[Federal Register Volume 77, Number 142 (Tuesday, July 24, 2012)]
[Notices]
[Pages 43301-43329]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-17954]


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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-2384-N]
RIN 0938-AR46


Medicaid Program; Disproportionate Share Hospital Allotments and 
Institutions for Mental Diseases Disproportionate Share Hospital Limits 
for FYs 2010, 2011, and Preliminary FY 2012 Disproportionate Share 
Hospital Allotments and 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 FY (FY) 2010, 2011 and the 
preliminary Federal share DSH allotments for FY 2012. This notice also 
announces the final FY 2010, 2011 and the preliminary FY 2012 limits on 
aggregate DSH payments that States may make to institutions for mental 
diseases (IMD) and other mental health facilities. In addition, this 
notice includes background information describing the methodology for 
determining the amounts of States' FY DSH allotments.

DATES: Effective Date: This notice is effective on August 23, 2012. The 
final allotments and limitations set forth in this notice are effective 
for the fiscal years specified.

FOR FURTHER INFORMATION CONTACT: Richard Strauss, (410) 786-2019.

SUPPLEMENTARY INFORMATION:

I. Background

    Under section 1923(f)(3) of the Social Security Act (the Act), 
States' Federal fiscal year (FY) 2003 disproportionate share hospital 
(DSH) allotments were calculated by increasing the amounts of the FY 
2002 allotments for each State (as specified in the chart, entitled 
``DSH Allotment (in millions of dollars)'', contained in section 
1923(f)(2) of the Act) by the percentage change in the Consumer Price 
Index for all Urban Consumers (CPI-U) for the prior fiscal year. The 
allotment, determined in this way, is subject to the limitation that an 
increase to a State's DSH allotment for a FY cannot result in the DSH 
allotment exceeding the greater of the State's DSH allotment for the 
previous FY or 12 percent of the State's total medical assistance 
expenditures for the allotment year (this is referred to as the 12 
percent limit).
    However, section 1001(a) of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003 (Pub. L. 108-173, enacted on 
December 8, 2003) (MMA) amended section 1923(f)(3) of the Act to 
provide for a ``Special, Temporary Increase In Allotments On A One-
Time, Non-Cumulative Basis.'' Under this provision, States' FY 2004 DSH 
allotments were determined by increasing their FY 2003 allotments by 16 
percent and the FY DSH allotment amounts determined were not subject to 
the 12 percent limit.
    Also, under section 1923(h) of the Act, Federal financial 
participation (FFP) is not available for DSH payments to institutions 
for mental diseases (IMDs) and other mental health facilities that are 
in excess of State-specific aggregate limits. Under this provision, 
this 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.
    In general, we initially determine States' DSH allotments and IMD 
DSH limits for a FY using estimates of medical assistance expenditures, 
including DSH expenditures in their Medicaid programs. These estimates 
are provided by States each year on the August quarterly Medicaid 
budget reports (Form CMS-37) before the FY for which the DSH allotments 
and IMD DSH limits are being determined. Also, as part of the basic 
determination of preliminary DSH allotments for a FY, we use the 
available CPI-U percentage increase that is available before the 
beginning of the FY for which the allotment is being determined to 
determine the preliminary FY DSH allotment. For example, in determining 
the preliminary FY 2012 DSH allotment, we would apply the CPI-U 
percentage increase for FY 2011 that was available just before the 
beginning of FY 2012 on October 1, 2011.
    Section 5002 of the American Recovery and Reinvestment Act of 2009 
(Pub. L. 111-5, enacted on February 17, 2009) (Recovery Act), added a 
new section 1923(f)(3)(E) of the Act; that provided fiscal relief to 
States during the recent national economic downturn. In that regard, 
section 1923(f)(3)(E)(i)(I) of the Act, as created by section 5002 of 
the Recovery Act, required that, in general, States' DSH allotments for 
FY

[[Page 43302]]

2009 be equal to 102.5 percent of the FY 2009 allotments that would 
otherwise have been determined; this Recovery Act provision does not 
apply to certain States.
    For a detailed description of the background of this notice, please 
refer to ``Final FY 2009 and Preliminary FY 2011 Disproportionate Share 
Hospital Allotments, and Final FY 2009 and Preliminary FY 2011 
Institutions for Mental Diseases Disproportionate Share Hospital 
Limits'' notice published in the January 3, 2011 Federal Register (76 
FR 148).

II. Provisions of the Notice

A. Calculation of the Final FY 2010, Final FY 2011 Federal Share State 
DSH Allotments, and the Preliminary FY 2012 Federal Share State DSH 
Allotments

1. Final FY 2010 and FY 2011 Federal Share State DSH Allotments
    Chart 1 and Chart 2 of the Addendum to this notice provides the 
States' final FY 2010 and final FY 2011 DSH allotments, respectively. 
As described in the previous Federal Register notices in determining 
non-Low DSH States' DSH allotments for FYs after FY 2004 under section 
1923(f)(3)(C) of the Act for DSH allotments, we determined States' DSH 
allotments under a ``parallel'' process. Under the parallel process, 
for each FY for each State, we determine whether the fiscal year 
specified (as defined in section 1923(f)(3)(D) of the Act) has 
occurred. Section 1923(f)(3)(D) of the Act describes the fiscal year 
specified is determined separately for each State and ``is the first FY 
for which the Secretary estimates that the DSH allotment for that State 
will equal (or no longer exceed) the DSH allotment for that State under 
the law as in effect before the date of enactment'' of MMA. The process 
in effect before the enactment in MMA is the process described in 
section 1923(f)(3)(A) of the Act; in this process each States' DSH 
allotment since FY 2003 is increased by the CPI-U increase for the 
prior FY and the result is then compared to the State's FY 2004 DSH 
allotment, as determined by section 1923(f)(3)(C)(i) of the Act. The 
fiscal year specified for a State is the FY when the FY 2004 allotment 
is no longer greater than the parallel process DSH allotment.
    In accordance to the parallel process provision, we determined that 
FY 2009 was the fiscal year specified for all non-Low DSH States 
(except Louisiana). Therefore, in section 1923(f)(3)(C)(ii) of the Act, 
the Final FY 2009 DSH allotment for all non-Low DSH States (except 
Louisiana) is equal to the prior FY 2008 DSH allotment increased by the 
CPI-U increase for FY 2008 (4.4 percent).
    Chart 1 contains the final FY 2010 DSH allotments and Chart 2 
contains the final FY 2011 DSH allotments. For the non-Low DSH States 
for which the FY 2009 is the fiscal year specified, that fiscal year 
and for following fiscal years, the FY DSH allotments are calculated by 
increasing the prior FY DSH allotment by the CPI-U increase for the 
prior fiscal year.
    For Low-DSH States, the FY 2009 DSH allotments were calculated 
using the same methodology as for the non-Low DSH States for which the 
fiscal year specified has occurred. That is, for FY 2009 and following 
FYs, the DSH allotment for Low-DSH States is calculated by increasing 
the prior FY DSH allotment by the percentage change in the CPI-U for 
the prior fiscal year.
    As discussed in the ``Background'' section of this notice, under 
section 5002 of the Recovery Act, the preliminary FY 2010 DSH allotment 
was determined as the higher of 102.5 percent of the FY 2009 DSH 
allotment (as determined under the Recovery Act) or the FY 2010 DSH 
allotment as would have been determined without application of the 
Recovery Act provisions. Accordingly, the preliminary FY 2010 DSH 
allotments were initially determined using the States' August 2009 
expenditure estimates submitted by the States on the Form CMS-37, and 
the percentage increase in the CPI-U for the previous FY that was 
available before the beginning of FY 2010. Then, this amount was 
compared to the DSH allotment amount equal to 102.5 percent of the FY 
2009 DSH allotments as determined under the Recovery Act provisions. 
For all applicable states the Recovery Act provision resulted in a 
higher FY 2010 DSH allotment.
    The final FY 2011 DSH allotments were determined by first 
determining the FY 2010 DSH allotments as they would have been 
calculated without application of the Recovery Act provisions. That is, 
first the amount of the final FY 2010 DSH allotments were determined by 
adjusting the amount of the final FY 2009 DSH allotments (also 
determined without application of the Recovery Act provisions) by the 
CPI-U percentage increase for FY 2009; this final FY 2010 DSH allotment 
amount (determined without application of the Recovery Act provisions) 
was then increased by the CPI-U percentage increase for FY 2010 to 
determine the final FY 2011 DSH allotments contained in this notice.
2. Calculation of the Preliminary FY 2012 Federal Share State DSH 
Allotments
    Chart 3 of the Addendum to this notice provides the preliminary FY 
2012 DSH allotments determined in accordance with the section 
1923(f)(3) of the Act. As described in the ``Background'' section of 
the January 3, 2011 Federal Register (76 FR 148) notice, the Recovery 
Act provisions which increased States' DSH allotments for FY 2009 and 
FY 2010 are not applicable for determining States' FY 2012 DSH 
allotments and following fiscal years. That is, the preliminary FY 2012 
DSH allotments were determined using States' estimates of FY 2012 
expenditures and increasing the FY 2011 allotments by the percentage 
increase in the CPI-U for FY 2011. States' final FY 2012 DSH allotments 
will be published in the Federal Register following receipt of the 
States' four quarterly Medicaid expenditure reports (Form CMS-64) for 
FY 2012 following the end of FY 2012.

B. Calculation of the Final FY 2010, the Final FY 2011, and the 
Preliminary FY 2012 IMD DSH Limits

    Section 1923(h) of the Act specifies the methodology to be used to 
establish the limits on the amount of DSH payments that a State can 
make to IMDs and other mental health facilities. FFP is not available 
for IMD or DSH payments that exceed the IMD limits. In this notice, we 
are publishing the final FY 2010, the final FY 2011, and the 
preliminary FY 2012 IMD DSH Limits determined in accordance with the 
provisions discussed above, and for FY 2010 reflecting the DSH 
allotments for the FY determined under the provisions of section 
1923(f)(3)(E) of the Act, as amended by section 5002 of the Recovery 
Act.
    Charts 4, 5, and 6 of the ``Addendum'' to this notice detail each 
State's final FY 2010, final FY 2011, and preliminary FY 2011 IMD DSH 
Limits, respectively, determined in accordance with section 1923(h) of 
the Act

III. Collection of Information Requirements

    This notice does not impose any new or revised information 
collection or recordkeeping requirements. The requirements and burden 
associated with CMS-37 (OMB 0938-0101) are unaffected by this notice. 
Consequently, this notice and CMS-37 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.).

[[Page 43303]]

IV. Regulatory Impact Statement

    We have examined the impact of this notice as required by Executive 
Order 12866 on Regulatory Planning and Review (September 1993), the 
Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96-354), 
section 1102(b) of the Act, section 202 of the Unfunded Mandates Reform 
Act of 1995 (March 22, 1995; Pub. L. 104-4), Executive Order 13132 on 
Federalism (August 4, 1999) and the Congressional Review Act (5 U.S.C. 
804(2)).
    Executive Order 12866 directs agencies to assess all costs and 
benefits of available regulatory alternatives and, if regulation is 
necessary, to select regulatory approaches that maximize net benefits 
(including potential economic, environmental, public health and safety 
effects, distributive impacts, and equity). A regulatory impact 
analysis (RIA) must be prepared for major rules with economically 
significant effects ($100 million or more in any 1 year). This notice 
does not reach the $100 million economic threshold and thus is not 
considered a major rule under the Congressional Review Act.
    There are no changes between the final FY 2010 DSH allotments and 
FY 2010 IMD DSH limits and the preliminary FY 2010 DSH allotments and 
FY 2010 IMD DSH limits published in the April 23, 2010 Federal Register 
(75 FR 21314).
    The final FY 2011 DSH allotments being published in this notice are 
approximately $10 million less than the preliminary FY 2011 DSH 
allotments published in the January 3, 2011 Federal Register (76 FR 
148). The final FY 2011 IMD DSH limits being published in this notice 
are approximately $1 million less than the preliminary FY 2011 IMD DSH 
limits published in the January 3, 2011 Federal Register on (76 FR 
148). The decrease in the FY 2011 DSH allotments are due to the 
difference between the final percentage change in the CPI-U for FY 2010 
used in the calculation of the final FY 2011 allotments (1.7 percent) 
as compared to the estimated percentage change in the CPI-U for FY 2010 
used in the calculation of the preliminary allotments (1.8 percent). 
The decreases 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, 
and since the final FY 2011 DSH allotments were decreased as compared 
to the preliminary FY 2011 DSH allotments, the associated FY 2011 IMD 
DSH limits for some States were also decreased.
    The preliminary FY 2012 DSH allotments being published in this 
notice are about $64 million more than the final FY 2011 DSH allotments 
being published in the Federal Register. The preliminary FY 2012 IMD 
DSH limits being published in this notice are about $11 million more 
than the final FY 2011 IMD DSH limits being published in the Federal 
Register. 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 increase in the IMD DSH 
limits is because the DSH allotment for a FY is a factor in the 
determination of the IMD DSH limit for the FY, and since the 
preliminary FY 2012 DSH allotments were greater than the final FY 2011 
DSH allotments, the associated FY 2012 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 $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 a significant economic impact 
on a substantial number of small entities. Specifically, the effects of 
the various controlling statutes on providers are not impacted by a 
result of any independent regulatory impact and not this notice. The 
purpose of the notice is to announce the latest distributions as 
required by the statute.
    In addition, section 1102(b) of the Act requires us to prepare a 
regulatory impact analysis if a rule may have a significant impact on 
the operations of a substantial number of small rural hospitals. This 
analysis must conform to the provisions of section 604 of the RFA. For 
purposes of section 1102(b) of the Act, we define a small rural 
hospital as a hospital that is located outside of a Core-Based 
Statistical Area for Medicaid payment regulations and has fewer than 
100 beds. We are not preparing analysis for section 1102(b) of the Act 
because the Secretary has determined that this notice will not have a 
significant impact on the operations of a substantial number of small 
rural hospitals.
    The Medicaid statute specifies the methodology for determining the 
amounts of States' DSH allotments and IMD DSH limits; and as described 
previously, results in the decreases or increases in States' DSH 
allotments and IMD DSH limits for the FYs referred to. The statute 
applicable to these allotments and limits does not apply to the 
determination of the amounts of DSH payments made to specific DSH 
hospitals; rather, these allotments and limits represent an overall 
limit on the total of such DSH payments. In this regard, we do not 
believe that this notice will have a significant economic impact on a 
substantial number of small entities.
    Section 202 of the Unfunded Mandates Reform Act of 1995 also 
requires that agencies assess anticipated costs and benefits before 
issuing any rule whose mandates require spending in any 1 year of $100 
million in 1995 dollars, updated annually for inflation. In 2012, that 
threshold is approximately $139 million. This notice will have no 
consequential effect on State, local, or tribal governments, in the 
aggregate, or on the private sector.
    Executive Order 13132 establishes certain requirements that an 
agency must meet when it 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, the requirements of E.O. 13132 are not applicable.

Alternatives Considered

    The methodologies for determining the States' fiscal year DSH 
allotments and IMD DSH Limits, as reflected in this notice, were 
established in accordance with the methodologies and formula for 
determining States' allotments as specified in statute. This notice 
does not put forward any further discretionary administrative policies 
for determining such allotments.

Accounting Statement

    As required by OMB Circular A-4 (available at http://www.whitehouse.gov/omb/circulars/a004/a-4.pdf), in the table below, we 
have prepared an accounting statement showing the classification of the 
estimated expenditures associated with the provisions of this notice. 
This table 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

[[Page 43304]]

relating to the calculation of States' FY DSH allotments and the 
increase in the FY DSH allotments from FY 2010 to FY 2011.

 Table--Accounting Statement: Classification of Estimated Expenditures,
                       From the FY 2010 to FY 2012
                              [In millions]
------------------------------------------------------------------------
               Category                            Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers.......  $54.
From Whom To Whom?...................  Federal Government to States.
------------------------------------------------------------------------

    In accordance with the provisions of Executive Order 12866, this 
notice was reviewed by the Office of Management and Budget.

(Catalog of Federal Domestic Assistance Program No. 93.778, Medical 
Assistance Program)

    Dated: May 14, 2012.
Marilyn Tavenner,
Acting Administrator, Centers for Medicare & Medicaid Services.
    Dated: June 11, 2012.
Kathleen Sebelius,
Secretary.

Addendum

    This addendum contains the charts 1 through 6 (preceded by 
associated keys) that are referred to in the preamble of this notice.

Key to Chart 1. Final DSH Allotments for FY 2010

       Key to Chart 1--Final DSH Allotments for Fiscal Year: 2010
    [The Final FY 2010 DSH Allotments for the NON-Low DSH States are
  presented in the top section of this chart, and the Final FY 2010 DSH
Allotments for the Low-DSH States are presented in the bottom section of
                               this chart]
------------------------------------------------------------------------
            Column                            Description
------------------------------------------------------------------------
Column A.....................  State.
Column B.....................  1923(f)(3)(D) Test Met. This column
                                indicates whether the ``FY Specified''
                                has occurred with respect to Non-Low DSH
                                States, determined in accordance with
                                section 1923(f)(3)(D) of the Act.
                                ``YES'' indicates the FY Specified has
                                occurred; ``NOT MET'' indicates that the
                                FY Specified has not occurred; and
                                ``na'' indicates that this provision is
                                not applicable. This provision is not
                                applicable for Low-DSH States indicated
                                in the bottom portion of chart 1.
Columns C-N..................  For all States, the entries in Columns B
                                through K present the determination of
                                the final FY 2010 DSH allotments as
                                would be calculated without the
                                application of section 1923(f)(3)(E) of
                                the Act as amended by section 5002 of
                                ARRA. For all States, the entries in
                                Columns L through N present the
                                calculation of the final FY 2010 DSH
                                Allotments, determined in accordance
                                with the provisions of section 5002 of
                                ARRA.
                               For Non-Low DSH States indicated in the
                                top portion of Chart 1, entries in
                                Columns C through K are only for States
                                meeting the ``FY Specified'' test
                                (``YES'' in Column B). For States not
                                meeting the test indicated in Column B,
                                these Columns indicate ``na'', and for
                                States for which such test is not
                                applicable, these Columns indicate
                                ``na''.
                               For Low DSH States, entries are in the
                                bottom portion of Chart 1.
Column C.....................  FY 2010 FMAPS. This column contains the
                                States' FY 2009 Federal Medical
                                Assistance Percentages.
Column D.....................  FY 2009 DSH Allotment for States Meeting
                                Test. This column contains the States'
                                prior FY 2009 DSH Allotments.
Column E.....................  FY 2009 Allotments X (1 + Percentage
                                Increase in CPI-U): 1.00. This column
                                contains the amount in Column D
                                increased by 1 plus the percentage
                                increase in the CPI-U for the prior FY
                                (0.0 percent).
Column F.....................  FY 2010 TC MAP Exp. Incl. DSH. This
                                column contains the amount of the
                                States' actual FY 2010 total computable
                                medical assistance expenditures
                                including DSH expenditures.
Column G.....................  FY 2010 TC MAP Exp. Net of DSH. This
                                column contains the amount of the
                                States' actual FY 2010 total computable
                                DSH expenditures.
Column H.....................  FY 2010 TC MAP Exp. Net of DSH. This
                                column contains the amount of the
                                States' actual FY 2010 total computable
                                medical assistance expenditures net of
                                DSH expenditures, calculated as the
                                amount in Column F minus the amount in
                                Column G.
Column I.....................  12% 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 J.....................  Greater of FY 2009 Allotment or 12%
                                Limit. This column contains the greater
                                of the State's prior FY (FY 2009) DSH
                                allotment or the amount of the 12%
                                Limit, determined as the maximum of the
                                amount in Column D or Column I.
Column K.....................  FY 2010 DSH Allotment. This column
                                contains the States' FY 2010 DSH
                                allotments as would be determined
                                without the application of the
                                provisions of section 5002 of ARRA,
                                determined as the minimum of the amount
                                in Column J or Column E. For Non-Low DSH
                                States that have not met the ``FY
                                Specified'' test (entry in Column B is
                                ``NOT MET''), the amount in Column K is
                                equal to the State's FY 2004 DSH
                                allotment. For States for which the
                                entry in Column B is ``na'', the amount
                                in Column K is determined in accordance
                                with the provisions of section.
                                1923(f)(6) of the Act.
Column L.....................  FY 2009 DSH Allotment Under ARRA. This
                                column contains the State's FY 2009 DSH
                                allotment as determined in accordance
                                with section 5002 of ARRA.
Column M.....................  FY 2010 DSH Allotment Under ARRA. This
                                column contains the State's FY 2010 DSH
                                allotment as determined in accordance
                                section 5002 of ARRA, and calculated as
                                the amount in Column L multiplied by
                                102.5 percent.

[[Page 43305]]

 
Column N.....................  FY 2010 DSH Allotment. (Max of Col K or
                                M). This column contains the State's
                                final FY 2010 DSH allotment as
                                determined as the higher of the amount
                                in Column K (the FY 2010 DSH allotment
                                as determined without the application of
                                section 5002 of ARRA) and the amount in
                                Column M (102.5 percent of the amount of
                                the State's FY 2009 DSH allotment
                                determined in accordance with section
                                5002 of ARRA).
------------------------------------------------------------------------

BILLING CODE P

[[Page 43306]]

[GRAPHIC] [TIFF OMITTED] TN24JY12.004


[[Page 43307]]


[GRAPHIC] [TIFF OMITTED] TN24JY12.005


[[Page 43308]]


[GRAPHIC] [TIFF OMITTED] TN24JY12.006


[[Page 43309]]



Key to Chart 2. Final DSH Allotments for FY 2011

       Key to Chart 2--Final DSH Allotments for Fiscal Year: 2011
    [The Final FY 2011 DSH Allotments for the NON-Low DSH States are
  presented in the top section of this chart, and the Final FY 2011 DSH
Allotments for the Low-DSH States are presented in the bottom section of
                               this chart]
------------------------------------------------------------------------
            Column                            Description
------------------------------------------------------------------------
Column A.....................  State.
Column B.....................  1923(f)(3)(D) Test Met. This column
                                indicates whether the ``FY Specified''
                                has occurred with respect to Non-Low DSH
                                States, determined in accordance with
                                section 1923(f)(3)(D) of the Act.
                                ``YES'' indicates the FY Specified has
                                occurred; ``NOT MET'' indicates that the
                                FY Specified has not occurred; and
                                ``na'' indicates that this provision is
                                not applicable. This provision is not
                                applicable for Low-DSH States indicated
                                in the bottom portion of chart 3.
Columns C-K..................  For all States, the entries in Columns B
                                through K present the determination of
                                the final FY 2011 DSH allotments as
                                would be calculated without the
                                application of section 5002 of ARRA
                                since such provisions were only
                                applicable for FY 2009 and FY 2010.
                               For Non-Low DSH States indicated in the
                                top portion of Chart 2, entries in
                                Columns C through J are only for States
                                meeting the ``FY Specified'' test
                                (``YES'' in Column B). For States not
                                meeting the test indicated in Column B,
                                these Columns indicate ``NA``, and for
                                States for which such test is not
                                applicable, these Columns indicate
                                ``na``. For Low DSH States, entries are
                                in the bottom portion of Chart 2.
Column C.....................  FY 2011 FMAPS. This column contains the
                                States' FY 2011 Federal Medical
                                Assistance Percentages.
Column D.....................  FY 2010 DSH Allotment for States Meeting
                                Test. This column contains the States'
                                prior FY 2010 DSH Allotments as would be
                                determined without the application of
                                section 5002 of ARRA.
Column E.....................  FY 2010 Allotments X (1 + Percentage
                                Increase in CPI-U): 1.017. This column
                                contains the amount in Column D
                                increased by 1 plus the percentage
                                increase in the CPI-U for the prior FY
                                (1.7 percent).
Column F.....................  FY 2011 TC MAP Exp. Incl. DSH. This
                                column contains the amount of the
                                States' projected FY 2011 total
                                computable medical assistance
                                expenditures including DSH expenditures.
Column G.....................  FY 2011 TC DSH Expenditures. This column
                                contains the amount of the States'
                                projected FY 2011 total computable DSH
                                expenditures.
Column H.....................  FY 2011 TC MAP Exp. Net of DSH. This
                                column contains the amount of the
                                States' projected FY 2011 total
                                computable medical assistance
                                expenditures net of DSH expenditures,
                                calculated as the amount in Column F
                                minus the amount in Column G.
Column I.....................  12% 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 J.....................  Greater of FY 2010 Allotment or 12%
                                Limit. This column contains the greater
                                of the State's prior FY (FY 2010) DSH
                                allotment or the amount of the 12%
                                Limit, determined as the maximum of the
                                amount in Column D or Column I.
Column K.....................  FY 2011 DSH Allotment. This column
                                contains the States' FY 2011 DSH
                                allotments as would be determined
                                without the application of the
                                provisions of section 5002 of ARRA,
                                determined as the minimum of the amount
                                in Column J or Column E.
                               For Non-Low DSH States that have not met
                                the ``FY Specified'' test (entry in
                                Column B is ``NOT MET''), the amount in
                                Column K is equal to the State's FY 2004
                                DSH allotment. For States for which the
                                entry in Column B is ``na'', the amount
                                in Column K is determined in accordance
                                with the provisions of section
                                1923(f)(6) of the Act.
------------------------------------------------------------------------

BILLING CODE P

[[Page 43310]]

[GRAPHIC] [TIFF OMITTED] TN24JY12.007


[[Page 43311]]


[GRAPHIC] [TIFF OMITTED] TN24JY12.008


[[Page 43312]]


[GRAPHIC] [TIFF OMITTED] TN24JY12.009


[[Page 43313]]



Key to Chart 3--Preliminary DSH Allotments for FY 2012

    Key to Chart 3--Preliminary DSH Allotments for Fiscal Year: 2012
 [The Preliminary FY 2012 DSH Allotments for the NON-Low DSH States are
 presented in the top section of this chart, and the Preliminary FY 2012
    DSH Allotments for the Low-DSH States are presented in the bottom
                         section of this chart]
------------------------------------------------------------------------
            Column                            Description
------------------------------------------------------------------------
Column A.....................  State.
Column B.....................  1923(f)(3)(D) Test Met. This column
                                indicates whether the ``FY Specified''
                                has occurred with respect to Non-Low DSH
                                States, determined in accordance with
                                section 1923(f)(3)(D) of the Act.
                                ``YES'' indicates the FY Specified has
                                occurred; ``NOT MET'' indicates that the
                                FY Specified has not occurred; and
                                ``na'' indicates that this provision is
                                not applicable. This provision is not
                                applicable for Low-DSH States indicated
                                in the bottom portion of chart 3.
Columns C-K..................  For Non-Low DSH States indicated in the
                                top portion of Chart 3, entries in
                                Columns C through J are only for States
                                meeting the ``FY Specified'' test
                                (``YES'' in Column B). For States not
                                meeting the test indicated in Column B,
                                these Columns indicate ``na,'' and for
                                States for which such test is not
                                applicable, these Columns indicate
                                ``na.'' For Low DSH States, entries are
                                in the bottom portion of Chart 3.
Column C.....................  FY 2012 FMAPS. This column contains the
                                States' FY 2012 Federal Medical
                                Assistance Percentages.
Column D.....................  FY 2011 DSH Allotment For States Meeting
                                Test. This column contains the States'
                                prior FY 2010 DSH Allotments as would be
                                determined without the application of
                                section 5002 of ARRA.
Column E.....................  FY 2011 Allotments X (1 + Percentage
                                Increase in CPI-U): 1.024.
                               This column contains the amount in Column
                                D increased by 1 plus the percentage
                                increase in the CPI-U for the prior FY
                                (1.024 percent).
Column F.....................  FY 2012 TC MAP Exp. Incl. DSH. This
                                column contains the amount of the
                                States' projected FY 2012 total
                                computable medical assistance
                                expenditures including DSH expenditures.
Column G.....................  FY 2012 TC DSH Expenditures. This column
                                contains the amount of the States'
                                projected FY 2012 total computable DSH
                                expenditures.
Column H.....................  FY 2012 TC MAP Exp. Net of DSH. This
                                column contains the amount of the
                                States' projected FY 2012 total
                                computable medical assistance
                                expenditures net of DSH expenditures,
                                calculated as the amount in Column F
                                minus the amount in Column G
Column I.....................  12% 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 J.....................  Greater of FY 2010 Allotment or 12%
                                Limit. This column contains the greater
                                of the State's prior FY (FY 2011) DSH
                                allotment or the amount of the 12%
                                Limit, determined as the maximum of the
                                amount in Column D or Column I
Column K.....................  FY 2012 DSH Allotment. This column
                                contains the States' preliminary FY 2012
                                DSH allotments, determined as the
                                minimum of the amount in Column J or
                                Column E.
                               For Non-Low DSH States that have not met
                                the ``FY Specified'' test (entry in
                                Column B is ``NOT MET''), the amount in
                                Column K is equal to the State's FY 2004
                                DSH allotment. For States for which the
                                entry in Column B is ``na'', the amount
                                in Column K is determined in accordance
                                with the provisions of section
                                1923(f)(6) of the Act.
------------------------------------------------------------------------

BILLING CODE P

[[Page 43314]]

[GRAPHIC] [TIFF OMITTED] TN24JY12.010


[[Page 43315]]


[GRAPHIC] [TIFF OMITTED] TN24JY12.011


[[Page 43316]]


[GRAPHIC] [TIFF OMITTED] TN24JY12.012


[[Page 43317]]



Key to Chart 4--Final IMD DSH Limit for FY 2010

             Key to Chart 4--Final IMD DSH Limt for FY: 2010
  [Key to the Chart of the Final FY 2010 IMD Limitations.--The Final FY
   2010 IMD DSH Limits for the regular States are presented in the top
  section of this chart and the final FY IMD DSH Limits for the Low DSH
        States are presented in the bottom section of the chart]
------------------------------------------------------------------------
            Column                            Description
------------------------------------------------------------------------
Column A.....................  State.
Column B.....................  Inpatient Hospital Services FY 95 DSH
                                Total Computable. This column contains
                                the States' total computable FY 1995
                                inpatient hospital DSH expenditures as
                                reported on the Form CMS-64.
Column C.....................  IMD and Mental Health Services FY 95 DSH
                                Total Computable. This column contains
                                the total computable FY 1995 mental
                                health facility DSH expenditures as
                                reported on the Form CMS-64 as of
                                January 1, 1997.
Column D.....................  Total Inpatient & 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 2010 Allotment in FS Under ARRA. This
                                column contains the States' final FY
                                2010 DSH allotments as determined under
                                ARRA.
Column G.....................  FY 2010 FMAP. This column contains the
                                States' FY 2010 FMAPs.
Column H.....................  FY 2010 DSH Allotments in TC. Col. F/G.
                                This column contains the FY 2010 total
                                computable DSH Allotment (determined as
                                the amount in Column F divided by the
                                amount in Column G).
Column I.....................  Col E * Col H in TC. This column contains
                                the applicable percent of FY 2010 total
                                computable DSH allotment (calculated as
                                the amount in Column E multiplied by the
                                amount in Column H).
Column J.....................  FY 2010 TC IMD DSH Limit. Lesser of Col.
                                C or I. This column contains the FY 2010
                                TC IMD DSH Limit equal to the lesser of
                                the amount in Column C or Column I.
Column K.....................  FY 2010 IMD DSH Limit in FS U/ARRA. Col.
                                G x J. This column contains the FY 2010
                                Federal share IMD DSH limit determined
                                by converting the total computable FY
                                2010 IMD DSH Limit from Column J into a
                                Federal share amount by multiplying it
                                by the FY 2010 FMAP in Column G.
------------------------------------------------------------------------

BILLING CODE P

[[Page 43318]]

[GRAPHIC] [TIFF OMITTED] TN24JY12.013


[[Page 43319]]


[GRAPHIC] [TIFF OMITTED] TN24JY12.014


[[Page 43320]]


[GRAPHIC] [TIFF OMITTED] TN24JY12.015


[[Page 43321]]



Key to Chart 5. Preliminary IMD DSH Limit for FY 2011

            Key to Chart 5--Final IMD DSH Limit for FY: 2011
[Key to the Chart of the FY 2011 IMD Limitations.--The final FY 2011 IMD
 DSH Limits for the Non-Low DSH States are presented in the top section
   of this chart and the final FY 2011 IMD DSH Limits for the Low-DSH
        States are presented in the bottom section of the chart]
------------------------------------------------------------------------
            Column                            Description
------------------------------------------------------------------------
Column A.....................  State.
Column B.....................  Inpatient Hospital Services FY 95 DSH
                                Total Computable. This column contains
                                the States' total computable FY 1995
                                inpatient hospital DSH expenditures as
                                reported on the Form CMS-64.
Column C.....................  IMD and Mental Health Services FY 95 DSH
                                Total Computable. This column contains
                                the total computable FY 1995 mental
                                health facility DSH expenditures as
                                reported on the Form CMS-64 as of
                                January 1, 1997.
Column D.....................  Total Inpatient & 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 Percent 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 2011 Federal Share DSH Allotment. This
                                column contains the States' final FY
                                2011 DSH allotments.
Column G.....................  FY 2011 FMAP. This columns contains the
                                States' FY 2010 FMAPs.
Column H.....................  FY 2011 DSH Allotments in Total
                                Computable Col. F/G. This column
                                contains States' FY 2011 total
                                computable DSH allotment (determined as
                                Column F/Column G).
Column I.....................  Col E * Col H in TC. This column contains
                                the applicable percent of FY 2010 total
                                computable DSH allotment (calculated as
                                the percentage in Column E multiplied by
                                the amount in Column H)
Column J.....................  FY 2011 TC IMD DSH Limit. Lesser of Col.
                                C or I. This column contains the FY 2011
                                TC IMD DSH Limit equal to the lesser of
                                the amount in Column C or Column I.
Column K.....................  FY 2011 IMD DSH Limit in Federal Share,
                                Col. G x J. This column contains the FY
                                2011 Federal share IMD DSH limit
                                determined by converting the total
                                computable FY 2011 IMD DSH Limit from
                                Column J into a Federal share amount by
                                multiplying it by the FY 2011 FMAP in
                                Column G.
------------------------------------------------------------------------

BILLING CODE P

[[Page 43322]]

[GRAPHIC] [TIFF OMITTED] TN24JY12.016


[[Page 43323]]


[GRAPHIC] [TIFF OMITTED] TN24JY12.017


[[Page 43324]]


[GRAPHIC] [TIFF OMITTED] TN24JY12.018


[[Page 43325]]



Key to Chart 6. Preliminary IMD DSH Limit for FY 2012

         Key to Chart 6--Preliminary IMD DSH Limit for FY: 2012
  [Key to the Chart of the FY 2012 IMD Limitations.--The preliminary FY
 2012 IMD DSH Limits for the Non-Low DSH States are presented in the top
section of this chart and the preliminary FY 2012 IMD DSH Limits for the
    Low-DSH States are presented in the bottom section of the chart]
------------------------------------------------------------------------
            Column                            Description
------------------------------------------------------------------------
Column A.....................  State.
Column B.....................  Inpatient Hospital Services FY 95 DSH
                                Total Computable. This column contains
                                the States' total computable FY 1995
                                inpatient hospital DSH expenditures as
                                reported on the Form CMS-64.
Column C.....................  IMD and Mental Health Services FY 95 DSH
                                Total Computable. This column contains
                                the total computable FY 1995 mental
                                health facility DSH expenditures as
                                reported on the Form CMS-64 as of
                                January 1, 1997.
Column D.....................  Total Inpatient & 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 Percent 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 2012 Federal Share DSH Allotment. This
                                column contains the States' preliminary
                                FY 2012 DSH allotments.
Column G.....................  FY 2012 FMAP. This columns contains the
                                States' FY 2010 FMAPs.
Column H.....................  FY 2012 DSH Allotments in Total
                                Computable Col. F/G. This column
                                contains States' FY 2012 total
                                computable DSH allotment (determined as
                                Column F/Column G).
Column I.....................  Col E * Col H in TC. This column contains
                                the applicable percent of FY 2012 total
                                computable DSH allotment (calculated as
                                the percentage in Column E multiplied by
                                the amount in Column H).
Column J.....................  FY 2012 TC IMD DSH Limit. Lesser of Col.
                                C or I. This column contains the FY 2012
                                TC IMD DSH Limit equal to the lesser of
                                the amount in Column C or Column I.
Column K.....................  FY 2012 IMD DSH Limit in Federal Share,
                                Col. G x J. This column contains the FY
                                2012 Federal share IMD DSH limit
                                determined by converting the total
                                computable FY 2012 IMD DSH Limit from
                                Column J into a Federal share amount by
                                multiplying it by the FY 2012 FMAP in
                                Column G.
------------------------------------------------------------------------

BILLING CODE P

[[Page 43326]]

[GRAPHIC] [TIFF OMITTED] TN24JY12.019


[[Page 43327]]


[GRAPHIC] [TIFF OMITTED] TN24JY12.020


[[Page 43328]]


[GRAPHIC] [TIFF OMITTED] TN24JY12.021


[[Page 43329]]


[FR Doc. 2012-17954 Filed 7-20-12; 11:15 am]
BILLING CODE C