[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]
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Category Transfers
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Annualized Monetized Transfers $108.
From Whom To Whom?............ Federal Government to States.
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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.
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Column Description
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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.
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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.
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[[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
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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
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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
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LOW DSH STATES
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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
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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
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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
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\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