the States' projected FY 2017 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 2016 Allotment or 12 percent Limit. This column contains the greater of the State's preliminary prior FY (FY 2016) 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 2017 DSH Allotment. This column contains the States' preliminary FY 2017 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 51266]] Addendum 2--Preliminary DSH Allotments for Fiscal Year: 2017 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Prior FY (2016) DSH allotment FY 2017 (Col C) x 100% + FY 2017 TC MAP FY 2017 TC MAP ``12% Amount`` = Greater of Col H FY 2017 DSH State FMAPs Prior FY (2016) Pct increase in Exp. including FY 2017 TC DSH EXP.net net Of DSH Col G x .12/(1- Or Col C (12% allotment MIN Col (percent) DSH allotments CPIU: DSH \2\ expenditures \2\ Col E-F .12/Col B)* (In Limit, FY 2016 I, Col D ------------------- FS) allotment) 100.9% ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ALABAMA...................... 70.16 $334,515,508 $337,526,148 $5,722,108,000 $480,212,000 $5,241,896,000 $758,813,116 $758,813,116 $337,526,148 ARIZONA...................... 69.24 110,145,351 111,136,659 12,751,216,000 161,305,000 12,589,911,000 1,827,516,641 1,827,516,641 111,136,659 CALIFORNIA................... 50.00 1,192,561,384 1,203,294,436 92,799,788,000 128,407,000 92,671,381,000 14,632,323,316 14,632,323,316 1,203,294,436 COLORADO..................... 50.02 100,626,616 101,532,256 8,208,119,000 199,337,000 8,008,782,000 1,264,384,878 1,264,384,878 101,532,256 CONNECTICUT.................. 50.00 217,571,062 219,529,202 7,618,871,000 141,094,000 7,477,777,000 1,180,701,632 1,180,701,632 219,529,202 DISTRICT OF COLUMBIA......... 70.00 66,631,138 67,230,818 2,789,426,000 10,000,000 2,779,426,000 402,537,559 402,537,559 67,230,818 FLORIDA...................... 61.10 217,571,062 219,529,202 24,118,173,000 358,261,000 23,759,912,000 3,548,017,816 3,548,017,816 219,529,202 GEORGIA...................... 67.89 292,361,115 294,992,365 10,198,853,000 581,504,000 9,617,349,000 1,401,871,870 1,401,871,870 294,992,365 ILLINOIS..................... 51.30 233,888,892 235,993,892 16,836,812,000 459,144,000 16,377,668,000 2,565,417,919 2,565,417,919 235,993,892 INDIANA...................... 66.74 232,529,074 234,621,836 11,762,997,000 811,661,000 10,951,336,000 1,602,248,077 1,602,248,077 234,621,836 KANSAS....................... 56.21 44,874,031 45,277,897 3,410,646,000 77,573,000 3,333,073,000 508,533,002 508,533,002 45,277,897 KENTUCKY..................... 70.46 157,739,021 159,158,672 10,676,966,000 227,501,000 10,449,465,000 1,511,329,396 1,511,329,396 159,158,672 LOUISIANA.................... 62.28 745,902,374 752,615,495 11,132,573,000 1,117,522,000 10,015,051,000 1,488,633,356 1,488,633,356 752,615,495 MAINE........................ 64.38 114,224,807 115,252,830 2,663,472,000 42,296,000 2,621,176,000 386,600,941 386,600,941 115,252,830 MARYLAND..................... 50.00 82,948,968 83,695,509 11,950,442,000 153,711,000 11,796,731,000 1,862,641,737 1,862,641,737 83,695,509 MASSACHUSETTS................ 50.00 331,795,869 334,782,032 18,581,439,000 0 18,581,439,000 2,933,911,421 2,933,911,421 334,782,032 MICHIGAN..................... 65.15 288,281,658 290,876,193 18,171,344,000 372,764,000 17,798,580,000 2,618,048,889 2,618,048,889 290,876,193 MISSISSIPPI.................. 74.63 165,897,935 167,391,016 5,723,846,000 225,000,000 5,498,846,000 786,291,957 786,291,957 167,391,016 MISSOURI..................... 63.21 515,371,453 520,009,796 10,670,006,000 693,986,000 9,976,020,000 1,477,643,173 1,477,643,173 520,009,796 NEVADA....................... 64.67 50,313,307 50,766,127 3,578,926,000 80,370,000 3,498,556,000 515,477,387 515,477,387 50,766,127 NEW HAMPSHIRE................ 50.00 174,164,027 175,731,503 2,169,830,000 247,753,000 1,922,077,000 303,485,842 303,485,842 175,731,503 NEW JERSEY................... 50.00 700,306,857 706,609,619 15,361,605,000 850,921,000 14,510,684,000 2,291,160,632 2,291,160,632 706,609,619 NEW YORK..................... 50.00 1,747,367,593 1,763,093,901 71,683,117,000 5,973,100,000 65,710,017,000 10,375,265,842 10,375,265,842 1,763,093,901 NORTH CAROLINA............... 66.88 320,917,316 323,805,572 13,175,069,000 257,682,000 12,917,387,000 1,889,026,624 1,889,026,624 323,805,572 OHIO......................... 62.32 441,941,221 445,918,692 24,746,576,000 0 24,746,576,000 3,677,758,227 3,677,758,227 445,918,692 PENNSYLVANIA................. 51.78 610,558,793 616,053,822 30,203,978,000 890,607,000 29,313,371,000 4,578,722,022 4,578,722,022 616,053,822 RHODE ISLAND................. 51.02 70,710,595 71,346,990 2,718,936,000 144,308,000 2,574,628,000 403,969,822 403,969,822 71,346,990 SOUTH CAROLINA............... 71.30 356,272,614 359,479,068 6,171,883,000 503,738,000 5,668,145,000 817,818,695 817,818,695 359,479,068 TENNESSEE \1\................ 64.96 na na na na na na na 53,100,000 TEXAS........................ 56.18 1,040,261,642 1,049,623,997 40,497,188,000 1,853,258,000 38,643,930,000 5,896,829,300 5,896,829,300 1,049,623,997 VERMONT...................... 54.46 24,476,746 24,697,037 1,726,339,000 37,449,000 1,688,890,000 259,944,275 259,944,275 24,697,037 VIRGINIA..................... 50.00 95,304,365 96,162,104 9,016,918,000 190,421,000 8,826,497,000 1,393,657,421 1,393,657,421 96,162,104 WASHINGTON................... 50.00 201,253,233 203,064,512 12,794,211,000 429,915,000 12,364,296,000 1,952,257,263 1,952,257,263 203,064,512 WEST VIRGINIA................ 71.80 73,430,234 74,091,106 4,246,975,000 73,358,000 4,173,617,000 601,335,854 601,335,854 74,091,106 ------------------------------------------------------------------------------------------------------------------------------------------------------------------ TOTAL.................... ......... 11,352,715,861 11,454,890,304 523,878,648,000 17,774,158,000 506,104,490,000 77,714,175,902 77,714,175,902 11,507,990,304 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ LOW DSH STATES ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ALASKA....................... 50.00 22,159,278 22,358,712 2,521,495,000 25,641,000 2,495,854,000 394,082,210.53 394,082,211 22,358,712 ARKANSAS..................... 69.69 46,927,667 47,350,016 6,490,998,000 50,820,000 6,440,178,000 933,574,633 933,574,633 47,350,016 DELAWARE..................... 54.20 9,848,568 9,937,205 1,968,900,000 0 1,968,900,000 303,453,213 303,453,213 9,937,205 HAWAII....................... 54.93 10,602,012 10,697,430 2,264,951,000 0 2,264,951,000 347,767,319.16 347,767,319 10,697,430 IDAHO........................ 71.51 17,881,623 18,042,558 2,075,465,000 27,147,000 2,048,318,000 295,362,568.00 295,362,568 18,042,558 IOWA......................... 56.74 42,840,981 43,226,550 4,891,542,000 48,927,000 4,842,615,000 736,978,029 736,978,029 43,226,550 MINNESOTA.................... 50.00 81,250,689 81,981,945 12,229,177,000 154,641,000 12,074,536,000 1,906,505,684 1,906,505,684 81,981,945 MONTANA...................... 65.56 12,348,001 12,459,133 1,664,645,000 1,810,000 1,662,835,000 244,246,742 244,246,742 12,459,133 NEBRASKA..................... 51.85 30,784,371 31,061,430 2,166,975,000 41,996,000 2,124,979,000 331,784,676 331,784,676 31,061,430 NEW MEXICO................... 71.13 22,159,278 22,358,712 5,528,792,000 31,460,000 5,497,332,000 793,557,027 793,557,027 22,358,712 NORTH DAKOTA................. 50.00 10,391,173 10,484,694 1,305,889,000 1,485,000 1,304,404,000 205,958,526 205,958,526 10,484,694 OKLAHOMA..................... 59.94 39,394,271 39,748,819 5,276,333,000 47,870,000 5,228,463,000 784,465,763 784,465,763 39,748,819 OREGON....................... 64.47 49,242,842 49,686,028 9,814,476,000 81,372,000 9,733,104,000 1,435,090,257 1,435,090,257 49,686,028 SOUTH DAKOTA................. 54.94 12,014,978 12,123,113 906,932,000 1,527,000 905,405,000 139,011,506 139,011,506 12,123,113 UTAH......................... 69.90 21,341,528 21,533,602 2,638,196,000 33,036,000 2,605,160,000 377,410,744 377,410,744 21,533,602 WISCONSIN.................... 58.51 102,838,032 103,763,574 8,862,528,000 102,737,000 8,759,791,000 1,322,387,542 1,322,387,542 103,763,574 WYOMING...................... 50.00 246,214 248,430 600,990,000 482,000 600,508,000 94,817,053 94,817,053 248,430 ------------------------------------------------------------------------------------------------------------------------------------------------------------------ [[Page 51267]] TOTAL LOW DSH STATES..... ......... 532,271,506 537,061,950 71,208,284,000 650,951,000 70,557,333,000 10,646,453,493 10,646,453,493 537,061,951 ------------------------------------------------------------------------------------------------------------------------------------------------------------------ TOTAL................ ......... 11,884,987,367 11,991,952,253 595,086,932,000 18,425,109,000 576,661,823,000 88,360,629,395 88,360,629,395 12,045,052,255 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ \1\ Tennessee's DSH allotment for FY 2017 determined under section 1923(f)(6)(A) of the Act. \2\ Expenditures based on the amounts reported by States on the Form CMS-37. [[Page 51268]] Key to Addendum 3--Final IMD DSH Limits for FY 2015 [The final 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 as of January 1, 1997. 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' FY 2015 DSH allotments from Addendum 1, Column J. 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 2015 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 51269]] Addendum 3--Final IMD DSH Limit for FY: 2015 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Applicable Inpatient IMD and Total inpatient percentage hospital mental health & IMD & mental Applicable FY 2015 FY 2015 applied to FY FY 2015 TC FY 2015 IMD State services FY 95 services FY health FY 95 percent FY 2015 FMAPs allotments in 2015 IMD limit limit in FS DSH total 95 DSH total DSH total Col C/D allotment in FS (percent) TC Col F/G allotments in (lesser of Col Col G x J computable computable computable Col TC Col E x I or Col C) B + C Col H ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ALABAMA............................. $413,006,229 $4,451,770 $417,457,999 1.07 $333,514,963 68.99 $483,425,080 $5,155,243 $4,451,770 $3,071,276 ARIZONA............................. 93,916,100 28,474,900 122,391,000 23.27 109,815,903 68.46 160,408,856 37,319,951 28,474,900 19,493,917 CALIFORNIA.......................... 2,189,879,543 1,555,919 2,191,435,462 0.07 1,188,994,401 50.00 2,377,988,802 1,688,372 1,555,919 777,960 COLORADO............................ 173,900,441 594,776 174,495,217 0.34 100,325,639 51.01 196,678,375 670,388 594,776 303,395 CONNECTICUT......................... 303,359,275 105,573,725 408,933,000 25.82 216,920,301 50.00 433,840,602 112,004,090 105,573,725 52,786,863 DISTRICT OF COLUMBIA................ 39,532,234 6,545,136 46,077,370 14.20 66,431,842 70.00 94,902,631 13,480,601 6,545,136 4,581,595 FLORIDA............................. 184,468,014 149,714,986 334,183,000 33.00 216,920,301 59.72 363,228,903 119,865,538 119,865,538 71,583,699 GEORGIA............................. 407,343,557 0 407,343,557 0.00 291,486,655 66.94 435,444,659 0 0 0 ILLINOIS............................ 315,868,508 89,408,276 405,276,784 22.06 233,189,324 50.76 459,395,831 101,347,501 89,408,276 45,383,641 INDIANA............................. 79,960,783 153,566,302 233,527,085 33.00 231,833,573 66.52 348,517,097 115,010,642 115,010,642 76,505,079 KANSAS.............................. 11,587,208 76,663,508 88,250,716 33.00 44,739,812 56.63 79,003,729 26,071,231 26,071,231 14,764,138 KENTUCKY............................ 158,804,908 37,443,073 196,247,981 19.08 157,267,219 69.94 224,860,193 42,902,131 37,443,073 26,187,685 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 MAINE............................... 99,957,958 60,958,342 160,916,300 33.00 113,883,158 61.88 184,038,717 60,732,777 60,732,777 37,581,442 MARYLAND............................ 22,226,467 120,873,531 143,099,998 33.00 82,700,865 50.00 165,401,730 54,582,571 54,582,571 27,291,285 MASSACHUSETTS....................... 469,653,946 105,635,054 575,289,000 18.36 330,803,459 50.00 661,606,918 121,484,823 105,635,054 52,817,527 MICHIGAN............................ 133,258,800 304,765,552 438,024,352 33.00 287,419,400 65.54 438,540,433 144,718,343 144,718,343 94,848,402 MISSISSIPPI......................... 182,608,033 0 182,608,033 0.00 165,401,730 73.58 224,791,696 0 0 0 MISSOURI............................ 521,946,524 207,234,618 729,181,142 28.42 513,829,963 63.45 809,818,697 230,151,959 207,234,618 131,490,365 NEVADA.............................. 73,560,000 0 73,560,000 0.00 50,162,819 64.36 77,940,987 0 0 0 NEW HAMPSHIRE....................... 92,675,916 94,753,948 187,429,864 33.00 173,643,098 50.00 347,286,196 114,604,445 94,753,948 47,376,974 NEW JERSEY.......................... 736,742,539 357,370,461 1,094,113,000 32.66 698,212,220 50.00 1,396,424,440 456,114,538 357,370,461 178,685,231 NEW YORK............................ 2,418,869,368 605,000,000 3,023,869,368 20.01 1,742,141,169 50.00 3,484,282,338 697,117,024 605,000,000 302,500,000 NORTH CAROLINA...................... 193,201,966 236,072,627 429,274,593 33.00 319,957,444 65.88 485,667,037 160,270,122 160,270,122 105,585,957 OHIO................................ 535,731,956 93,432,758 629,164,714 14.85 440,619,363 62.64 703,415,330 104,459,187 93,432,758 58,526,280 PENNSYLVANIA........................ 388,207,319 579,199,682 967,407,001 33.00 608,732,595 51.82 1,174,705,895 387,652,945 387,652,945 200,881,756 RHODE ISLAND........................ 108,503,167 2,397,833 110,901,000 2.16 70,499,098 50.00 140,998,196 3,048,576 2,397,833 1,198,917 SOUTH CAROLINA...................... 366,681,364 72,076,341 438,757,705 16.43 355,206,993 70.64 502,841,157 82,603,565 72,076,341 50,914,727 TENNESSEE *......................... 0 0 0 0.00 53,100,000 64.99 81,704,878 0 0 0 TEXAS............................... 1,220,515,401 292,513,592 1,513,028,993 19.33 1,037,150,191 58.05 1,786,649,769 345,412,642 292,513,592 169,804,140 VERMONT **.......................... 19,979,252 9,071,297 29,050,549 31.23 24,403,535 56.21 43,414,935 13,556,707 9,071,297 5,098,976 VIRGINIA............................ 129,313,480 7,770,268 137,083,748 5.67 95,019,307 50.00 190,038,614 10,771,889 7,770,268 3,885,134 WASHINGTON.......................... 171,725,815 163,836,435 335,562,250 33.00 200,651,279 50.03 401,061,921 132,350,434 132,350,434 66,214,922 WEST VIRGINIA....................... 66,962,606 18,887,045 85,849,651 22.00 73,210,602 71.35 102,607,711 22,573,842 18,887,045 13,475,907 ----------------------------------------------------------------------------------------------------------------------------------------------------------- TOTAL........................... 13,402,460,846 4,118,758,904 17,521,219,750 .......... 11,371,859,581 ......... 20,259,435,756 3,849,221,003 3,472,944,320 1,945,212,274 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ LOW DSH STATES ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ALASKA.............................. 2,506,827 17,611,765 20,118,592 33.00 22,092,999 50.00 44,185,998 14,581,379 14,581,379 7,290,690 ARKANSAS............................ 2,422,649 819,351 3,242,000 25.27 46,787,305 70.88 66,009,177 16,682,506 819,351 580,756 DELAWARE............................ 0 7,069,000 7,069,000 33.00 9,819,111 53.63 18,308,989 6,041,966 6,041,966 3,240,307 HAWAII.............................. 0 0 0 0.00 10,570,301 52.23 20,237,988 0 0 0 IDAHO............................... 2,081,429 0 2,081,429 0.00 17,828,139 71.75 24,847,580 0 0 0 IOWA................................ 12,011,250 0 12,011,250 0.00 42,712,842 55.54 76,904,649 0 0 0 MINNESOTA........................... 24,240,000 5,257,214 29,497,214 17.82 81,007,666 50.00 162,015,332 28,875,584 5,257,214 2,628,607 MONTANA............................. 237,048 0 237,048 0.00 12,311,068 65.90 18,681,439 0 0 0 NEBRASKA............................ 6,449,102 1,811,337 8,260,439 21.93 30,692,294 53.27 57,616,471 12,634,056 1,811,337 964,899 NEW MEXICO.......................... 6,490,015 254,786 6,744,801 3.78 22,092,999 69.65 31,720,027 1,198,229 254,786 177,458 NORTH DAKOTA........................ 214,523 988,478 1,203,001 33.00 10,360,093 50.00 20,720,186 6,837,661 988,478 494,239 OKLAHOMA............................ 20,019,969 3,273,248 23,293,217 14.05 39,276,442 62.30 63,044,048 8,859,180 3,273,248 2,039,234 OREGON.............................. 11,437,908 19,975,092 31,413,000 33.00 49,095,555 64.06 76,639,955 25,291,185 19,975,092 12,796,044 SOUTH DAKOTA........................ 321,120 751,299 1,072,419 33.00 11,979,041 51.64 23,197,213 7,655,080 751,299 387,971 UTAH................................ 3,621,116 934,586 4,555,702 20.51 21,277,695 70.56 30,155,463 6,186,286 934,586 659,444 WISCONSIN........................... 6,609,524 4,492,011 11,101,535 33.00 102,530,441 58.27 175,957,510 58,065,978 4,492,011 2,617,495 WYOMING............................. 0 0 0 0.00 245,478 50.00 490,956 0 0 0 ----------------------------------------------------------------------------------------------------------------------------------------------------------- [[Page 51270]] TOTAL LOW DSH STATES............ 98,662,480 63,238,167 161,900,647 .......... 530,679,469 ......... 910,732,982 192,909,092 59,180,748 33,877,144 ----------------------------------------------------------------------------------------------------------------------------------------------------------- TOTAL....................... 13,501,123,326 4,181,997,071 17,683,120,397 .......... 11,902,539,050 ......... 21,170,168,738 4,042,130,095 3,532,125,067 1,979,089,418 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ * Tennessee's DSH allotment for FY 2015 determined under section 1923(f)(6)(A) of the Act. ** Vermont's FMAP for FY 2015 determined in accordance with section 1905(z)(1)(A) of the Act. [[Page 51271]] Key to Addendum 4--Preliminary IMD DSH Limits for FY 2017 [The preliminary FY 2017 IMD DSH Limits for the Non-Low DSH States are presented in the top section of this addendum and the preliminary FY 2017 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 as of January 1, 1997. 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 2017 Federal Share DSH Allotment. This column contains the states' preliminary FY 2017 DSH allotments from Addendum 1, Column J. Column G................. FY 2017 FMAP. Column H................. FY 2017 DSH Allotments in Total Computable, Col. F/G. This column contains states' FY 2017 total computable DSH allotment (determined as Column F/Column G). Column I................. Applicable Percentage Applied to FY 2017 Allotments in TC, Col E x Col H. This column contains the applicable percentage of FY 2016 total computable DSH allotment (calculated as the percentage in Column E multiplied by the amount in Column H). Column J................. FY 2017 TC IMD DSH Limit. Lesser of Col. I or C. This column contains the total computable FY 2017 TC IMD DSH Limit equal to the lesser of the amount in Column I or Column C. Column K................. FY 2017 IMD DSH Limit in Federal Share, Col. G x J. This column contains the FY 2017 Federal Share IMD DSH limit determined by converting the total computable FY 2017 IMD DSH Limit from Column J into a federal share amount by multiplying it by the FY 2017 FMAP in Column G. ------------------------------------------------------------------------ [[Page 51272]] Addendum 4--Preliminary IMD DSH Limit for Fiscal Year: 2017 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Applicable Inpatient IMD and Total inpatient percentage hospital mental health & IMD & mental Applicable FY 2017 FY 2017 FY 2017 applied to FY FY 2017 TC FY 2017 IMD State services FY 95 services FY health FY 95 percent allotment in FMAPs allotments in 2017 IMD limit limit in FS DSH total 95 DSH total DSH total Col C/D FS (percent) TC Col F/G allotments in (lesser of Col Col G x J computable computable computable Col TC Col E x I or Col C) B + C Col H ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ALABAMA.............................. $413,006,229 $4,451,770 $417,457,999 1.07 $337,526,148 70.16 $481,080,599 $5,130,241 $4,451,770 $3,123,362 ARIZONA.............................. 93,916,100 28,474,900 122,391,000 23.27 111,136,659 69.24 160,509,328 37,343,327 28,474,900 19,716,021 CALIFORNIA........................... 2,189,879,543 1,555,919 2,191,435,462 0.07 1,203,294,436 50.00 2,406,588,872 1,708,678 1,555,919 777,960 COLORADO............................. 173,900,441 594,776 174,495,217 0.34 101,532,256 50.02 202,983,319 691,879 594,776 297,507 CONNECTICUT.......................... 303,359,275 105,573,725 408,933,000 25.82 219,529,202 50.00 439,058,404 113,351,163 105,573,725 52,786,863 DISTRICT OF COLUMBIA................. 39,532,234 6,545,136 46,077,370 14.20 67,230,818 70.00 96,044,026 13,642,732 6,545,136 4,581,595 FLORIDA.............................. 184,468,014 149,714,986 334,183,000 33.00 219,529,202 61.10 359,294,930 118,567,327 118,567,327 72,444,637 GEORGIA.............................. 407,343,557 0 407,343,557 0.00 294,992,365 67.89 434,515,194 0 0 0 ILLINOIS............................. 315,868,508 89,408,276 405,276,784 22.06 235,993,892 51.30 460,027,080 101,486,761 89,408,276 45,866,446 INDIANA.............................. 79,960,783 153,566,302 233,527,085 33.00 234,621,836 66.74 351,546,053 116,010,198 116,010,198 77,425,206 KANSAS............................... 11,587,208 76,663,508 88,250,716 33.00 45,277,897 56.21 80,551,320 26,581,936 26,581,936 14,941,706 KENTUCKY............................. 158,804,908 37,443,073 196,247,981 19.08 159,158,672 70.46 225,885,143 43,097,686 37,443,073 26,382,389 LOUISIANA............................ 1,078,512,169 132,917,149 1,211,429,318 10.97 752,615,495 62.28 1,208,438,496 132,588,998 132,588,998 82,576,428 MAINE................................ 99,957,958 60,958,342 160,916,300 33.00 115,252,830 64.38 179,019,618 59,076,474 59,076,474 38,033,434 MARYLAND............................. 22,226,467 120,873,531 143,099,998 33.00 83,695,509 50.00 167,391,018 55,239,036 55,239,036 27,619,518 MASSACHUSETTS........................ 469,653,946 105,635,054 575,289,000 18.36 334,782,032 50.00 669,564,064 122,945,921 105,635,054 52,817,527 MICHIGAN............................. 133,258,800 304,765,552 438,024,352 33.00 290,876,193 65.15 446,471,517 147,335,600 147,335,600 95,989,144 MISSISSIPPI.......................... 182,608,033 0 182,608,033 0.00 167,391,016 74.63 224,294,541 0 0 0 MISSOURI............................. 521,946,524 207,234,618 729,181,142 28.42 520,009,796 63.21 822,670,141 233,804,363 207,234,618 130,993,002 NEVADA............................... 73,560,000 0 73,560,000 0.00 50,766,127 64.67 78,500,274 0 0 0 NEW HAMPSHIRE........................ 92,675,916 94,753,948 187,429,864 33.00 175,731,503 50.00 351,463,006 115,982,792 94,753,948 47,376,974 NEW JERSEY........................... 736,742,539 357,370,461 1,094,113,000 32.66 706,609,619 50.00 1,413,219,238 461,600,228 357,370,461 178,685,231 NEW YORK............................. 2,418,869,368 605,000,000 3,023,869,368 20.01 1,763,093,901 50.00 3,526,187,802 705,501,250 605,000,000 302,500,000 NORTH CAROLINA....................... 193,201,966 236,072,627 429,274,593 33.00 323,805,572 66.88 484,159,049 159,772,486 159,772,486 106,855,839 OHIO................................. 535,731,956 93,432,758 629,164,714 14.85 445,918,692 62.32 715,530,635 106,258,344 93,432,758 58,227,295 PENNSYLVANIA......................... 388,207,319 579,199,682 967,407,001 33.00 616,053,822 51.78 1,189,752,457 392,618,311 392,618,311 203,297,761 RHODE ISLAND......................... 108,503,167 2,397,833 110,901,000 2.16 71,346,990 51.02 139,841,219 3,023,561 2,397,833 1,223,374 SOUTH CAROLINA....................... 366,681,364 72,076,341 438,757,705 16.43 359,479,068 71.30 504,178,216 82,823,209 72,076,341 51,390,431 TENNESSEE*........................... 0 0 0 0.00 53,100,000 64.96 81,742,611 0 0 0 TEXAS................................ 1,220,515,401 292,513,592 1,513,028,993 19.33 1,049,623,997 56.18 1,868,323,241 361,202,558 292,513,592 164,334,136 VERMONT.............................. 19,979,252 9,071,297 29,050,549 31.23 24,697,037 54.46 45,348,948 14,160,620 9,071,297 4,940,228 VIRGINIA............................. 129,313,480 7,770,268 137,083,748 5.67 96,162,104 50.00 192,324,208 10,901,443 7,770,268 3,885,134 WASHINGTON........................... 171,725,815 163,836,435 335,562,250 33.00 203,064,512 50.00 406,129,024 134,022,578 134,022,578 67,011,289 WEST VIRGINIA........................ 66,962,606 18,887,045 85,849,651 22.00 74,091,106 71.80 103,190,955 22,702,157 18,887,045 13,560,898 ---------------------------------------------------------------------------------------------------------------------------------------------------------- TOTAL............................ 13,402,460,846 4,118,758,904 17,521,219,750 .......... 11,507,990,304 ......... 20,515,824,545 3,899,171,855 3,482,003,733 1,949,661,335 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ LOW DSH STATES ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ALASKA............................... 2,506,827 17,611,765 20,118,592 33.00 22,358,712 50.00 44,717,424 14,756,750 14,756,750 7,378,375 ARKANSAS............................. 2,422,649 819,351 3,242,000 25.27 47,350,016 69.69 67,943,774 17,171,437 819,351 571,006 DELAWARE............................. 0 7,069,000 7,069,000 33.00 9,937,205 54.20 18,334,327 6,050,328 6,050,328 3,279,278 HAWAII............................... 0 0 0 0.00 10,697,430 54.93 19,474,659 0 0 0 IDAHO................................ 2,081,429 0 2,081,429 0.00 18,042,558 71.51 25,230,818 0 0 0 IOWA................................. 12,011,250 0 12,011,250 0.00 43,226,550 56.74 76,183,557 0 0 0 MINNESOTA............................ 24,240,000 5,257,214 29,497,214 17.82 81,981,945 50.00 163,963,890 29,222,870 5,257,214 2,628,607 MONTANA.............................. 237,048 0 237,048 0.00 12,459,133 65.56 19,004,169 0 0 0 NEBRASKA............................. 6,449,102 1,811,337 8,260,439 21.93 31,061,430 51.85 59,906,326 13,136,172 1,811,337 939,178 NEW MEXICO........................... 6,490,015 254,786 6,744,801 3.78 22,358,712 71.13 31,433,589 1,187,409 254,786 181,229 NORTH DAKOTA......................... 214,523 988,478 1,203,001 33.00 10,484,694 50.00 20,969,388 6,919,898 988,478 494,239 OKLAHOMA............................. 20,019,969 3,273,248 23,293,217 14.05 39,748,819 59.94 66,314,346 9,318,734 3,273,248 1,961,985 OREGON............................... 11,437,908 19,975,092 31,413,000 33.00 49,686,028 64.47 77,068,447 25,432,588 19,975,092 12,877,942 SOUTH DAKOTA......................... 321,120 751,299 1,072,419 33.00 12,123,113 54.94 22,066,096 7,281,812 751,299 412,764 UTAH................................. 3,621,116 934,586 4,555,702 20.51 21,533,602 69.90 30,806,298 6,319,802 934,586 653,276 WISCONSIN............................ 6,609,524 4,492,011 11,101,535 33.00 103,763,574 58.51 177,343,316 58,523,294 4,492,011 2,628,276 WYOMING.............................. 0 0 0 0.00 248,430 50.00 496,860 0 0 0 ---------------------------------------------------------------------------------------------------------------------------------------------------------- [[Page 51273]] TOTAL LOW DSH STATES............. 98,662,480 63,238,167 161,900,647 .......... 537,061,951 ......... 921,257,282 195,321,094 59,364,480 34,006,155 ---------------------------------------------------------------------------------------------------------------------------------------------------------- TOTAL........................ 13,501,123,326 4,181,997,071 17,683,120,397 .......... 12,045,052,255 ......... 21,437,081,826 4,094,492,949 3,541,368,213 1,983,667,490 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ * Tennessee's DSH allotment for FY 2017, determined under section 1923(f)(6)(A) of the Act, is $53,100,000. [[Page 51274]] [FR Doc. 2017-23933 Filed 11-2-17; 8:45 am] BILLING CODE 4120-01-P
![Federal Register / Vol. 82, No. 212 / Friday, November 3, 2017 / Notices 51259
DEPARTMENT OF HEALTH AND through FY 2020, the calculation of CMS–64 as of January 1, 1997), or the
HUMAN SERVICES which was described in the amount equal to the product of the
Disproportionate Share Hospital state’s current year total computable
Centers for Medicare & Medicaid Payment Reduction final rule published DSH allotment and the applicable
Services in the September 18, 2013 Federal percentage specified in section 1923(h)
[CMS–2409–N] Register (78 FR 57293). Subsequent of the Act.
legislation, most recently by the In general, we determine states’ DSH
RIN 0938–ZB43 Medicare Access and CHIP allotments for a FY and the IMD DSH
Reauthorization Act of 2015 (Pub. L. limits for the same FY using the most
Medicaid Program; Final FY 2015 and 114–10, enacted on April 16, 2015) recent available estimates of or actual
Preliminary FY 2017 Disproportionate (MACRA), delayed the start of these medical assistance expenditures,
Share Hospital Allotments, and Final reductions until FY 2018. The proposed including DSH expenditures in their
FY 2015 and Preliminary FY 2017 rule delineating the methodology for the Medicaid programs and the most recent
Institutions for Mental Diseases calculation of DSH allotment reductions available change in the CPI–U used for
Disproportionate Share Hospital Limits scheduled to begin in FY 2018 was the FY in accordance with the
AGENCY: Centers for Medicare & published in the July 28, 2017 Federal methodology prescribed in the statute.
Medicaid Services (CMS), HHS. Register (82 FR 35155). The indicated estimated or actual
Because there are no reductions to expenditures are obtained from states
ACTION: Notice.
DSH allotments for FY 2015 and FY for each relevant FY from the most
SUMMARY: This notice announces the 2017 under section 1923(f)(7) of the Act, recent available quarterly Medicaid
final federal share disproportionate as amended, this notice contains only budget reports (Form CMS–37) or
share hospital (DSH) allotments for the state-specific final FY 2015 DSH quarterly Medicaid expenditure reports
federal fiscal year (FY) 2015 and the allotments and preliminary FY 2017 (Form CMS–64), respectively, submitted
preliminary federal share DSH DSH allotments, as calculated under the by the states. For example, as part of the
allotments for FY 2017. This notice also statute without application of the initial determination of a state’s FY DSH
announces the final FY 2015 and the reductions that would have been allotment (referred to as the preliminary
preliminary FY 2017 limitations on imposed under the Affordable Care Act DSH allotments) that is determined
aggregate DSH payments that states may provisions beginning with FY 2014. before the beginning of the FY for which
make to institutions for mental disease This notice also provides information the DSH allotments and IMD DSH limits
and other mental health facilities. In on the calculation of such FY DSH are being determined, we use estimated
addition, this notice includes allotments, the calculation of the states’ expenditures for the FY obtained from
background information describing the institutions for mental diseases (IMDs) the August submission of the CMS–37
methodology for determining the DSH limits, and the amounts of states’ submitted by states prior to the
final FY 2015 IMD DSH limits and beginning of the FY; such estimated
amounts of states’ FY DSH allotments.
preliminary FY 2017 IMD DSH limits. expenditures are subject to update and
DATES: This notice is applicable revision during the FY before such
December 4, 2017. The final allotments B. Determination of Fiscal Year DSH
actual expenditure data become
and limitations set forth in this notice Allotments
available. We also use the most recent
are applicable for the fiscal years Generally, in accordance with the available estimated CPI–U percentage
specified. methodology specified under section change that is available before the
FOR FURTHER INFORMATION CONTACT: 1923(f)(3) of the Act, a state’s FY DSH beginning of the FY for determining the
Stuart Goldstein, (410) 786–0694 and allotment is calculated by increasing the states’ preliminary FY DSH allotments;
Richard Cuno, (410) 786–1111. amount of its DSH allotment for the such estimated CPI–U percentage
preceding FY by the percentage change change is subject to update and revision
SUPPLEMENTARY INFORMATION:
in the CPI–U for the previous FY. Also during the FY before the actual CPI–U
I. Background in accordance with section 1923(f)(3) of percentage change becomes available. In
the Act, a state’s DSH allotment for a FY determining the final DSH allotments
A. Fiscal Year DSH Allotments
is subject to the limitation that an and IMD DSH limits for a FY we use the
A state’s federal fiscal year (FY) increase to a state’s DSH allotment for actual expenditures for the FY and
disproportionate share hospital (DSH) a FY cannot result in the DSH allotment actual CPI–U percentage change for the
allotment represents the aggregate limit exceeding the greater of the state’s DSH previous FY.
on the federal share amount of the allotment for the previous FY or 12
state’s DSH payments to DSH hospitals percent of the state’s total medical II. Provisions of the Notice
in the state for the FY. The amount of assistance expenditures for the A. Calculation of the Final FY 2015
such allotment is determined in allotment year (this is referred to as the Federal Share State DSH Allotments,
accordance with the provisions of 12 percent limit). and the Preliminary FY 2017 Federal
section 1923(f)(3) of the Social Security Furthermore, under section 1923(h) of Share State DSH Allotments
Act (the Act). Under such provisions, in the Act, federal financial participation
general a state’s FY DSH allotment is (FFP) for DSH payments to IMDs and 1. Final FY 2015 Federal Share State
calculated by increasing the amount of other mental health facilities is limited DSH Allotments
its DSH allotment for the preceding FY to state-specific aggregate amounts. Addendum 1 to this notice provides
by the percentage change in the Under this provision, the aggregate limit the states’ final FY 2015 DSH allotments
ethrower on DSK3G9T082PROD with NOTICES
Consumer Price Index for all Urban for DSH payments to IMDs and other determined in accordance with section
Consumers (CPI–U) for the previous FY. mental health facilities is the lesser of 1923(f)(3) of the Act. As described in the
The Affordable Care Act amended a state’s FY 1995 total computable (state background section, in general, the DSH
Medicaid DSH provisions, adding and federal share) IMD and other mental allotment for a FY is calculated by
section 1923(f)(7) of the Act which health facility DSH expenditures increasing the FY DSH allotment for the
would have required reductions to applicable to the state’s FY 1995 DSH preceding FY by the CPI–U increase for
states’ FY DSH allotments from FY 2014 allotment (as reported on the Form the previous fiscal year. For purposes of
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![Federal Register / Vol. 82, No. 212 / Friday, November 3, 2017 / Notices 51261
economic impact on a substantial Section 202 of the Unfunded 1, we have prepared an accounting
number of small entities. Specifically, Mandates Reform Act of 1995 also statement showing the classification of
any impact on providers is due to the requires that agencies assess anticipated the estimated expenditures associated
effect of the various controlling statutes; costs and benefits before issuing any with the provisions of this notice. Table
providers are not impacted as a result of rule whose mandates require spending 1 provides our best estimate of the
the independent regulatory action in in any 1 year of $100 million in 1995 change (decrease) in the federal share of
publishing this notice. The purpose of dollars, updated annually for inflation. states’ Medicaid DSH payments
the notice is to announce the latest DSH In 2017, that threshold is approximately resulting from the application of the
allotments and IMD DSH limits, as $148 million. This notice will have no provisions of the Medicaid statute
required by the statute. consequential effect on spending by relating to the calculation of states’ FY
state, local, or tribal governments, in the DSH allotments and the increase in the
In addition, section 1102(b) of the Act
aggregate, or on the private sector. FY DSH allotments from FY 2016 to FY
requires us to prepare a regulatory Executive Order 13132 establishes
impact analysis if a rule may have a 2017.
certain requirements that an agency
significant impact on the operations of must meet when it promulgates a
a substantial number of small rural TABLE 1—ACCOUNTING STATEMENT:
proposed rule (and subsequent final CLASSIFICATION OF ESTIMATED EX-
hospitals. This analysis must conform to rule) that imposes substantial direct
the provisions of section 604 of the PENDITURES, FROM THE FY 2016 TO
requirement costs on state and local
RFA. For purposes of section 1102(b) of governments, preempts state law, or FY 2017
the Act, we define a small rural hospital otherwise has Federalism implications. [In millions]
as a hospital that is located outside of Since this notice does not impose any
a Core-Based Statistical Area for costs on state or local governments or Category Transfers
Medicaid payment regulations and has otherwise have Federalism implications,
fewer than 100 beds. We are not Annualized Monetized $118.
the requirements of E.O. 13132 are not Transfers.
preparing analysis for section 1102(b) of applicable. From Whom To Federal Government
the Act because the Secretary has Executive Order 13771, titled Whom?. to States.
determined that this notice will not ‘‘Reducing Regulation and Controlling
have a significant impact on the Regulatory Costs,’’ was issued on Congressional Review Act
operations of a substantial number of January 30, 2017. It has been
small rural hospitals. determined that this notice is a transfer This proposed regulation is subject to
The Medicaid statute specifies the rule and is not a regulatory action for the Congressional Review Act
methodology for determining the the purposes of Executive Order 13771. provisions of the Small Business
amounts of states’ DSH allotments and A. Alternatives Considered Regulatory Enforcement Fairness Act of
IMD DSH limits; and as described 1996 (5 U.S.C. 801 et seq.) and has been
The methodologies for determining transmitted to the Congress and the
previously, the application of the the states’ fiscal year DSH allotments
methodology specified in statute results Comptroller General for review.
and IMD DSH limits, as reflected in this
in the decreases or increases in states’ notice, were established in accordance In accordance with the provisions of
DSH allotments and IMD DSH limits for with the methodologies and formula for Executive Order 12866, this notice was
the applicable FYs. The statute determining states’ allotments and reviewed by the Office of Management
applicable to these allotments and limits limits as specified in statute. This notice and Budget.
does not apply to the determination of does not put forward any further Dated October 11, 2017.
the amounts of DSH payments made to discretionary administrative policies for Seema Verma,
specific DSH hospitals; rather, these determining such allotments and limits,
allotments and limits represent an Administrator, Centers for Medicare &
or otherwise. Medicaid Services.
overall limit on the total of such DSH
payments. For this reason, we do not B. Accounting Statement Dated October 27, 2017.
believe that this notice will have a As required by OMB Circular A–4 Eric D. Hargan,
significant economic impact on a (available at http://www.whitehouse.gov Acting Secretary, Department of Health and
substantial number of small entities. /omb/circulars/a004/a-4.pdf), in Table Human Services.
KEY TO ADDENDUM 1—FINAL DSH ALLOTMENTS FOR FY 2015
[The Final FY 2015 DSH Allotments for the NON-Low DSH States are presented in the top section of this addendum, and the Final 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) × (100percent + Percentage Increase in CPIU): 101.6 percent. This column contains
the amount in Column C increased by 1 plus the 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’ FY 2015 total computable (TC) med-
ethrower on DSK3G9T082PROD with NOTICES
ical assistance expenditures including DSH expenditures.
Column F .......... FY 2015 TC DSH Expenditures. This column contains the amount of the States’ FY 2015 total computable DSH expenditures.
Column G ......... FY 2015 TC MAP Exp. Net of DSH. This column contains the amount of the States’ FY 2015 total computable medical assist-
ance 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 al-
lotment or the amount of the 12 percent limit, determined as the maximum of the amount in Column C or Column H.
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![51262 Federal Register / Vol. 82, No. 212 / Friday, November 3, 2017 / Notices
KEY TO ADDENDUM 1—FINAL DSH ALLOTMENTS FOR FY 2015—Continued
[The Final FY 2015 DSH Allotments for the NON-Low DSH States are presented in the top section of this addendum, and the Final FY 2015
DSH Allotments for the Low-DSH States are presented in the bottom section of this addendum.]
Column Description
Column J .......... FY 2015 DSH Allotment. This column contains the States’ final 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. 82, No. 212 / Friday, November 3, 2017 / Notices 51265
KEY TO ADDENDUM 2: PRELIMINARY DSH ALLOTMENTS FOR FY 2017
[The Preliminary FY 2017 DSH Allotments for the NON-Low DSH States are presented in the top section of this addendum, and the Preliminary
FY 2017 DSH Allotments for the Low-DSH States are presented in the bottom section of this addendum.]
Column Description
Column A .......... State.
Column B .......... FY 2017 FMAPs. This column contains the States’ FY 2017 Federal Medical Assistance Percentages.
Column C ......... Prior FY (2016) DSH Allotments. This column contains the States’ prior preliminary FY 2016 DSH Allotments.
Column D ......... Prior FY (2016) DSH Allotments (Col C) × (100 percent + Percentage Increase in CPIU): 100.9 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 (100.9 per-
cent).
Column E .......... FY 2017 TC MAP Exp. Including DSH. This column contains the amount of the States’ projected FY 2017 total computable
(TC) medical assistance expenditures including DSH expenditures.
Column F .......... FY 2017 TC DSH Expenditures. This column contains the amount of the States’ projected FY 2017 total computable DSH ex-
penditures.
Column G ......... FY 2017 TC MAP Exp. Net of DSH. This column contains the amount of the States’ projected FY 2017 total computable med-
ical 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 2016 Allotment or 12 percent Limit. This column contains the greater of the State’s preliminary prior FY (FY
2016) 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 2017 DSH Allotment. This column contains the States’ preliminary FY 2017 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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![51268 Federal Register / Vol. 82, No. 212 / Friday, November 3, 2017 / Notices
KEY TO ADDENDUM 3—FINAL IMD DSH LIMITS FOR FY 2015
[The final 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 inpa-
tient hospital DSH expenditures as reported on the Form CMS–64 as of January 1, 1997.
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’ FY 2015 DSH allotments from Addendum 1, Column
J.
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 allot-
ment (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 2015 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 deter-
mined by converting the total computable FY 2015 IMD DSH Limit from Column J into a federal share amount by multi-
plying it by the FY 2015 FMAP in Column G.
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![Federal Register / Vol. 82, No. 212 / Friday, November 3, 2017 / Notices 51271
KEY TO ADDENDUM 4—PRELIMINARY IMD DSH LIMITS FOR FY 2017
[The preliminary FY 2017 IMD DSH Limits for the Non-Low DSH States are presented in the top section of this addendum and the preliminary
FY 2017 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 inpa-
tient hospital DSH expenditures as reported on the Form CMS–64 as of January 1, 1997.
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 2017 Federal Share DSH Allotment. This column contains the states’ preliminary FY 2017 DSH allotments from Adden-
dum 1, Column J.
Column G ......... FY 2017 FMAP.
Column H ......... FY 2017 DSH Allotments in Total Computable, Col. F/G. This column contains states’ FY 2017 total computable DSH allot-
ment (determined as Column F/Column G).
Column I ........... Applicable Percentage Applied to FY 2017 Allotments in TC, Col E x Col H. This column contains the applicable percentage
of FY 2016 total computable DSH allotment (calculated as the percentage in Column E multiplied by the amount in Column
H).
Column J .......... FY 2017 TC IMD DSH Limit. Lesser of Col. I or C. This column contains the total computable FY 2017 TC IMD DSH Limit
equal to the lesser of the amount in Column I or Column C.
Column K .......... FY 2017 IMD DSH Limit in Federal Share, Col. G x J. This column contains the FY 2017 Federal Share IMD DSH limit deter-
mined by converting the total computable FY 2017 IMD DSH Limit from Column J into a federal share amount by multi-
plying it by the FY 2017 FMAP in Column G.
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![51274 Federal Register / Vol. 82, No. 212 / Friday, November 3, 2017 / Notices
[FR Doc. 2017–23933 Filed 11–2–17; 8:45 am] Act provides that the Medicaid February 2, 2016 (81 FR 5444). On
BILLING CODE 4120–01–P provisions in 1902(kk) are also August 3, 2016 (81 FR 51120), we
applicable to CHIP. extended the moratoria for an additional
In the February 2, 2011 Federal 6 months and expanded them to
DEPARTMENT OF HEALTH AND Register (76 FR 5862), CMS published a statewide for enrollment of HHAs in
HUMAN SERVICES final rule with comment period titled, Florida, Illinois, Michigan, and Texas,
‘‘Medicare, Medicaid, and Children’s and non-emergency ground ambulance
Centers for Medicare & Medicaid Health Insurance Programs; Additional suppliers in New Jersey, Pennsylvania,
Services Screening Requirements, Application and Texas. We also announced the
[CMS–6077–N] Fees, Temporary Enrollment Moratoria, lifting of temporary moratoria for all
Payment Suspensions and Compliance Part B emergency ambulance suppliers
Medicare, Medicaid, and Children’s Plans for Providers and Suppliers,’’ as well as emergency ambulance
Health Insurance Programs: which implemented section 1866(j)(7) of providers in Medicaid and CHIP.2
Announcement of Decision To Lift the the Act by establishing new regulations Finally, on January 29, 2017 (82 FR
Temporary Moratorium on Enrollment at 42 CFR 424.570. Under 2363) and again on July 28, 2017 (82 FR
of Non-Emergency Ground Ambulance § 424.570(a)(2)(i) and (iv), CMS, or CMS 35122), we extended the statewide
Suppliers in Texas in consultation with the Department of moratoria of HHAs in Florida, Illinois,
Health and Human Services’ Office of Michigan, and Texas, and Part B non-
AGENCY: Centers for Medicare & Inspector General (HHS–OIG) or the emergency ground ambulance suppliers
Medicaid Services (CMS), HHS. Department of Justice (DOJ), or both, in New Jersey, Pennsylvania, and Texas
ACTION: Lifting of temporary enrollment may impose a temporary moratorium on for additional 6 month periods. These
moratorium on non-emergency ground newly enrolling Medicare providers and extensions also applied to such
ambulance suppliers in Texas. suppliers if CMS determines that there providers in Medicaid and CHIP.
is a significant potential for fraud,
SUMMARY: This document announces waste, or abuse with respect to a II. Lifting a Temporary Moratorium
that on September 1, 2017, the statewide particular provider or supplier type, or CMS has authority under § 424.570(d)
temporary moratorium on the particular geographic locations, or both. to lift a temporary moratorium at any
enrollment of new Medicare Part B non- At § 424.570(a)(1)(ii), CMS stated that it time in specified situations, including if
emergency ground ambulance suppliers would announce any temporary the President declares an area a disaster
in Texas was lifted. This announcement moratorium in a Federal Register under the Robert T. Stafford Disaster
also applies to the temporary document that includes the rationale for Relief and Emergency Assistance Act.
moratorium on enrollment of non- the imposition of such moratorium. On August 25, 2017, the President of the
emergency ground ambulance suppliers Based on this authority and our United States signed the Presidential
in Medicaid and the Children’s Health regulations at § 424.570, we initially Disaster Declaration for several counties
Insurance Program in Texas. imposed moratoria to prevent in the State of Texas. As a result of the
FOR FURTHER INFORMATION CONTACT: Jung enrollment of new Home Health President’s declaration, CMS carefully
Kim, (410) 786–9370. News media Agencies, subunits, and branch reviewed the potential impact of
representatives must contact CMS’ locations 1 (hereafter referred to as continued moratoria in Texas, and
Public Affairs Office at (202) 690–6145 HHAs) in Miami-Dade County, Florida decided to lift the temporary enrollment
or email them at press@cms.hhs.gov. and Cook County, Illinois, as well as moratorium on Medicare Part B non-
SUPPLEMENTARY INFORMATION: surrounding counties, and Medicare emergency ground ambulance suppliers
Part B ground ambulance suppliers in in Texas in order to aid in the disaster
I. Background Harris County, Texas and surrounding response to Hurricane Harvey. This
A. CMS’ Implementation of Temporary counties, in a notice issued on July 31, lifting of the moratorium also applied to
Enrollment Moratoria 2013 (78 FR 46339). These moratoria Medicaid and CHIP in Texas. A
also applied to Medicaid and CHIP. We notification that CMS lifted the
The Social Security Act (the Act) exercised this authority again in a notice moratorium was published at https://
provides the Secretary with tools and published on February 4, 2014 (79 FR www.cms.gov/Medicare/Provider-
resources to combat fraud, waste, and 6475) when we extended the existing Enrollment-and-Certification/Medicare
abuse in Medicare, Medicaid, and the moratoria for an additional 6 months ProviderSupEnroll/ProviderEnrollment
Children’s Health Insurance Program and expanded them to include Moratorium.html and became effective
(CHIP). In particular, section 1866(j)(7) enrollment of HHAs in Broward County, on September 1, 2017. In accordance
of the Act provides the Secretary with Florida; Dallas County, Texas; Harris with § 424.570(d), CMS is also
authority to impose a temporary County, Texas; and Wayne County, publishing this document in the Federal
moratorium on the enrollment of new Michigan and surrounding counties, Register to announce this action. Non-
Medicare, Medicaid, or CHIP providers and enrollment of ground ambulance emergency ground ambulance suppliers
and suppliers, including categories of suppliers in Philadelphia, Pennsylvania that were previously unable to enroll in
providers and suppliers, if the Secretary and surrounding counties. Then, we Medicare, Medicaid or CHIP in Texas
determines such a moratorium is further extended these moratoria in
necessary to prevent or combat fraud, documents issued on August 1, 2014 (79 2 CMS also concurrently announced a
waste, or abuse under these programs. FR 44702), February 2, 2015 (80 FR demonstration under the authority provided in
Regarding Medicaid, section 1902(kk)(4) section 402(a)(l)(J) of the Social Security
5551), July 28, 2015 (80 FR 44967), and
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Amendments of 1967 (42 U.S.C. 1395b–l(a)(l)(J))
of the Act requires States to comply that allows for access to care-based exceptions to
with any moratorium imposed by the 1 As noted in the preamble to the final rule with the moratoria in certain limited circumstances after
Secretary unless the State determines comment period implementing the moratorium a heightened review of that provider has been
that the imposition of such temporary authority (February 2, 2011, CMS–6028–FC (76 FR conducted. This demonstration also applies to
5870), home health agency subunits and branch Medicaid and CHIP providers in each state. This
moratorium would adversely impact locations are subject to the moratoria to the same announcement may be found in the Federal
Medicaid beneficiaries’ access to care. extent as any other newly enrolling home health Register document issued on August 3, 2016 (81 FR
In addition, section 2107(e)(1)(F) of the agency. 51116).
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Document Created: 2018-10-25 10:22:37
Document Modified: 2018-10-25 10:22:37
| 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 applicable December 4, 2017. The final allotments and limitations set forth in this notice are applicable for the fiscal years specified. | |
| Contact | Stuart Goldstein, (410) 786-0694 and Richard Cuno, (410) 786-1111. | |
| FR Citation | 82 FR 51259 | |
| RIN Number | 0938-ZB43 |
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