[Federal Register Volume 79, Number 40 (Friday, February 28, 2014)]
[Notices]
[Pages 11436-11445]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-04032]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-2389-N]


Medicaid Program; Preliminary Disproportionate Share Hospital 
Allotments (DSH) for Fiscal Year (FY) 2014 and the Preliminary 
Institutions for Mental Diseases Disproportionate Share Hospital Limits 
for FY 2014

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice.

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SUMMARY: This notice announces the preliminary federal share DSH 
allotments for FY 2014 and the preliminary federal share FY 2014 limits 
on aggregate DSH payments that states may make to institutions for 
mental diseases (IMDs) and other mental health facilities. This notice 
also includes additional information regarding the calculation of the 
FY 2014 DSH allotments and FY 2014 IMD DSH limits.

DATES:  Effective Date: This notice is effective on March 31, 2014. The 
final allotments and limitations set forth in this notice are effective 
for the fiscal years specified.

FOR FURTHER INFORMATION CONTACT:  Rory Howe, (410) 786-4878; or Richard 
Strauss, (410) 786-2019.

SUPPLEMENTARY INFORMATION: 

I. Background

A. Fiscal Year DSH Allotments

    A state's federal fiscal year (FY) disproportionate share hospital 
(DSH) allotment represents the aggregate limit on the federal share 
amount of the state's payments to DSH hospitals in the state for the 
FY. The amount of such allotment is determined in accordance with the 
provisions of section 1923(f)(3) of the Social Security Act (the Act). 
Under such provisions, in general a state's FY DSH allotment is 
calculated by increasing the amount of its DSH allotment for the 
preceding FY by the percentage change in the Consumer Price Index for 
all Urban Consumers (CPI-U) for the previous FY.
    The Affordable Care Act amended Medicaid DSH provisions, adding 
section 1923(f)(7) of the Act which would have required reductions to 
states' FY DSH allotments beginning with FY 2014, the calculation of 
which was described in the Disproportionate Share Hospital Payment 
Reduction final rule published in the September 18, 2013 Federal 
Register (78 FR 57293). Under the DSH reduction methodology, first, 
each state's unreduced FY DSH allotment would have been calculated in 
accordance with the provisions of section 1923(f) of the Act, excluding 
section 1923(f)(7) of the Act; then, the reduction amount for each 
state would have been determined under the provisions of section 
1923(f)(7) of the Act and implementing regulations at 42 CFR 447.294; 
and, finally, the net FY DSH allotment for each state would have been 
determined by subtracting the DSH reduction amount for the state from 
its unreduced FY 2014 DSH allotment.
    The reductions under section 1923(f)(7) of the Act were delayed and 
modified by section 1204 of Division B (Medicare and Other Health 
Provisions) of the ``Pathway for SGR Reform Act of 2013'' (Pub. L. 113-
67), which was enacted on December 26, 2013. The reductions of states' 
fiscal year DSH allotments under section 1923(f)(7) of the Act that 
were applicable to FY 2014 and 2015 were repealed, and the FY 2016 was 
increased substantially.
    Because there is no reduction to DSH allotments for FY 2014 under 
section 1923(f)(7) of the Act, this notice contains only the state-
specific FY 2014 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' IMD DSH limits, and the 
amounts of states' preliminary FY 2014 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 institutions for mental 
diseases (IMDs) and other mental health facilities is limited to state-
specific aggregate amounts. Under this provision, the aggregate limit 
for DSH payments to IMDs and other mental health facilities is the 
lesser of a state's FY 1995 total computable (state and federal share) 
IMD and other mental health facility DSH expenditures applicable to the 
state's FY 1995 DSH allotment (as reported on the Form CMS-64 as of 
January 1, 1997), or the amount equal to the product of the state's 
current year total computable DSH allotment and the applicable 
percentage specified in section 1902(h) of the Act (the applicable 
percentage is the IMD share of DSH total computable expenditures as of 
FY 1995).
    In general, we determine states' DSH allotments for a FY and the 
IMD DSH limits for the same FY using the most

[[Page 11437]]

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 Preliminary FY 2014 Federal Share State DSH 
Allotments and the Preliminary FY 2014 IMD DSH Limits

1. Calculation of the Preliminary FY 2014 Federal Share State DSH 
Allotments
    Addendum 1 to this notice provides the preliminary FY 2014 DSH 
allotments determined in accordance with section 1923(f)(3) of the Act. 
The preliminary FY 2014 DSH allotments contained in this notice were 
determined based on the most recent available estimates from states of 
their FY 2014 total computable Medicaid expenditures. Also, the 
preliminary FY 2014 allotments contained in this notice were determined 
by increasing the preliminary FY 2013 DSH allotments as contained in 
the notice published in the Federal Register on July 26, 2013 (78 FR 
45217) by 1.5 percent, representing the most recent available estimate 
of the percentage increase in the CPI-U for FY 2013 (the previous FY to 
FY 2014).
    We will publish states's final FY 2014 DSH allotments in future 
notices based on the states' four quarterly Medicaid expenditure 
reports (Form CMS-64) for FY 2014 available following the end of FY 
2014 and the actual change in the CPI-U for FY 2013.

B. Calculation of the Preliminary FY 2014 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 preliminary FY 2014 IMD DSH Limits determined in 
accordance with the provisions discussed above.
    Addendum 2 to this notice details each state's preliminary FY 2014 
IMD DSH Limit, 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, recordkeeping, or third-party disclosure requirements. The 
currently approved requirements and burden estimates associated with 
Form CMS-37 (OCN 0938-0101) and Form CMS-64 (OCN 0938-0067) are 
unaffected by this notice. Consequently, this notice, Form CMS-37, and 
Form 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.).

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 (March 22, 1995; Pub. L. 104-4), Executive Order 13132 on 
Federalism (August 4, 1999) and the Congressional Review Act (5 U.S.C. 
804(2)).
    Executive Order 12866 directs agencies to assess all costs and 
benefits of available regulatory alternatives and, if regulation is 
necessary, to select regulatory approaches that maximize net benefits 
(including potential economic, environmental, public health and safety 
effects, distributive impacts, and equity). A regulatory impact 
analysis (RIA) must be prepared for major rules with economically 
significant effects ($100 million or more in any 1 year). This notice 
reaches the $100 million economic threshold and thus is considered a 
major rule under the Congressional Review Act.
    The preliminary FY 2014 DSH allotments being published in this 
notice are about $108 million more than the preliminary FY 2013 DSH 
allotments previously published in the July 26, 2013 Federal Register 
(78 FR 45217). The increase in the FY 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 2014 IMD DSH limits being published in this 
notice are about $9 million more than the preliminary FY 2013 IMD DSH 
limits previously published in the FR on July 26, 2013 (78 FR 45217). 
The increase in the IMD DSH limits is because the DSH allotment for a 
FY is a factor in the determination of the IMD DSH limit for the FY. 
Since the preliminary FY 2014 DSH allotments were increased as compared 
to the preliminary FY 2013 DSH allotments previously published in the 
Federal Register, the associated FY 2014 IMD DSH limits for some states 
were 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 less than $35.5 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 
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 state 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

[[Page 11438]]

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 changes 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 a 
state can make. 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. Currently the 
threshhold is approximately $141 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.

A. Alternatives Considered

    We calculated the state-specific FY 2014 DSH allotments and the 
associated state-specific IMD DSH limits in accordance with the 
methodologies specified in statute and regulation. This notice does not 
put forward any further discretionary administrative policies for 
determining such allotments.

B. Accounting Statement

    As required by OMB Circular A-4 (available at http://www.whitehouse.gov/omb/circulars/a004/a-4.pdf), in the Table 1, we have 
prepared an accounting statement showing the classification of the 
estimated expenditures associated with the provisions of this notice. 
Table 1 provides our best estimate of the change (decrease) in the 
federal share of states' Medicaid DSH payments resulting from the 
application of the provisions of the Medicaid statute relating to the 
calculation of states' FY DSH allotments and the increase in the FY DSH 
allotments from FY 2013 to FY 2014.

Table 1--Accounting Statement: Classification of Estimated Expenditures,
                       From the FY 2013 to FY 2014
                              [In millions]
------------------------------------------------------------------------
           Category                             Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers  $108.
From Whom To Whom?............  Federal Government to States.
------------------------------------------------------------------------

C. 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.

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

    Dated: January 24, 2014.
Marilyn Tavenner,
Administrator, Centers for Medicare & Medicaid Services.
    Dated: February 11, 2014.
Kathleen Sebelius,
Secretary.
    Department of Health and Human Services.

       Key to ADDENDUM 1--Preliminary DSH Allotments for FY 2014.
------------------------------------------------------------------------
          Column                            Description
------------------------------------------------------------------------
  The Preliminary FY 2014 DSH Allotments for the NON-Low DSH States are
  presented in the top section of this addendum, and the Preliminary FY
 2014 DSH Allotments for the Low-DSH States are presented in the bottom
                        section of this addendum.
------------------------------------------------------------------------
Column A.................  State.
Column B.................  FY 2014 FMAPs.
                           This column contains the States' FY 2014
                            Federal Medical Assistance Percentages.
Column C.................  Prior FY (2013) DSH Allotments.
                           This column contains the States' prior FY
                            2013 DSH Allotments.
Column D.................  Prior FY (2013) DSH Allotments (Col C) x (100
                            percent + Percentage Increase in CPIU):
                            101.5 percent.
                           This column contains the amount in Column C
                            increased by 1 plus the estimated percentage
                            increase in the CPI-U for the prior FY
                            (101.5 percent).
Column E.................  FY 2014 TC MAP Exp. Including DSH.
                           This column contains the amount of the
                            States' projected FY 2014 total computable
                            (TC) medical assistance expenditures
                            including DSH expenditures.
Column F.................  FY 2014 TC DSH Expenditures.
                           This column contains the amount of the
                            States' projected FY 2014 total computable
                            DSH expenditures.
Column G.................  FY 2014 TC MAP Exp. Net of DSH.

[[Page 11439]]

 
                           This column contains the amount of the
                            States' projected FY 2014 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 2013 Allotment or 12 percent
                            limit.
                           This column contains the greater of the
                            State's prior FY (FY 2013) 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 2014 DSH Allotment.
                           This column contains the States' preliminary
                            FY 2014 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 11440]]


                                                                   Addendum 1--Preliminary DSH Allotments for Fiscal Year 2014
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                                                                     Prior FY (2013)
                                                                      DSH allotment
                                          FY 2014                     (Col C) x 100%    FY 2014 TC MAP    FY 2014 TC DSH      FY 2014 TC       ``12% Amount''    Greater of Col    FY 2014 DSH
                 STATE                     FMAPs    Prior FY (2013)   + pct increase    Exp. including     Expenditures     MAPEXP. net of    =Col G x .12(1-   H or Col C (12%   allotment MIN
                                         (percent)   DSH allotments      in CPIU:          DSH \4\             \4\          DSH Col E - F     .12/Col B)'' (in   Limit, FY 2013    Col I, Col D
                                                                    -----------------                                                               FS)            allotment)
                                                                          101.5%
A                                                B                C                D                  E                F                  G                  H                I                J
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
ALABAMA...............................       68.12     $323,093,267     $327,939,666     $5,837,507,000     $517,367,000     $5,320,140,000       $774,927,876     $774,927,876     $327,939,666
ARIZONA...............................       67.23      106,384,369      107,980,135      8,763,763,000      156,364,000      8,607,399,000      1,257,306,757    1,257,306,757      107,980,135
CALIFORNIA............................       50.00    1,151,840,630    1,169,118,239     72,253,198,000      935,479,000     71,317,719,000     11,260,692,474   11,260,692,474    1,169,118,239
COLORADO..............................       50.00       97,190,657       98,648,517      5,510,334,000      195,772,000      5,314,562,000        839,141,368      839,141,368       98,648,517
CONNECTICUT...........................       50.00      210,141,962      213,294,091      6,585,550,000      228,325,000      6,357,225,000      1,003,772,368    1,003,772,368      213,294,091
DISTRICT OF COLUMBIA..................       70.00       64,355,975       65,321,315      2,345,594,000       44,744,000      2,300,850,000        333,226,552      333,226,552       65,321,315
FLORIDA...............................       58.79      210,141,962      213,294,091     21,065,753,000      361,462,000     20,704,291,000      3,121,706,180    3,121,706,180      213,294,091
GEORGIA...............................       65.93      282,378,262      286,613,936      8,929,625,000      435,776,000      8,493,849,000      1,246,058,516    1,246,058,516      286,613,936
ILLINOIS..............................       50.00      225,902,609      229,291,148     16,174,722,000      428,796,000     15,745,926,000      2,486,198,842    2,486,198,842      229,291,148
INDIANA...............................       66.92      224,589,223      227,958,061      8,960,665,000                0      8,960,665,000      1,310,228,045    1,310,228,045      227,958,061
KANSAS................................       56.91       43,341,780       43,991,907      2,825,757,000       74,228,000      2,751,529,000        418,408,859      418,408,859       43,991,907
KENTUCKY..............................       69.83      152,352,923      154,638,217      6,276,300,000      152,353,000      6,123,947,000        887,363,415      887,363,415      154,638,217
LOUISIANA \1\.........................          na               na               na                 na               na                 na                 na               na      731,960,000
MAINE.................................       61.55      110,324,530      111,979,398      2,491,965,000       37,000,000      2,454,965,000        365,940,898      365,940,898      111,979,398
MARYLAND..............................       50.00       80,116,623       81,318,372      8,676,095,000       85,128,000      8,590,967,000      1,356,468,474    1,356,468,474       81,318,372
MASSACHUSETTS.........................       50.00      320,466,492      325,273,489     14,210,660,000                0     14,210,660,000      2,243,788,421    2,243,788,421      325,273,489
MICHIGAN..............................       66.32      278,438,100      282,614,672     13,523,842,000      364,144,000     13,159,698,000      1,928,021,733    1,928,021,733      282,614,672
MISSISSIPPI...........................       73.05      160,233,246      162,636,745      5,094,327,000      321,190,000      4,773,137,000        685,361,490      685,361,490      162,636,745
MISSOURI..............................       62.03      497,773,773      505,240,380      9,279,932,000      684,657,000      8,595,275,000      1,278,828,483    1,278,828,483      505,240,380
NEVADA................................       63.10       48,595,328       49,324,258      2,092,603,000       77,014,000      2,015,589,000        298,670,057      298,670,057       49,324,258
NEW HAMPSHIRE.........................       50.00      168,217,088      170,740,344      1,340,075,000      124,810,000      1,215,265,000        191,883,947      191,883,947      170,740,344
NEW JERSEY............................       50.00      676,394,441      686,540,358     13,682,358,000    1,207,107,000     12,475,251,000      1,969,776,474    1,969,776,474      686,540,358
NEW YORK..............................       50.00    1,687,702,633    1,713,018,172     67,240,475,000    3,373,800,000     63,866,675,000     10,084,211,842   10,084,211,842    1,713,018,172
NORTH CAROLINA........................       65.78      309,959,394      314,608,785     13,134,561,000      478,361,000     12,656,200,000      1,857,623,286    1,857,623,286      314,608,785
OHIO..................................       63.02      426,850,861      433,253,624     19,534,779,000                0     19,534,779,000      2,895,527,493    2,895,527,493      433,253,624
PENNSYLVANIA..........................       53.52      589,710,881      598,556,544     21,451,173,000      732,037,000     20,719,136,000      3,204,879,071    3,204,879,071      598,556,544
RHODE ISLAND..........................       50.11       68,296,138       69,320,580      2,302,742,000      137,098,000      2,165,644,000        341,706,914      341,706,914       69,320,580
SOUTH CAROLINA........................       70.57      344,107,463      349,269,075      5,582,305,000      474,540,000      5,107,765,000        738,511,134      738,511,134      349,269,075
TENNESSEE \2\.........................       65.29               na               na                 na               na                 na                 na               na                0
TEXAS.................................       58.69    1,004,741,257    1,019,812,376     37,675,429,000    2,991,551,000     34,683,878,000      5,231,775,883    5,231,775,883    1,019,812,376
VERMONT\5\............................       56.76       23,640,971       23,995,586      1,536,190,000       37,449,000      1,498,741,000        228,065,789      228,065,789       23,995,586
VIRGINIA..............................       50.00       92,050,138       93,430,890      8,287,311,000      243,321,000      8,043,990,000      1,270,103,684    1,270,103,684       93,430,890
WASHINGTON............................       50.00      194,381,315      197,297,035      7,949,059,000      456,511,000      7,492,548,000      1,183,033,895    1,183,033,895      197,297,035
WEST VIRGINIA.........................       71.09       70,922,912       71,986,756      3,534,234,000       70,185,000      3,464,049,000        500,103,388      500,103,388       71,986,756
                                       ---------------------------------------------------------------------------------------------------------------------------------------------------------
    TOTAL.............................  ..........   10,244,637,203   10,398,306,761    424,148,883,000   15,426,569,000    408,722,314,000     62,783,822,812   62,783,822,812   11,130,266,762
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                         LOW DSH STATES
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
ALASKA................................       50.00       21,402,636       21,723,676      1,583,467,000       20,638,000      1,562,829,000     246,762,473.68      246,762,474       21,723,676
ARKANSAS..............................       70.10       45,325,292       46,005,171      4,549,145,000       43,820,000      4,505,325,000        652,302,821      652,302,821       46,005,171
DELAWARE..............................       55.31        9,512,282        9,654,966      1,620,151,000       16,804,000      1,603,347,000        245,710,799      245,710,799        9,654,966
HAWAII \3\............................       51.85       10,240,000       10,393,600      1,940,694,000                0      1,940,694,000     303,011,243.86      303,011,244       10,393,600
IDAHO.................................       71.64       17,271,044       17,530,110      1,867,605,000       23,451,000      1,844,154,000     265,825,337.14      265,825,337       17,530,110
IOWA..................................       57.93       41,378,149       41,998,821      3,852,612,000       53,536,000      3,799,076,000        574,997,969      574,997,969       41,998,821
MINNESOTA.............................       50.00       78,476,334       79,653,479     10,571,446,000      154,792,000     10,416,654,000      1,644,734,842    1,644,734,842       79,653,479
MONTANA...............................       66.33       11,926,371       12,105,267      1,078,653,000       18,023,000      1,060,630,000        155,387,273      155,387,273       12,105,267
NEBRASKA..............................       54.74       29,733,219       30,179,217      2,060,181,000       41,391,000      2,018,790,000        310,272,058      310,272,058       30,179,217
NEW MEXICO............................       69.20       21,402,636       21,723,676      3,598,324,000       21,380,000      3,576,944,000        519,282,220      519,282,220       21,723,676
NORTH DAKOTA..........................       50.00       10,036,360       10,186,905        844,103,000        1,600,000        842,503,000        133,026,789      133,026,789       10,186,905
OKLAHOMA..............................       64.02       38,049,129       38,619,866      5,219,568,000       58,140,000      5,161,428,000        762,248,260      762,248,260       38,619,866
OREGON................................       63.14       47,561,414       48,274,835      6,163,918,000       71,176,000      6,092,742,000        902,688,455      902,688,455       48,274,835
SOUTH DAKOTA..........................       53.54       11,604,719       11,778,790        843,570,000        1,476,000        842,094,000        130,242,791      130,242,791       11,778,790
UTAH..................................       70.34       20,612,808       20,922,000      2,089,446,000       29,583,000      2,059,863,000        298,026,939      298,026,939       20,922,000
WISCONSIN.............................       59.06       99,326,563      100,816,461      7,532,985,000      159,936,000      7,373,049,000      1,110,375,539    1,110,375,539      100,816,461

[[Page 11441]]

 
WYOMING...............................       50.00          237,807          241,374        568,307,000          463,000        567,844,000         89,659,579       89,659,579          241,374
                                       ---------------------------------------------------------------------------------------------------------------------------------------------------------
    TOTAL LOW DSH STATES..............  ..........      514,096,763      521,808,214     55,984,175,000      716,209,000     55,267,966,000      8,344,555,389    8,344,555,389      521,808,214
                                       ---------------------------------------------------------------------------------------------------------------------------------------------------------
        TOTAL.........................  ..........   10,758,733,966   10,920,114,975    480,133,058,000   16,142,778,000    463,990,280,000     71,128,378,201   71,128,378,201   11,652,074,976
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Louisiana's FY 2014 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 2014, determined under section 1923(f)(6)(A) of the Act, is 0.
\3\ Begining FY 2013, under section 1923(f)(6)(B)(II) of the Act, Hawaii's DSH allotment for a fiscal year is determined as for low-DSH states. This means Hawaii's DSH alloment for a fiscal
  year is determined as for all States, by increasing the previous fiscal year allotment by the percentage increase in the CPIU for the previous fiscal year.
\4\ Expenditures based on the amounts reported by States on the Form CMS-37.
\5\ FMAP for Vermont for FY 2014 determined in accordance with section 1905(z)(1)(A) of the Act.


[[Page 11442]]


        Key to ADDENDUM 2--Preliminary IMD DSH Limits for FY 2014
------------------------------------------------------------------------
          Column                            Description
------------------------------------------------------------------------
The preliminary FY 2014 IMD DSH Limits for the Non-Low DSH States are
 presented in the top section of this addendum and the preliminary FY
 2014 IMD DSH Limits for the Low-DSH States are presented in the bottom
 section of the addendum.
------------------------------------------------------------------------
Column A.................  State.
Column B.................  Inpatient Hospital Services FY 95 DSH Total
                            Computable.
                           This column contains the States' total
                            computable FY 1995 inpatient hospital DSH
                            expenditures as reported on the Form CMS-64.
Column C.................  IMD and Mental Health Services FY 95 DSH
                            Total.
                           Computable. This column contains the total
                            computable FY 1995 mental health facility
                            DSH expenditures as reported on the Form CMS-
                            64 as of January 1, 1997.
Column D.................  Total Inpatient Hospital & IMD & Mental
                            Health FY 95 DSH Total.
                           Computable, Col. B + C. This column contains
                            the total computation of all inpatient
                            hospital DSH expenditures and mental health
                            facility DSH expenditures for FY 1995 as
                            reported on the Form CMS-64 as of January 1,
                            1997 (representing the sum of Column B and
                            Column C).
Column E.................  Applicable Percentage, Col. C/D.
                           This column contains the ``applicable
                            percentage'' representing the total
                            Computable FY 1995 mental health facility
                            DSH expenditures divided by total computable
                            all inpatient hospital and mental health
                            facility DSH expenditures for FY 1995 (the
                            amount in Column C divided by the amount in
                            Column D) Per section 1923(h)(2)(A)(ii)(III)
                            of the Act, for FYs after FY 2002, the
                            applicable percentage can be no greater than
                            33 percent.
Column F.................  FY 2014 Federal Share DSH Allotment.
                           This column contains the states' preliminary
                            FY 2014 DSH allotments from Column J
                            Addendum 1.
Column G.................  FY 2014 FMAP.
Column H.................  FY 2014 DSH Allotments in Total Computable,
                            Col. F/G.
                           This column contains states' FY 2014 total
                            computable DSH allotment (determined as
                            Column F/Column G).
Column I.................  Applicable Percentage Applied to FY 2014
                            Allotments in TC, Col E x Col H.
                           This column contains the applicable
                            percentage of FY 2013 total computable DSH
                            allotment (calculated as the percentage in
                            Column E multiplied by the amount in Column
                            H).
Column J.................  FY 2014 TC IMD DSH Limit. Lesser of Col.
                           I or C. This column contains the total
                            computable FY 2014 TC IMD DSH Limit equal to
                            the lesser of the amount in Column I or
                            Column C.
Column K.................  FY 2014 IMD DSH Limit in Federal Share, Col.
                            G x J.
                           This column contains the FY 2014 Federal
                            Share IMD DSH limit determined by converting
                            the total computable FY 2014 IMD DSH Limit
                            from Column J into a federal share amount by
                            multiplying it by the FY 2014 FMAP in Column
                            G.
------------------------------------------------------------------------


[[Page 11443]]


                                                                   Addendum 2--Preliminary IMD DSH Limit for Fiscal Year 2014
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                                  Applicable
                                                       IMD and     Total inpatient &                                                              percentage
                                    Inpatient       mental health     IMD & mental    Applicable                     FY 2014       FY 2014       applied to FY   FY 2014 TC IMD    FY 2014 IMD
             State              hospital services  services FY 95   health FY 95 DSH    percent       FY 2014         FMAPs     allotments in        2014        limit  (lesser    limit in FS
                                 FY 95 DSH total      DSH total     total computable    col C/D   allotment in FS   (percent)    TC  col F/G    allotments iin  of col I or Col     col G x J
                                    computable       computable        col B + C                                                                  TC  col E x          C)
                                                                                                                                                     Col H
A                                               B               C                  D           E                F           G                H               I                J                K
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
ALABAMA.......................       $413,006,229      $4,451,770       $417,457,999        1.07     $327,939,666       68.12     $481,414,659      $5,133,804       $4,451,770       $3,032,546
ARIZONA.......................         93,916,100      28,474,900        122,391,000       23.27      107,980,135       67.23      160,613,022      37,367,451       28,474,900       19,143,675
CALIFORNIA....................      2,189,879,543       1,555,919      2,191,435,462        0.07    1,169,118,239       50.00    2,338,236,478       1,660,148        1,555,919          777,960
COLORADO......................        173,900,441         594,776        174,495,217        0.34       98,648,517       50.00      197,297,034         672,497          594,776          297,388
CONNECTICUT...................        303,359,275     105,573,725        408,933,000       25.82      213,294,091       50.00      426,588,182     110,131,741      105,573,725       52,786,863
DISTRICT OF COLUMBIA..........         39,532,234       6,545,136         46,077,370       14.20       65,321,315       70.00       93,316,164      13,255,248        6,545,136        4,581,595
FLORIDA.......................        184,468,014     149,714,986        334,183,000       33.00      213,294,091       58.79      362,806,755     119,726,229      119,726,229       70,387,050
GEORGIA.......................        407,343,557               0        407,343,557        0.00      286,613,936       65.93      434,724,611               0                0                0
ILLINOIS......................        315,868,508      89,408,276        405,276,784       22.06      229,291,148       50.00      458,582,296     101,168,027       89,408,276       44,704,138
INDIANA.......................         79,960,783     153,566,302        233,527,085       33.00      227,958,061       66.92      340,642,649     112,412,074      112,412,074       75,226,160
KANSAS........................         11,587,208      76,663,508         88,250,716       33.00       43,991,907       56.91       77,300,838      25,509,277       25,509,277       14,517,329
KENTUCKY......................        158,804,908      37,443,073        196,247,981       19.08      154,638,217       69.83      221,449,545      42,251,398       37,443,073       26,146,498
LOUISIANA.....................      1,078,512,169     132,917,149      1,211,429,318       10.97      731,960,000       60.98    1,200,327,976     131,699,118      131,699,118       80,310,122
MAINE.........................         99,957,958      60,958,342        160,916,300       33.00      111,979,398       61.55      181,932,409      60,037,695       60,037,695       36,953,201
MARYLAND......................         22,226,467     120,873,531        143,099,998       33.00       81,318,372       50.00      162,636,744      53,670,126       53,670,126       26,835,063
MASSACHUSETTS.................        469,653,946     105,635,054        575,289,000       18.36      325,273,489       50.00      650,546,978     119,453,988      105,635,054       52,817,527
MICHIGAN......................        133,258,800     304,765,552        438,024,352       33.00      282,614,672       66.32      426,137,925     140,625,515      140,625,515       93,262,842
MISSISSIPPI...................        182,608,033               0        182,608,033        0.00      162,636,745       73.05      222,637,570               0                0                0
MISSOURI......................        521,946,524     207,234,618        729,181,142       28.42      505,240,380       62.03      814,509,721     231,485,157      207,234,618      128,547,634
NEVADA........................         73,560,000               0         73,560,000        0.00       49,324,258       63.10       78,168,396               0                0                0
NEW HAMPSHIRE.................         92,675,916      94,753,948        187,429,864       33.00      170,740,344       50.00      341,480,688     112,688,627       94,753,948       47,376,974
NEW JERSEY....................        736,742,539     357,370,461      1,094,113,000       32.66      686,540,358       50.00    1,373,080,716     448,489,771      357,370,461      178,685,231
NEW YORK......................      2,418,869,368     605,000,000      3,023,869,368       20.01    1,713,018,172       50.00    3,426,036,344     685,463,469      605,000,000      302,500,000
NORTH CAROLINA................        193,201,966     236,072,627        429,274,593       33.00      314,608,785       65.78      478,274,225     157,830,494      157,830,494      103,820,899
OHIO..........................        535,731,956      93,432,758        629,164,714       14.85      433,253,624       63.02      687,485,916     102,093,623       93,432,758       58,881,324
PENNSYLVANIA..................        388,207,319     579,199,682        967,407,001       33.00      598,556,544       53.52    1,118,379,193     369,065,134      369,065,134      197,523,660
RHODE ISLAND..................        108,503,167       2,397,833        110,901,000        2.16       69,320,580       50.11      138,336,819       2,991,033        2,397,833        1,201,554
SOUTH CAROLINA................        366,681,364      72,076,341        438,757,705       16.43      349,269,075       70.57      494,925,712      81,303,266       72,076,341       50,864,274
TENNESSEE *...................                  0               0                  0        0.00                0       65.29                0               0                0                0
TEXAS.........................      1,220,515,401     292,513,592      1,513,028,993       19.33    1,019,812,376       58.69    1,737,625,449     335,934,780      292,513,592      171,676,227
VERMONT **....................         19,979,252       9,071,297         29,050,549       31.23       23,995,586       56.76       42,275,521      13,200,914        9,071,297        5,148,868
VIRGINIA......................        129,313,480       7,770,268        137,083,748        5.67       93,430,890       50.00      186,861,780      10,591,818        7,770,268        3,885,134
WASHINGTON....................        171,725,815     163,836,435        335,562,250       33.00      197,297,035       50.00      394,594,070     130,216,043      130,216,043       65,108,022
WEST VIRGINIA.................         66,962,606      18,887,045         85,849,651       22.00       71,986,756       71.09      101,261,438      22,277,660       18,887,045       13,426,800
                               -----------------------------------------------------------------------------------------------------------------------------------------------------------------
    TOTAL.....................     13,402,460,846   4,118,758,904     17,521,219,750  ..........   11,130,266,762  ..........   19,837,936,852   3,778,134,755    3,440,982,495    1,930,546,450
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                         LOW DSH STATES
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
ALASKA........................          2,506,827      17,611,765         20,118,592       33.00       21,723,676       50.00       43,447,352      14,337,626       14,337,626        7,168,813
ARKANSAS......................          2,422,649         819,351          3,242,000       25.27       46,005,171       70.10       65,627,919      16,586,151          819,351          574,365
DELAWARE......................                  0       7,069,000          7,069,000       33.00        9,654,966       55.31       17,456,095       5,760,511        5,760,511        3,186,139
HAWAII........................                  0               0                  0        0.00       10,393,600       51.85       20,045,516               0                0                0
IDAHO.........................          2,081,429               0          2,081,429        0.00       17,530,110       71.64       24,469,724               0                0                0
IOWA..........................         12,011,250               0         12,011,250        0.00       41,998,821       57.93       72,499,259               0                0                0
MINNESOTA.....................         24,240,000       5,257,214         29,497,214       17.82       79,653,479       50.00      159,306,958      28,392,877        5,257,214        2,628,607
MONTANA.......................            237,048               0            237,048        0.00       12,105,267       66.33       18,250,063               0                0                0
NEBRASKA......................          6,449,102       1,811,337          8,260,439       21.93       30,179,217       54.74       55,131,927      12,089,248        1,811,337          991,526
NEW MEXICO....................          6,490,015         254,786          6,744,801        3.78       21,723,676       69.20       31,392,595       1,185,861          254,786          176,312
NORTH DAKOTA..................            214,523         988,478          1,203,001       33.00       10,186,905       50.00       20,373,810       6,723,357          988,478          494,239
OKLAHOMA......................         20,019,969       3,273,248         23,293,217       14.05       38,619,866       64.02       60,324,689       8,477,046        3,273,248        2,095,533
OREGON........................         11,437,908      19,975,092         31,413,000       33.00       48,274,835       63.14       76,456,818      25,230,750       19,975,092       12,612,273
SOUTH DAKOTA..................            321,120         751,299          1,072,419       33.00       11,778,790       53.54       21,999,981       7,259,994          751,299          402,245
UTAH..........................          3,621,116         934,586          4,555,702       20.51       20,922,000       70.34       29,744,100       6,101,896          934,586          657,388
WISCONSIN.....................          6,609,524       4,492,011         11,101,535       33.00      100,816,461       59.06      170,701,763      56,331,582        4,492,011        2,652,982

[[Page 11444]]

 
WYOMING.......................                  0               0                  0        0.00          241,374       50.00          482,748               0                0                0
                               -----------------------------------------------------------------------------------------------------------------------------------------------------------------
    TOTAL LOW DSH STATES......         98,662,480      63,238,167        161,900,647  ..........      521,808,214  ..........      887,711,318     188,476,899       58,655,539       33,640,422
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
        TOTAL.................     13,501,123,326   4,181,997,071     17,683,120,397  ..........   11,652,074,976  ..........   20,724,648,170   3,966,611,654    3,499,638,034   1,964,186,872
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
FOOTNOTES:
* Tennessee's DSH allotment for FY 2014, determined under section 1923(f)(6)(A) of the Act, is $0.
** Vermont's FMAP for FY 2014 determined in accordance with section 1905(z)(1)(A) of the Act.


[[Page 11445]]

[FR Doc. 2014-04032 Filed 2-27-14; 8:45 am]
BILLING CODE 4120-01-P