[Federal Register Volume 84, Number 28 (Monday, February 11, 2019)]
[Notices]
[Pages 3169-3185]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-01928]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-2417-N]
RIN 0938-ZB50


Medicaid Program; Final FY 2017 and Preliminary FY 2019 
Disproportionate Share Hospital Allotments, and Final FY 2017 and 
Preliminary FY 2019 Institutions for Mental Diseases Disproportionate 
Share Hospital Limits

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

ACTION: Notice.

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SUMMARY: This notice announces the final federal share disproportionate 
share hospital (DSH) allotments for federal fiscal year (FY) 2017 and 
the preliminary federal share DSH allotments for FY 2019. This notice 
also announces the final FY 2017 and the preliminary FY 2019 
limitations on aggregate DSH payments that states may make to 
institutions for mental disease and other mental health facilities. In 
addition, this notice includes background information describing the 
methodology for determining the amounts of states' FY DSH allotments.

DATES: This notice is effective March 13, 2019. The final allotments 
and limitations set forth in this notice are applicable for the fiscal 
years specified.

FOR FURTHER INFORMATION CONTACT: Stuart Goldstein, (410) 786-0694 and 
Richard Cuno, (410) 786-1111.

SUPPLEMENTARY INFORMATION:

I. Background

A. Fiscal Year DSH Allotments

    A state's federal fiscal year (FY) disproportionate share hospital 
(DSH) allotment represents the aggregate limit on the federal share 
amount of the state's DSH payments to DSH hospitals in the state for 
the FY. The amount of such allotment is determined in accordance with 
the provisions of section 1923(f)(3) of the Social Security Act (the 
Act), with some state-specific exceptions as specified in section 
1923(f) of 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 Patient Protection and Affordable Care Act of 2010 (Pub. L. 
111-148), as amended by the Health Care and Education Reconciliation 
Act of 2010 (Pub. L. 111-152) (collectively, the Affordable Care Act), 
amended Medicaid DSH provisions, adding section 1923(f)(7) of the Act. 
Section 1923(f)(7) would have required reductions to states' FY DSH 
allotments from FY 2014 through FY 2020, the calculation of which was 
described in the Disproportionate Share Hospital Payment Reduction 
final rule published in the September 18, 2013 Federal Register (78 FR 
57293). Subsequent legislation, most recently by the Bipartisan Budget 
Act of 2018 (Pub. L. 115-123, enacted February 9, 2018), delayed the 
start of these reductions until FY 2020. A proposed rule delineating a 
revised methodology for the calculation of DSH allotment reductions 
previously scheduled to begin in FY 2018 was published in the July 28, 
2017 Federal Register (82 FR 35155).
    Because there are no reductions to DSH allotments for FY 2017 and 
FY 2019 under section 1923(f)(7) of the Act, as amended, this notice 
contains only the state-specific final FY 2017 DSH allotments and 
preliminary FY 2019 DSH allotments, as calculated under the statute 
without application of the reductions that would have been imposed 
under the Affordable Care Act provisions beginning with FY 2014. This 
notice also provides information on the calculation of such FY DSH 
allotments, the calculation of the states' institutions for mental 
diseases (IMDs) DSH limits, and the amounts of states' final FY 2017 
IMD DSH limits and preliminary FY 2019 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

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in the CPI-U for the previous FY. Also in accordance with section 
1923(f)(3) of the Act, a state's DSH allotment for a FY is subject to 
the limitation that an increase to a state's DSH allotment for a FY 
cannot result in the DSH allotment exceeding the greater of the state's 
DSH allotment for the previous FY or 12 percent of the state's total 
medical assistance expenditures for the allotment year (this is 
referred to as the 12 percent limit).
    Furthermore, under section 1923(h) of the Act, federal financial 
participation (FFP) for DSH payments to IMDs and other mental health 
facilities is limited to state-specific aggregate amounts. Under this 
provision, the aggregate limit for DSH payments to IMDs and other 
mental health facilities is the lesser of a state's FY 1995 total 
computable (state and federal share) IMD and other mental health 
facility DSH expenditures applicable to the state's FY 1995 DSH 
allotment (as reported on the Form CMS-64 as of January 1, 1997), or 
the amount equal to the product of the state's current year total 
computable DSH allotment and the applicable percentage specified in 
section 1923(h) of the Act.
    In general, we determine states' DSH allotments for a FY and the 
IMD DSH limits for the same FY using the most recent available 
estimates of or actual medical assistance expenditures, including DSH 
expenditures in their Medicaid programs and the most recent available 
change in the CPI-U used for the FY in accordance with the methodology 
prescribed in the statute. The indicated estimated or actual 
expenditures are obtained from states for each relevant FY from the 
most recent available quarterly Medicaid budget reports (Form CMS-37) 
or quarterly Medicaid expenditure reports (Form CMS-64), respectively, 
submitted by the states. For example, as part of the initial 
determination of a state's FY DSH allotment (referred to as the 
preliminary DSH allotments) that is determined before the beginning of 
the FY for which the DSH allotments and IMD DSH limits are being 
determined, we use estimated expenditures for the FY obtained from the 
August submission of the CMS-37 submitted by states prior to the 
beginning of the FY; such estimated expenditures are subject to update 
and revision during the FY before such actual expenditure data become 
available. We also use the most recent available estimated CPI-U 
percentage change that is available before the beginning of the FY for 
determining the states' preliminary FY DSH allotments; such estimated 
CPI-U percentage change is subject to update and revision during the FY 
before the actual CPI-U percentage change becomes available. In 
determining the final DSH allotments and IMD DSH limits for a FY we use 
the actual expenditures for the FY and actual CPI-U percentage change 
for the previous FY.

II. Provisions of the Notice

A. Calculation of the Final FY 2017 Federal Share State DSH Allotments, 
and the Preliminary FY 2019 Federal Share State DSH Allotments

1. Final FY 2017 Federal Share State DSH Allotments
    Addendum 1 to this notice provides the states' final FY 2017 DSH 
allotments determined in accordance with section 1923(f)(3) of the Act. 
As described in the background section, in general, the DSH allotment 
for a FY is calculated by increasing the FY DSH allotment for the 
preceding FY by the CPI-U increase for the previous fiscal year. For 
purposes of calculating the states' final FY 2017 DSH allotments, the 
preceding final fiscal year DSH allotments (for FY 2016) were published 
in the July 6, 2018 Federal Register (83 FR 31536). For purposes of 
calculating the states' final FY 2017 DSH allotments we are using the 
actual Medicaid expenditures for FY 2017. Finally, for purposes of 
calculating the states' final FY 2017 DSH allotments, the applicable 
historical percentage change in the CPI-U for the previous FY (FY 2016) 
was 0.9 percent; we note that this is the same as the estimated 0.9 
percentage change in the CPI-U for FY 2016 that was available and used 
in the calculation of the preliminary FY 2017 DSH allotments which were 
published in the November 3, 2017 Federal Register (82 FR 51259).
2. Calculation of the Preliminary FY 2019 Federal Share State DSH 
Allotments
    Addendum 2 to this notice provides the preliminary FY 2019 DSH 
allotments determined in accordance with section 1923(f)(3) of the Act. 
The preliminary FY 2019 DSH allotments contained in this notice were 
determined based on the most recent available estimates from states of 
their FY 2019 total computable Medicaid expenditures. Also, the 
preliminary FY 2019 allotments contained in this notice were determined 
by increasing the preliminary FY 2018 DSH allotments. The estimated 
percentage increase in the CPI-U for FY 2018 was 2.4 percent (CMS 
originally published the preliminary FY 2018 DSH allotments in the July 
6, 2018 Federal Register (83 FR 31536)).
    We will publish states' final FY 2019 DSH allotments in a future 
notice based on the states' four quarterly Medicaid expenditure reports 
(Form CMS-64) for FY 2019 available following the end of FY 2019 
utilizing the actual change in the CPI-U for FY 2018.

B. Calculation of the Final FY 2017 and Preliminary FY 2019 IMD DSH 
Limits

    Section 1923(h) of the Act specifies the methodology to be used to 
establish the limits on the amount of DSH payments that a state can 
make to IMDs and other mental health facilities. FFP is not available 
for DSH payments to IMDs or other mental health facilities that exceed 
the IMD DSH limits. In this notice, we are publishing the final FY 2017 
and the preliminary FY 2019 IMD DSH limits determined in accordance 
with the provisions discussed above.
    Addendums 3 and 4 to this notice detail each state's final FY 2017 
and preliminary FY 2019 IMD DSH limit, respectively, determined in 
accordance with section 1923(h) of the Act.

III. Collection of Information Requirements

    As it relates to the Paperwork Reduction Act of 1995 (44 U.S.C. 
3501 et seq.), this notice does not impose any new or revised 
collection of information requirements or burden. While discussed in 
section I.B. and in Addendums 3 and 4 of this notice, the requirements 
and burden associated with Form CMS-37 and Form CMS-64 are unaffected 
by this notice. Both forms are approved by the Office of Management and 
Budget (OMB) under control number 0938-1265. Since this notice will not 
impose any new or revised requirements/burden, we are not making any 
changes under that control number.

IV. Regulatory Impact Analysis

    We have examined the impact of this notice as required by Executive 
Order 12866 on Regulatory Planning and Review (September 1993), the 
Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96-354), 
section 1102(b) of the Act, section 202 of the Unfunded Mandates Reform 
Act of 1995 (Pub. L. 104-4; enacted on March 22, 1995) (UMRA `95), 
Executive Order 13132 on Federalism (August 4, 1999) and the 
Congressional Review Act (5 U.S.C. 804(2)), and Executive Order 13771 
on Reducing Regulation and Controlling Regulatory Costs (January 30, 
2017).
    Executive Order 12866 directs agencies to assess all costs and 
benefits of available regulatory alternatives and, if regulation is 
necessary, to select

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regulatory approaches that maximize net benefits (including potential 
economic, environmental, public health and safety effects, distributive 
impacts, and equity). A regulatory impact analysis (RIA) must be 
prepared for major rules with economically significant effects ($100 
million or more in any 1 year). This notice reaches the $100 million 
economic threshold and thus is considered a major rule under the 
Congressional Review Act.
    The final FY 2017 DSH allotments being published in this notice are 
equal to the preliminary FY 2017 DSH allotments published in the 
November 3, 2017 Federal Register (82 FR 51259). This is due to the 
actual percentage change in the CPI-U for FY 2016 used in the 
calculation of the final FY 2017 allotments (0.9 percent) being equal 
to the estimated percentage change in the CPI-U for FY 2016 used in the 
calculation of the preliminary FY 2017 allotments (0.9 percent). The 
final FY 2017 IMD DSH limits being published in this notice are also 
equal to the preliminary FY 2017 IMD DSH limits published in the 
November 3, 2017 Federal Register (82 FR 51259). Since the final FY 
2017 DSH allotments were equal to the preliminary FY 2017 DSH 
allotments, the associated FY 2017 IMD DSH limits also remained the 
same.
    The preliminary FY 2019 DSH allotments being published in this 
notice have been increased by approximately $295 million more than the 
preliminary FY 2018 DSH allotments published in the July 6, 2018 
Federal Register (83 FR 31536). The increase in the DSH allotments is 
due to the application of the statutory formula for calculating DSH 
allotments under which the prior fiscal year allotments are increased 
by the percentage increase in the CPI-U for the prior fiscal year. The 
preliminary FY 2019 IMD DSH limits being published in this notice are 
approximately $24 million more than the preliminary FY 2018 IMD DSH 
limits published in the July 6, 2018 Federal Register (83 FR 31536). 
The increases in the IMD DSH limits are because the DSH allotment for a 
FY is a factor in the determination of the IMD DSH limit for the FY. 
Since the preliminary FY 2019 DSH allotments are greater than the 
preliminary FY 2018 DSH allotments, the associated preliminary FY 2019 
IMD DSH limits for some states also increased.
    The RFA requires agencies to analyze options for regulatory relief 
of small businesses, if a rule has a significant impact on a 
substantial number of small entities. For purposes of the RFA, small 
entities include small businesses, nonprofit organizations, and small 
governmental jurisdictions. Most hospitals and most other providers and 
suppliers are small entities, either by nonprofit status or by having 
revenues of less than $7.5 million to $38.5 million in any 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 DSH allotments and IMD 
DSH limits, as required by the statute.
    In addition, section 1102(b) of the Act requires us to prepare a 
regulatory impact analysis if a rule may have a significant impact on 
the operations of a substantial number of small rural hospitals. This 
analysis must conform to the provisions of section 604 of the RFA. For 
purposes of section 1102(b) of the Act, we define a small rural 
hospital as a hospital that is located outside of a Core-Based 
Statistical Area for Medicaid payment regulations and has fewer than 
100 beds. We are not preparing analysis for section 1102(b) of the Act 
because the Secretary has determined that this notice will not have a 
significant impact on the operations of a substantial number of small 
rural hospitals.
    The Medicaid statute specifies the methodology for determining the 
amounts of states' DSH allotments and IMD DSH limits; and as described 
previously, the application of the methodology specified in statute 
results in the decreases or increases in states' DSH allotments and IMD 
DSH limits for the applicable FYs. The statute applicable to these 
allotments and limits does not apply to the determination of the 
amounts of DSH payments made to specific DSH hospitals; rather, these 
allotments and limits represent an overall limit on the total of such 
DSH payments. For this reason, we do not believe that this notice will 
have a significant economic impact on a substantial number of small 
entities.
    Section 202 of the Unfunded Mandates Reform Act of 1995 also 
requires that agencies assess anticipated costs and benefits before 
issuing any rule whose mandates require spending in any 1 year of $100 
million in 1995 dollars, updated annually for inflation. In 2018, that 
threshold is approximately $150 million. This notice will have no 
consequential effect on spending by state, local, or tribal 
governments, in the aggregate, or on the private sector.
    Executive Order 13132 establishes certain requirements that an 
agency must meet when it promulgates a proposed rule (and subsequent 
final rule) that imposes substantial direct requirement costs on state 
and local governments, preempts state law, or otherwise has Federalism 
implications. Since this notice does not impose any costs on state or 
local governments or otherwise have Federalism implications, the 
requirements of E.O. 13132 are not applicable.
    Executive Order 13771, titled ``Reducing Regulation and Controlling 
Regulatory Costs,'' was issued on January 30, 2017. It has been 
determined that this notice is a transfer rule and is not a regulatory 
action for the purposes of Executive Order 13771.

A. Alternatives Considered

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

B. Accounting Statement

    As required by OMB Circular A-4 (available at http://www.whitehouse.gov/omb/circulars/a004/a-4.pdf), in Table 1, we have 
prepared an accounting statement showing the classification of the 
estimated expenditures associated with the provisions of this notice. 
Table 1 provides our best estimate of the change (decrease) in the 
federal share of states' Medicaid DSH payments resulting from the 
application of the provisions of the Medicaid statute relating to the 
calculation of states' FY DSH allotments and the increase in the FY DSH 
allotments from FY 2018 to FY 2019.

Table 1--Accounting Statement: Classification of Estimated Expenditures,
                       From the FY 2018 to FY 2019
                              [in Millions]
------------------------------------------------------------------------
                 Category                             Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers............  $295.
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.

    Dated: January 9, 2019.
Seema Verma,
Administrator, Centers for Medicare & Medicaid Services.
    Dated: January 18, 2019.
Alex M. Azar II,
Secretary, Department of Health and Human Services.

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                                                   Key to ADDENDUM 1--Final DSH Allotments for FY 2017
[The Final FY 2017 DSH Allotments for the NON-Low DSH States are presented in the top section of this addendum, and the Final FY 2017 DSH Allotments for
                                        the Low-DSH States are presented in the bottom section of this addendum.]
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                   Column                                                                    Description
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Column A...................................  State.
Column B...................................  FY 2017 FMAPs.
                                             This column contains the States' FY 2017 Federal Medical Assistance Percentages.
Column C...................................  Prior FY (2016) DSH Allotments.
                                             This column contains the States' prior FY 2016 DSH Allotments.
Column D...................................  Prior FY (2016) DSH Allotments (Col C) x (100 percent + Percentage Increase in CPIU): 100.9 percent.
                                             This column contains the amount in Column C increased by 1 plus the percentage increase in the CPI-U for
                                              the prior FY (100.9 percent).
Column E...................................  FY 2017 TC MAP Exp. Including DSH.
                                             This column contains the amount of the States' FY 2017 total computable (TC) medical assistance
                                              expenditures including DSH expenditures.
Column F...................................  FY 2017 TC DSH Expenditures.
                                             This column contains the amount of the States' FY 2017 total computable DSH expenditures.
Column G...................................  FY 2017 TC MAP Exp. Net of DSH.
                                             This column contains the amount of the States' FY 2017 total computable medical assistance expenditures net
                                              of DSH expenditures, calculated as the amount in Column E minus the amount in Column F.
Column H...................................  12 percent Amount.
                                             This column contains the amount of the ``12 percent limit'' in Federal share, determined in accordance with
                                              the provisions of section 1923(f)(3) of the Act.
Column I...................................  Greater of FY 2016 Allotment or 12 percent Limit.
                                             This column contains the greater of the State's prior FY (FY 2016) DSH allotment or the amount of the 12
                                              percent Limit, determined as the greater of the amount in Column C or Column H.
Column J...................................  FY 2017 DSH Allotment.
                                             This column contains the States' final FY 2017 DSH allotments, determined as the lesser 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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                                                Key to ADDENDUM 2--Preliminary DSH Allotments for FY 2019
  [The Preliminary FY 2019 DSH Allotments for the NON-Low DSH States are presented in the top section of this addendum, and the Preliminary FY 2019 DSH
                                Allotments for the Low-DSH States are presented in the bottom section of this addendum.]
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                   Column                                                                    Description
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Column A...................................  State.
Column B...................................  FY 2019 FMAPs.
                                             This column contains the States' FY 2019 Federal Medical Assistance Percentages.
Column C...................................  Prior FY (2018) DSH Allotments.
                                             This column contains the States' prior preliminary FY 2018 DSH Allotments.
Column D...................................  Prior FY (2018) DSH Allotments (Col C) x (100 percent + Percentage Increase in CPIU): 102.4 percent.
                                             This column contains the amount in Column C increased by 1 plus the estimated percentage increase in the
                                              CPI-U for the prior FY (102.4 percent).
Column E...................................  FY 2019 TC MAP Exp. Including DSH.
                                             This column contains the amount of the States' projected FY 2019 total computable (TC) medical assistance
                                              expenditures including DSH expenditures.
Column F...................................  FY 2019 TC DSH Expenditures.
                                             This column contains the amount of the States' projected FY 2019 total computable DSH expenditures.
Column G...................................  FY 2019 TC MAP Exp. Net of DSH.
                                             This column contains the amount of the States' projected FY 2019 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 2018 Allotment or 12 percent Limit.
                                             This column contains the greater of the State's preliminary prior FY (FY 2018) DSH allotment or the amount
                                              of the 12 percent Limit, determined as the greater of the amount in Column C or Column H.
Column J...................................  FY 2019 DSH Allotment.
                                             This column contains the States' preliminary FY 2018 DSH allotments, determined as the lesser 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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                                                   Key to ADDENDUM 3--Final IMD DSH Limits for FY 2017
   [The final FY 2017 IMD DSH Limits for the Non-Low DSH States are presented in the top section of this addendum and the preliminary FY 2017 IMD DSH
                                   Limits for the Low-DSH States are presented in the bottom section of the addendum.]
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                   Column                                                                    Description
--------------------------------------------------------------------------------------------------------------------------------------------------------
Column A...................................  State.
Column B...................................  Inpatient Hospital Services FY 95 DSH Total Computable.
                                             This column contains the States' total computable FY 1995 inpatient hospital DSH expenditures as reported
                                              on the Form CMS-64 as of January 1, 1997.
Column C...................................  IMD and Mental Health Services FY 95 DSH Total Computable.
                                             This column contains the total computable FY 1995 mental health facility DSH expenditures as reported on
                                              the Form CMS-64 as of January 1, 1997.
Column D...................................  Total Inpatient Hospital & IMD & Mental Health FY 95 DSH Total Computable, Col. B + C.
                                             This column contains the total computation of all inpatient hospital DSH expenditures and mental health
                                              facility DSH expenditures for FY 1995 as reported on the Form CMS-64 as of January 1, 1997 (representing
                                              the sum of Column B and Column C).
Column E...................................  Applicable Percentage, Col. C/D.
                                             This column contains the ``applicable percentage'' representing the total Computable FY 1995 mental health
                                              facility DSH expenditures divided by total computable all inpatient hospital and mental health facility
                                              DSH expenditures for FY 1995 (the amount in Column C divided by the amount in Column D) Per section
                                              1923(h)(2)(A)(ii)(III) of the Act, for FYs after FY 2002, the applicable percentage can be no greater than
                                              33 percent.
Column F...................................  FY 2017 Federal Share DSH Allotment.
                                             This column contains the states' FY 2017 DSH allotments from Addendum 1, Column J.
Column G...................................  FY 2017 FMAP.
Column H...................................  FY 2017 DSH Allotments in Total Computable, Col. F/G.
                                             This column contains states' FY 2017 total computable DSH allotment (determined as Column F/Column G).
Column I...................................  Applicable Percentage Applied to FY 2017 Allotments in TC, Col E x Col H.
                                             This column contains the applicable percentage of FY 2017 total computable DSH allotment (calculated as the
                                              percentage in Column E multiplied by the amount in Column H).
Column J...................................  FY 2017 TC IMD DSH Limit. Lesser of Col. I or C.
                                             This column contains the total computable FY 2017 TC IMD DSH Limit equal to the lesser of the amount in
                                              Column I or Column C.
Column K...................................  FY 2017 IMD DSH Limit in Federal Share, Col. G x J.
                                             This column contains the FY 2017 Federal Share IMD DSH limit determined by converting the total computable
                                              FY 2017 IMD DSH Limit from Column J into a federal share amount by multiplying it by the FY 2016 FMAP in
                                              Column G.
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                                                Key to ADDENDUM 4--Preliminary IMD DSH Limits for FY 2019
[The preliminary FY 2019 IMD DSH Limits for the Non-Low DSH States are presented in the top section of this addendum and the preliminary FY 2019 IMD DSH
                                   Limits for the Low-DSH States are presented in the bottom section of the addendum.]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                   Column                                                                    Description
--------------------------------------------------------------------------------------------------------------------------------------------------------
Column A...................................  State.
Column B...................................  Inpatient Hospital Services FY 95 DSH Total Computable.
                                             This column contains the States' total computable FY 1995 inpatient hospital DSH expenditures as reported
                                              on the Form CMS-64 as of January 1, 1997.
Column C...................................  IMD and Mental Health Services FY 95 DSH Total Computable.
                                             This column contains the total computable FY 1995 mental health facility DSH expenditures as reported on
                                              the Form CMS-64 as of January 1, 1997.
Column D...................................  Total Inpatient Hospital & IMD & Mental Health FY 95 DSH Total Computable, Col. B + C.
                                             This column contains the total computation of all inpatient hospital DSH expenditures and mental health
                                              facility DSH expenditures for FY 1995 as reported on the Form CMS-64 as of January 1, 1997 (representing
                                              the sum of Column B and Column C).
Column E...................................  Applicable Percentage, Col. C/D.
                                             This column contains the ``applicable percentage'' representing the total Computable FY 1995 mental health
                                              facility DSH expenditures divided by total computable all inpatient hospital and mental health facility
                                              DSH expenditures for FY 1995 (the amount in Column C divided by the amount in Column D) Per section
                                              1923(h)(2)(A)(ii)(III) of the Act, for FYs after FY 2002, the applicable percentage can be no greater than
                                              33 percent.
Column F...................................  FY 2019 Federal Share DSH Allotment.
                                             This column contains the states' preliminary FY 2019 DSH allotments from Addendum 1, Column J.
Column G...................................  FY 2019 FMAP.
Column H...................................  FY 2019 DSH Allotments in Total Computable, Col. F/G.
                                             This column contains states' FY 2019 total computable DSH allotment (determined as Column F/Column G).
Column I...................................  Applicable Percentage Applied to FY 2019 Allotments in TC, Col E x Col H.
                                             This column contains the applicable percentage of FY 2019 total computable DSH allotment (calculated as the
                                              percentage in Column E multiplied by the amount in Column H).
Column J...................................  FY 2019 TC IMD DSH Limit. Lesser of Col. I or C.
                                             This column contains the total computable FY 2019 TC IMD DSH Limit equal to the lesser of the amount in
                                              Column I or Column C.
Column K...................................  FY 2019 IMD DSH Limit in Federal Share, Col. G x J.
                                             This column contains the FY 2018 Federal Share IMD DSH limit determined by converting the total computable
                                              FY 2019 IMD DSH Limit from Column J into a federal share amount by multiplying it by the FY 2018 FMAP in
                                              Column G.
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[FR Doc. 2019-01928 Filed 2-8-19; 8:45 am]
BILLING CODE 4120-01-P