[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
[[Page 3171]]
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
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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.
[[Page 3173]]
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
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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.]
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Column Description
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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