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, 11436-11445 [2014-04032]
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[FR Doc. 2014–04327 Filed 2–27–14; 8:45 am]
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DEPARTMENT OF HEALTH AND
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[CMS–2389–N]
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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
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice.
AGENCY:
This notice announces the
preliminary federal share DSH
allotments for FY 2014 and the
SUMMARY:
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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.
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:
DATES:
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)
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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
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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
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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
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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
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11437
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
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Federal Register / Vol. 79, No. 40 / Friday, February 28, 2014 / Notices
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 https://
www.whitehouse.gov/omb/circulars/
a004/a-4.pdf), in the Table 1, we have
prepared an accounting statement
showing the classification of the
estimated expenditures associated with
the provisions of this notice. Table 1
provides our best estimate of the change
(decrease) in the federal share of states’
Medicaid DSH payments resulting from
the application of the provisions of the
Medicaid statute relating to the
calculation of states’ FY DSH allotments
and the increase in the FY DSH
allotments from FY 2013 to FY 2014.
TABLE 1—ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED EXPENDITURES, FROM THE FY 2013 TO FY 2014
[In millions]
Category
Transfers
Annualized Monetized Transfers .............................................................................................................................
From Whom To Whom? ..........................................................................................................................................
$108.
Federal Government to States.
C. Congressional Review Act
This proposed regulation is subject to
the Congressional Review Act
provisions of the Small Business
Regulatory Enforcement Fairness Act of
1996 (5 U.S.C. 801 et seq.) and has been
transmitted to the Congress and the
Comptroller General for review.
In accordance with the provisions of
Executive Order 12866, this notice was
reviewed by the Office of Management
and Budget.
(Catalog of Federal Domestic Assistance
Program No. 93.778, Medical Assistance
Program)
Dated: January 24, 2014.
Marilyn Tavenner,
Administrator, Centers for Medicare &
Medicaid Services.
Dated: February 11, 2014.
Kathleen Sebelius,
Secretary.
Department of Health and Human
Services.
KEY TO ADDENDUM 1—PRELIMINARY DSH ALLOTMENTS FOR FY 2014.
Column
Description
The Preliminary FY 2014 DSH Allotments for the NON-Low DSH States are presented in the top section of this addendum, and the
Preliminary FY 2014 DSH Allotments for the Low-DSH States are presented in the bottom section of this addendum.
Column A ..........
Column B ..........
Column C .........
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Column D .........
Column E ..........
Column F ..........
Column G .........
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State.
FY 2014 FMAPs.
This column contains the States’ FY 2014 Federal Medical Assistance Percentages.
Prior FY (2013) DSH Allotments.
This column contains the States’ prior FY 2013 DSH Allotments.
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).
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.
FY 2014 TC DSH Expenditures.
This column contains the amount of the States’ projected FY 2014 total computable DSH expenditures.
FY 2014 TC MAP Exp. Net of DSH.
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11439
KEY TO ADDENDUM 1—PRELIMINARY DSH ALLOTMENTS FOR FY 2014.—Continued
Column
Description
Column H .........
Column I ...........
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Column J ..........
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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.
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.
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
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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50.00
70.10
55.31
51.85
71.64
57.93
50.00
66.33
54.74
69.20
50.00
64.02
63.14
53.54
70.34
59.06
..................
TOTAL .......................................................
ALASKA ............................................................
ARKANSAS ......................................................
DELAWARE ......................................................
HAWAII 3 ...........................................................
IDAHO ...............................................................
IOWA ................................................................
MINNESOTA .....................................................
MONTANA ........................................................
NEBRASKA ......................................................
NEW MEXICO ..................................................
NORTH DAKOTA .............................................
OKLAHOMA ......................................................
OREGON ..........................................................
SOUTH DAKOTA .............................................
UTAH ................................................................
WISCONSIN .....................................................
68.12
67.23
50.00
50.00
50.00
70.00
58.79
65.93
50.00
66.92
56.91
69.83
na
61.55
50.00
50.00
66.32
73.05
62.03
63.10
50.00
50.00
50.00
65.78
63.02
53.52
50.11
70.57
65.29
58.69
56.76
50.00
50.00
71.09
B
A
ALABAMA .........................................................
ARIZONA ..........................................................
CALIFORNIA ....................................................
COLORADO .....................................................
CONNECTICUT ................................................
DISTRICT OF COLUMBIA ...............................
FLORIDA ..........................................................
GEORGIA .........................................................
ILLINOIS ...........................................................
INDIANA ...........................................................
KANSAS ...........................................................
KENTUCKY ......................................................
LOUISIANA 1 .....................................................
MAINE ...............................................................
MARYLAND ......................................................
MASSACHUSETTS ..........................................
MICHIGAN ........................................................
MISSISSIPPI .....................................................
MISSOURI ........................................................
NEVADA ...........................................................
NEW HAMPSHIRE ...........................................
NEW JERSEY ..................................................
NEW YORK ......................................................
NORTH CAROLINA ..........................................
OHIO .................................................................
PENNSYLVANIA ..............................................
RHODE ISLAND ...............................................
SOUTH CAROLINA ..........................................
TENNESSEE 2 ..................................................
TEXAS ..............................................................
VERMONT5 .......................................................
VIRGINIA ..........................................................
WASHINGTON .................................................
WEST VIRGINIA ...............................................
FY 2014
FMAPs
(percent)
21,402,636
45,325,292
9,512,282
10,240,000
17,271,044
41,378,149
78,476,334
11,926,371
29,733,219
21,402,636
10,036,360
38,049,129
47,561,414
11,604,719
20,612,808
99,326,563
10,244,637,203
$323,093,267
106,384,369
1,151,840,630
97,190,657
210,141,962
64,355,975
210,141,962
282,378,262
225,902,609
224,589,223
43,341,780
152,352,923
na
110,324,530
80,116,623
320,466,492
278,438,100
160,233,246
497,773,773
48,595,328
168,217,088
676,394,441
1,687,702,633
309,959,394
426,850,861
589,710,881
68,296,138
344,107,463
na
1,004,741,257
23,640,971
92,050,138
194,381,315
70,922,912
C
Prior FY (2013)
DSH allotments
21,723,676
46,005,171
9,654,966
10,393,600
17,530,110
41,998,821
79,653,479
12,105,267
30,179,217
21,723,676
10,186,905
38,619,866
48,274,835
11,778,790
20,922,000
100,816,461
10,398,306,761
$327,939,666
107,980,135
1,169,118,239
98,648,517
213,294,091
65,321,315
213,294,091
286,613,936
229,291,148
227,958,061
43,991,907
154,638,217
na
111,979,398
81,318,372
325,273,489
282,614,672
162,636,745
505,240,380
49,324,258
170,740,344
686,540,358
1,713,018,172
314,608,785
433,253,624
598,556,544
69,320,580
349,269,075
na
1,019,812,376
23,995,586
93,430,890
197,297,035
71,986,756
D
101.5%
Prior FY (2013)
DSH allotment
(Col C) × 100%
+ pct increase
in CPIU:
1,583,467,000
4,549,145,000
1,620,151,000
1,940,694,000
1,867,605,000
3,852,612,000
10,571,446,000
1,078,653,000
2,060,181,000
3,598,324,000
844,103,000
5,219,568,000
6,163,918,000
843,570,000
2,089,446,000
7,532,985,000
LOW DSH STATES
424,148,883,000
$5,837,507,000
8,763,763,000
72,253,198,000
5,510,334,000
6,585,550,000
2,345,594,000
21,065,753,000
8,929,625,000
16,174,722,000
8,960,665,000
2,825,757,000
6,276,300,000
na
2,491,965,000
8,676,095,000
14,210,660,000
13,523,842,000
5,094,327,000
9,279,932,000
2,092,603,000
1,340,075,000
13,682,358,000
67,240,475,000
13,134,561,000
19,534,779,000
21,451,173,000
2,302,742,000
5,582,305,000
na
37,675,429,000
1,536,190,000
8,287,311,000
7,949,059,000
3,534,234,000
E
FY 2014 TC MAP
Exp. including
DSH 4
20,638,000
43,820,000
16,804,000
0
23,451,000
53,536,000
154,792,000
18,023,000
41,391,000
21,380,000
1,600,000
58,140,000
71,176,000
1,476,000
29,583,000
159,936,000
15,426,569,000
$517,367,000
156,364,000
935,479,000
195,772,000
228,325,000
44,744,000
361,462,000
435,776,000
428,796,000
0
74,228,000
152,353,000
na
37,000,000
85,128,000
0
364,144,000
321,190,000
684,657,000
77,014,000
124,810,000
1,207,107,000
3,373,800,000
478,361,000
0
732,037,000
137,098,000
474,540,000
na
2,991,551,000
37,449,000
243,321,000
456,511,000
70,185,000
F
FY 2014 TC
DSH
Expenditures 4
1,562,829,000
4,505,325,000
1,603,347,000
1,940,694,000
1,844,154,000
3,799,076,000
10,416,654,000
1,060,630,000
2,018,790,000
3,576,944,000
842,503,000
5,161,428,000
6,092,742,000
842,094,000
2,059,863,000
7,373,049,000
408,722,314,000
$5,320,140,000
8,607,399,000
71,317,719,000
5,314,562,000
6,357,225,000
2,300,850,000
20,704,291,000
8,493,849,000
15,745,926,000
8,960,665,000
2,751,529,000
6,123,947,000
na
2,454,965,000
8,590,967,000
14,210,660,000
13,159,698,000
4,773,137,000
8,595,275,000
2,015,589,000
1,215,265,000
12,475,251,000
63,866,675,000
12,656,200,000
19,534,779,000
20,719,136,000
2,165,644,000
5,107,765,000
na
34,683,878,000
1,498,741,000
8,043,990,000
7,492,548,000
3,464,049,000
G
FY 2014 TC
MAPEXP. net of
DSH Col E ¥ F
ADDENDUM 1—PRELIMINARY DSH ALLOTMENTS FOR FISCAL YEAR 2014
STATE
tkelley on DSK3SPTVN1PROD with NOTICES
246,762,473.68
652,302,821
245,710,799
303,011,243.86
265,825,337.14
574,997,969
1,644,734,842
155,387,273
310,272,058
519,282,220
133,026,789
762,248,260
902,688,455
130,242,791
298,026,939
1,110,375,539
62,783,822,812
$774,927,876
1,257,306,757
11,260,692,474
839,141,368
1,003,772,368
333,226,552
3,121,706,180
1,246,058,516
2,486,198,842
1,310,228,045
418,408,859
887,363,415
na
365,940,898
1,356,468,474
2,243,788,421
1,928,021,733
685,361,490
1,278,828,483
298,670,057
191,883,947
1,969,776,474
10,084,211,842
1,857,623,286
2,895,527,493
3,204,879,071
341,706,914
738,511,134
na
5,231,775,883
228,065,789
1,270,103,684
1,183,033,895
500,103,388
H
‘‘12% Amount’’
=Col G ×
.12(1¥.12/Col B)’’
(in FS)
246,762,474
652,302,821
245,710,799
303,011,244
265,825,337
574,997,969
1,644,734,842
155,387,273
310,272,058
519,282,220
133,026,789
762,248,260
902,688,455
130,242,791
298,026,939
1,110,375,539
62,783,822,812
$774,927,876
1,257,306,757
11,260,692,474
839,141,368
1,003,772,368
333,226,552
3,121,706,180
1,246,058,516
2,486,198,842
1,310,228,045
418,408,859
887,363,415
na
365,940,898
1,356,468,474
2,243,788,421
1,928,021,733
685,361,490
1,278,828,483
298,670,057
191,883,947
1,969,776,474
10,084,211,842
1,857,623,286
2,895,527,493
3,204,879,071
341,706,914
738,511,134
na
5,231,775,883
228,065,789
1,270,103,684
1,183,033,895
500,103,388
I
Greater of Col
H or Col C
(12% Limit, FY
2013 allotment)
21,723,676
46,005,171
9,654,966
10,393,600
17,530,110
41,998,821
79,653,479
12,105,267
30,179,217
21,723,676
10,186,905
38,619,866
48,274,835
11,778,790
20,922,000
100,816,461
11,130,266,762
$327,939,666
107,980,135
1,169,118,239
98,648,517
213,294,091
65,321,315
213,294,091
286,613,936
229,291,148
227,958,061
43,991,907
154,638,217
731,960,000
111,979,398
81,318,372
325,273,489
282,614,672
162,636,745
505,240,380
49,324,258
170,740,344
686,540,358
1,713,018,172
314,608,785
433,253,624
598,556,544
69,320,580
349,269,075
0
1,019,812,376
23,995,586
93,430,890
197,297,035
71,986,756
J
FY 2014 DSH
allotment MIN
Col I, Col D
11440
Federal Register / Vol. 79, No. 40 / Friday, February 28, 2014 / Notices
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..................
TOTAL LOW DSH STATES ......................
TOTAL ................................................
10,758,733,966
514,096,763
237,807
10,920,114,975
521,808,214
241,374
480,133,058,000
55,984,175,000
568,307,000
16,142,778,000
716,209,000
463,000
463,990,280,000
55,267,966,000
567,844,000
71,128,378,201
8,344,555,389
89,659,579
71,128,378,201
8,344,555,389
89,659,579
11,652,074,976
521,808,214
241,374
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.
1 Louisiana’s
..................
WYOMING ........................................................
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Federal Register / Vol. 79, No. 40 / Friday, February 28, 2014 / Notices
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 ..........
Column B ..........
Column C .........
Column D .........
Column E ..........
Column F ..........
Column G .........
Column H .........
Column I ...........
Column J ..........
tkelley on DSK3SPTVN1PROD with NOTICES
Column K ..........
VerDate Mar<15>2010
State.
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.
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.
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).
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.
FY 2014 Federal Share DSH Allotment.
This column contains the states’ preliminary FY 2014 DSH allotments from Column J Addendum 1.
FY 2014 FMAP.
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).
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).
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.
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.
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DSH total
computable
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2,506,827
2,422,649
0
0
2,081,429
12,011,250
24,240,000
237,048
6,449,102
6,490,015
214,523
20,019,969
11,437,908
321,120
3,621,116
6,609,524
13,402,460,846
TOTAL .........................................
ALASKA ..............................................
ARKANSAS ........................................
DELAWARE ........................................
HAWAII ...............................................
IDAHO .................................................
IOWA ..................................................
MINNESOTA .......................................
MONTANA ..........................................
NEBRASKA ........................................
NEW MEXICO ....................................
NORTH DAKOTA ...............................
OKLAHOMA ........................................
OREGON ............................................
SOUTH DAKOTA ...............................
UTAH ..................................................
WISCONSIN .......................................
$413,006,229
93,916,100
2,189,879,543
173,900,441
303,359,275
39,532,234
184,468,014
407,343,557
315,868,508
79,960,783
11,587,208
158,804,908
1,078,512,169
99,957,958
22,226,467
469,653,946
133,258,800
182,608,033
521,946,524
73,560,000
92,675,916
736,742,539
2,418,869,368
193,201,966
535,731,956
388,207,319
108,503,167
366,681,364
0
1,220,515,401
19,979,252
129,313,480
171,725,815
66,962,606
A
ALABAMA ...........................................
ARIZONA ............................................
CALIFORNIA ......................................
COLORADO .......................................
CONNECTICUT ..................................
DISTRICT OF COLUMBIA .................
FLORIDA ............................................
GEORGIA ...........................................
ILLINOIS .............................................
INDIANA .............................................
KANSAS .............................................
KENTUCKY ........................................
LOUISIANA .........................................
MAINE .................................................
MARYLAND ........................................
MASSACHUSETTS ............................
MICHIGAN ..........................................
MISSISSIPPI .......................................
MISSOURI ..........................................
NEVADA .............................................
NEW HAMPSHIRE .............................
NEW JERSEY ....................................
NEW YORK ........................................
NORTH CAROLINA ............................
OHIO ...................................................
PENNSYLVANIA ................................
RHODE ISLAND .................................
SOUTH CAROLINA ............................
TENNESSEE * ....................................
TEXAS ................................................
VERMONT ** .......................................
VIRGINIA ............................................
WASHINGTON ...................................
WEST VIRGINIA .................................
B
State
tkelley on DSK3SPTVN1PROD with NOTICES
17,611,765
819,351
7,069,000
0
0
0
5,257,214
0
1,811,337
254,786
988,478
3,273,248
19,975,092
751,299
934,586
4,492,011
4,118,758,904
$4,451,770
28,474,900
1,555,919
594,776
105,573,725
6,545,136
149,714,986
0
89,408,276
153,566,302
76,663,508
37,443,073
132,917,149
60,958,342
120,873,531
105,635,054
304,765,552
0
207,234,618
0
94,753,948
357,370,461
605,000,000
236,072,627
93,432,758
579,199,682
2,397,833
72,076,341
0
292,513,592
9,071,297
7,770,268
163,836,435
18,887,045
C
IMD and
mental health
services FY 95
DSH total
computable
20,118,592
3,242,000
7,069,000
0
2,081,429
12,011,250
29,497,214
237,048
8,260,439
6,744,801
1,203,001
23,293,217
31,413,000
1,072,419
4,555,702
11,101,535
17,521,219,750
$417,457,999
122,391,000
2,191,435,462
174,495,217
408,933,000
46,077,370
334,183,000
407,343,557
405,276,784
233,527,085
88,250,716
196,247,981
1,211,429,318
160,916,300
143,099,998
575,289,000
438,024,352
182,608,033
729,181,142
73,560,000
187,429,864
1,094,113,000
3,023,869,368
429,274,593
629,164,714
967,407,001
110,901,000
438,757,705
0
1,513,028,993
29,050,549
137,083,748
335,562,250
85,849,651
D
Total inpatient &
IMD & mental
health FY 95 DSH
total computable
col B + C
11,130,266,762
$327,939,666
107,980,135
1,169,118,239
98,648,517
213,294,091
65,321,315
213,294,091
286,613,936
229,291,148
227,958,061
43,991,907
154,638,217
731,960,000
111,979,398
81,318,372
325,273,489
282,614,672
162,636,745
505,240,380
49,324,258
170,740,344
686,540,358
1,713,018,172
314,608,785
433,253,624
598,556,544
69,320,580
349,269,075
0
1,019,812,376
23,995,586
93,430,890
197,297,035
71,986,756
33.00
25.27
33.00
0.00
0.00
0.00
17.82
0.00
21.93
3.78
33.00
14.05
33.00
33.00
20.51
33.00
F
FY 2014
allotment in FS
21,723,676
46,005,171
9,654,966
10,393,600
17,530,110
41,998,821
79,653,479
12,105,267
30,179,217
21,723,676
10,186,905
38,619,866
48,274,835
11,778,790
20,922,000
100,816,461
LOW DSH STATES
..................
1.07
23.27
0.07
0.34
25.82
14.20
33.00
0.00
22.06
33.00
33.00
19.08
10.97
33.00
33.00
18.36
33.00
0.00
28.42
0.00
33.00
32.66
20.01
33.00
14.85
33.00
2.16
16.43
0.00
19.33
31.23
5.67
33.00
22.00
E
Applicable
percent
col C/D
50.00
70.10
55.31
51.85
71.64
57.93
50.00
66.33
54.74
69.20
50.00
64.02
63.14
53.54
70.34
59.06
..................
68.12
67.23
50.00
50.00
50.00
70.00
58.79
65.93
50.00
66.92
56.91
69.83
60.98
61.55
50.00
50.00
66.32
73.05
62.03
63.10
50.00
50.00
50.00
65.78
63.02
53.52
50.11
70.57
65.29
58.69
56.76
50.00
50.00
71.09
G
FY 2014
FMAPs
(percent)
43,447,352
65,627,919
17,456,095
20,045,516
24,469,724
72,499,259
159,306,958
18,250,063
55,131,927
31,392,595
20,373,810
60,324,689
76,456,818
21,999,981
29,744,100
170,701,763
19,837,936,852
$481,414,659
160,613,022
2,338,236,478
197,297,034
426,588,182
93,316,164
362,806,755
434,724,611
458,582,296
340,642,649
77,300,838
221,449,545
1,200,327,976
181,932,409
162,636,744
650,546,978
426,137,925
222,637,570
814,509,721
78,168,396
341,480,688
1,373,080,716
3,426,036,344
478,274,225
687,485,916
1,118,379,193
138,336,819
494,925,712
0
1,737,625,449
42,275,521
186,861,780
394,594,070
101,261,438
H
FY 2014
allotments in
TC
col F/G
ADDENDUM 2—PRELIMINARY IMD DSH LIMIT FOR FISCAL YEAR 2014
14,337,626
16,586,151
5,760,511
0
0
0
28,392,877
0
12,089,248
1,185,861
6,723,357
8,477,046
25,230,750
7,259,994
6,101,896
56,331,582
3,778,134,755
$5,133,804
37,367,451
1,660,148
672,497
110,131,741
13,255,248
119,726,229
0
101,168,027
112,412,074
25,509,277
42,251,398
131,699,118
60,037,695
53,670,126
119,453,988
140,625,515
0
231,485,157
0
112,688,627
448,489,771
685,463,469
157,830,494
102,093,623
369,065,134
2,991,033
81,303,266
0
335,934,780
13,200,914
10,591,818
130,216,043
22,277,660
I
Applicable
percentage
applied to FY
2014
allotments iin
TC
col E × Col H
14,337,626
819,351
5,760,511
0
0
0
5,257,214
0
1,811,337
254,786
988,478
3,273,248
19,975,092
751,299
934,586
4,492,011
3,440,982,495
$4,451,770
28,474,900
1,555,919
594,776
105,573,725
6,545,136
119,726,229
0
89,408,276
112,412,074
25,509,277
37,443,073
131,699,118
60,037,695
53,670,126
105,635,054
140,625,515
0
207,234,618
0
94,753,948
357,370,461
605,000,000
157,830,494
93,432,758
369,065,134
2,397,833
72,076,341
0
292,513,592
9,071,297
7,770,268
130,216,043
18,887,045
J
FY 2014 TC
IMD limit
(lesser of col I
or Col C)
7,168,813
574,365
3,186,139
0
0
0
2,628,607
0
991,526
176,312
494,239
2,095,533
12,612,273
402,245
657,388
2,652,982
1,930,546,450
$3,032,546
19,143,675
777,960
297,388
52,786,863
4,581,595
70,387,050
0
44,704,138
75,226,160
14,517,329
26,146,498
80,310,122
36,953,201
26,835,063
52,817,527
93,262,842
0
128,547,634
0
47,376,974
178,685,231
302,500,000
103,820,899
58,881,324
197,523,660
1,201,554
50,864,274
0
171,676,227
5,148,868
3,885,134
65,108,022
13,426,800
K
FY 2014 IMD
limit in FS
col G × J
Federal Register / Vol. 79, No. 40 / Friday, February 28, 2014 / Notices
28FEN1
11443
VerDate Mar<15>2010
B
A
0
Inpatient hospital
services FY 95
DSH total
computable
17:47 Feb 27, 2014
13,501,123,326
TOTAL LOW DSH STATES ........
TOTAL ..................................
4,181,997,071
63,238,167
0
0
17,683,120,397
161,900,647
D
Total inpatient &
IMD & mental
health FY 95 DSH
total computable
col B + C
0.00
..................
..................
E
Applicable
percent
col C/D
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.
98,662,480
WYOMING ..........................................
C
IMD and
mental health
services FY 95
DSH total
computable
11,652,074,976
521,808,214
241,374
F
FY 2014
allotment in FS
..................
..................
50.00
G
FY 2014
FMAPs
(percent)
20,724,648,170
887,711,318
482,748
H
FY 2014
allotments in
TC
col F/G
ADDENDUM 2—PRELIMINARY IMD DSH LIMIT FOR FISCAL YEAR 2014—Continued
State
tkelley on DSK3SPTVN1PROD with NOTICES
0
3,966,611,654
188,476,899
I
Applicable
percentage
applied to FY
2014
allotments iin
TC
col E × Col H
0
3,499,638,034
58,655,539
J
FY 2014 TC
IMD limit
(lesser of col I
or Col C)
0
1,964,186,872
33,640,422
K
FY 2014 IMD
limit in FS
col G × J
11444
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11445
Federal Register / Vol. 79, No. 40 / Friday, February 28, 2014 / Notices
[FR Doc. 2014–04032 Filed 2–27–14; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Administration for Children and
Families
Proposed Information Collection
Activity; Comment Request
Title: Head Start Family and Child
Experiences Survey (FACES).
OMB No.: 0970–0151.
Description: The Office of Planning,
Research and Evaluation (OPRE),
Administration for Children and
Families (ACF), U.S. Department of
Health and Human Services (HHS), is
proposing to collect data for the Head
Start Family and Child Experiences
Survey (FACES). Featuring a new ‘‘Core
Plus’’ study design, FACES will provide
data on a set of key indicators, including
information for performance measures.
This design also allows for more rapid
and frequent data reporting (Core study)
and serves as a vehicle for studying
more complex issues and topics in
greater detail and with increased
efficiency (Plus studies).
The FACES Core study will assess the
school readiness skills of Head Start
children, survey their parents, and ask
their Head Start teachers to rate
children’s social and emotional skills. In
addition, FACES will include
observations in Head Start classrooms,
and program director, center director,
and teacher surveys. FACES Plus
studies include additional survey
content of policy or programmatic
interest, and may include additional
programs or respondents beyond those
participating in the Core FACES study.
Previous notices provided the
opportunity for public comment on the
proposed Head Start program
recruitment and center selection process
(FR V.78, pg. 75569 12/12/2013; FR
V.79, pg. 8461 02/12/2014). This notice
describes the planned data collection
activities for the FACES Core study and
Plus studies. Direct child assessments,
parent surveys, and teacher child
reports for the Core study are included
in this clearance package. Additionally,
we describe instruments to support the
Core study at the program and
classroom levels and the Plus studies
anticipated for future submission. Since
these instruments will be informed by
initial findings of FACES and emerging
policy needs, they cannot be fully
specified at this time. However, we
describe the respondents and data
collection methods, estimated
respondent burden, and how the
information will be used to the extent
possible at this time. Subsequently,
when fully developed in a manner
consistent with the description
provided in this 60-day notice and prior
to use, we will submit these materials
for a 30-day public comment period
under the Paperwork Reduction Act.
Methods for Core data collection start
with site visits in fall 2014 to 60 Head
Start programs to directly assess the
school readiness skills of 2,400 children
sampled to participate in FACES.
Parents of sampled children will
complete surveys on the Web or by
telephone about their children and
family background. Head Start teachers
will rate each sampled child
(approximately 10 children per
classroom) using the Web or paper-andpencil forms. These activities will occur
a second time in spring 2015.
Additionally, the program sample size
will increase to 180 programs in the
spring to collect program- and
classroom-level data. The methods of
data collection for this phase will
feature site visitors conducting
observations of the types and quality of
classroom activities. Head Start program
Total number
of respondents
Instrument
Annual
number of
respondents
directors, center directors, and teachers
will complete surveys about themselves
and the services and instruction at Head
Start. The program- and classroom-level
data collection will occur a second time
in spring 2017.
Plus study data collection will
parallel the Core design in many ways,
including recruitment and data
collection procedures, to add new
respondents, include new populations,
or expand on the information gathered
in the Core study. Additional early care
and education administrators or
providers (such as Education
Coordinators or Family Service Staff)
may be sampled. Plus studies may
involve data collection in additional
programs, such as programs serving
different populations or programs
implementing specific interventions.
Data collection for these Plus studies
may include child assessments, parent
surveys, teacher child reports, and staff
surveys. Plus studies may also feature
topical modules to gather information in
greater depth on particular topics (for
example, parent engagement or program
functioning). The methods of data
collection will involve new
methodologies such as qualitative
interviews and supplemental surveys
with expanded content.
The purpose of the Core data
collection is to support the 2007
reauthorization of the Head Start
program (P.L. 110–134), which calls for
periodic assessments of Head Start’s
quality and effectiveness. Plus data
collection will further support
understanding Head Start functioning
for a broader set of programs or in more
depth for particular topics.
Annual Burden Estimates
Respondents: Head Start children,
parents of Head Start children, and
Head Start teachers, directors, and other
early care and education program staff.
Number of
responses per
respondent
Average
burden hour
per response
Estimated
annual burden
hours
tkelley on DSK3SPTVN1PROD with NOTICES
Core Study
Head
Head
Head
Head
Head
Head
Head
Head
Start
Start
Start
Start
Start
Start
Start
Start
core child assessment .......................................
core parent survey ............................................
fall parent supplemental survey ........................
spring parent supplemental survey ...................
core teacher child report ...................................
core teacher survey ...........................................
core program director survey ............................
core center director survey ...............................
2,400
2,400
2,400
2,400
240
720
180
360
800
800
800
800
80
240
60
120
2
2
1
1
20
2
2
2
0.75
0.25
0.08
0.08
0.17
0.50
0.25
0.25
1,200
400
64
64
272
240
30
60
133
100
450
2
2
2
1.00
1.00
0.75
267
200
675
Plus Studies
Head Start parent qualitative interview ................................
Head Start staff qualitative interview ...................................
Head Start child assessment for plus study ........................
VerDate Mar<15>2010
17:47 Feb 27, 2014
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300
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]]>Agencies
[Federal Register Volume 79, Number 40 (Friday, February 28, 2014)]
[Notices]
[Pages 11436-11445]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-04032]
-----------------------------------------------------------------------
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.
-----------------------------------------------------------------------
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 https://www.whitehouse.gov/omb/circulars/a004/a-4.pdf), in the Table 1, we have
prepared an accounting statement showing the classification of the
estimated expenditures associated with the provisions of this notice.
Table 1 provides our best estimate of the change (decrease) in the
federal share of states' Medicaid DSH payments resulting from the
application of the provisions of the Medicaid statute relating to the
calculation of states' FY DSH allotments and the increase in the FY DSH
allotments from FY 2013 to FY 2014.
Table 1--Accounting Statement: Classification of Estimated Expenditures,
From the FY 2013 to FY 2014
[In millions]
------------------------------------------------------------------------
Category Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers $108.
From Whom To Whom?............ Federal Government to States.
------------------------------------------------------------------------
C. Congressional Review Act
This proposed regulation is subject to the Congressional Review Act
provisions of the Small Business Regulatory Enforcement Fairness Act of
1996 (5 U.S.C. 801 et seq.) and has been transmitted to the Congress
and the Comptroller General for review.
In accordance with the provisions of Executive Order 12866, this
notice was reviewed by the Office of Management and Budget.
(Catalog of Federal Domestic Assistance Program No. 93.778, Medical
Assistance Program)
Dated: January 24, 2014.
Marilyn Tavenner,
Administrator, Centers for Medicare & Medicaid Services.
Dated: February 11, 2014.
Kathleen Sebelius,
Secretary.
Department of Health and Human Services.
Key to ADDENDUM 1--Preliminary DSH Allotments for FY 2014.
------------------------------------------------------------------------
Column Description
------------------------------------------------------------------------
The Preliminary FY 2014 DSH Allotments for the NON-Low DSH States are
presented in the top section of this addendum, and the Preliminary FY
2014 DSH Allotments for the Low-DSH States are presented in the bottom
section of this addendum.
------------------------------------------------------------------------
Column A................. State.
Column B................. FY 2014 FMAPs.
This column contains the States' FY 2014
Federal Medical Assistance Percentages.
Column C................. Prior FY (2013) DSH Allotments.
This column contains the States' prior FY
2013 DSH Allotments.
Column D................. Prior FY (2013) DSH Allotments (Col C) x (100
percent + Percentage Increase in CPIU):
101.5 percent.
This column contains the amount in Column C
increased by 1 plus the estimated percentage
increase in the CPI-U for the prior FY
(101.5 percent).
Column E................. FY 2014 TC MAP Exp. Including DSH.
This column contains the amount of the
States' projected FY 2014 total computable
(TC) medical assistance expenditures
including DSH expenditures.
Column F................. FY 2014 TC DSH Expenditures.
This column contains the amount of the
States' projected FY 2014 total computable
DSH expenditures.
Column G................. FY 2014 TC MAP Exp. Net of DSH.
[[Page 11439]]
This column contains the amount of the
States' projected FY 2014 total computable
medical assistance expenditures net of DSH
expenditures, calculated as the amount in
Column E minus the amount in Column F.
Column H................. 12 percent Amount.
This column contains the amount of the ``12
percent limit'' in Federal share, determined
in accordance with the provisions of section
1923(f)(3) of the Act.
Column I................. Greater of FY 2013 Allotment or 12 percent
limit.
This column contains the greater of the
State's prior FY (FY 2013) DSH allotment or
the amount of the 12 percent limit,
determined as the maximum of the amount in
Column C or Column H
Column J................. FY 2014 DSH Allotment.
This column contains the States' preliminary
FY 2014 DSH allotments, determined as the
minimum of the amount in Column I or Column
D.
For states with ``na'' in Columns I or D,
refer to the footnotes in the addendum.
------------------------------------------------------------------------
[[Page 11440]]
Addendum 1--Preliminary DSH Allotments for Fiscal Year 2014
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Prior FY (2013)
DSH allotment
FY 2014 (Col C) x 100% FY 2014 TC MAP FY 2014 TC DSH FY 2014 TC ``12% Amount'' Greater of Col FY 2014 DSH
STATE FMAPs Prior FY (2013) + pct increase Exp. including Expenditures MAPEXP. net of =Col G x .12(1- H or Col C (12% allotment MIN
(percent) DSH allotments in CPIU: DSH \4\ \4\ DSH Col E - F .12/Col B)'' (in Limit, FY 2013 Col I, Col D
----------------- FS) allotment)
101.5%
A B C D E F G H I J
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
ALABAMA............................... 68.12 $323,093,267 $327,939,666 $5,837,507,000 $517,367,000 $5,320,140,000 $774,927,876 $774,927,876 $327,939,666
ARIZONA............................... 67.23 106,384,369 107,980,135 8,763,763,000 156,364,000 8,607,399,000 1,257,306,757 1,257,306,757 107,980,135
CALIFORNIA............................ 50.00 1,151,840,630 1,169,118,239 72,253,198,000 935,479,000 71,317,719,000 11,260,692,474 11,260,692,474 1,169,118,239
COLORADO.............................. 50.00 97,190,657 98,648,517 5,510,334,000 195,772,000 5,314,562,000 839,141,368 839,141,368 98,648,517
CONNECTICUT........................... 50.00 210,141,962 213,294,091 6,585,550,000 228,325,000 6,357,225,000 1,003,772,368 1,003,772,368 213,294,091
DISTRICT OF COLUMBIA.................. 70.00 64,355,975 65,321,315 2,345,594,000 44,744,000 2,300,850,000 333,226,552 333,226,552 65,321,315
FLORIDA............................... 58.79 210,141,962 213,294,091 21,065,753,000 361,462,000 20,704,291,000 3,121,706,180 3,121,706,180 213,294,091
GEORGIA............................... 65.93 282,378,262 286,613,936 8,929,625,000 435,776,000 8,493,849,000 1,246,058,516 1,246,058,516 286,613,936
ILLINOIS.............................. 50.00 225,902,609 229,291,148 16,174,722,000 428,796,000 15,745,926,000 2,486,198,842 2,486,198,842 229,291,148
INDIANA............................... 66.92 224,589,223 227,958,061 8,960,665,000 0 8,960,665,000 1,310,228,045 1,310,228,045 227,958,061
KANSAS................................ 56.91 43,341,780 43,991,907 2,825,757,000 74,228,000 2,751,529,000 418,408,859 418,408,859 43,991,907
KENTUCKY.............................. 69.83 152,352,923 154,638,217 6,276,300,000 152,353,000 6,123,947,000 887,363,415 887,363,415 154,638,217
LOUISIANA \1\......................... na na na na na na na na 731,960,000
MAINE................................. 61.55 110,324,530 111,979,398 2,491,965,000 37,000,000 2,454,965,000 365,940,898 365,940,898 111,979,398
MARYLAND.............................. 50.00 80,116,623 81,318,372 8,676,095,000 85,128,000 8,590,967,000 1,356,468,474 1,356,468,474 81,318,372
MASSACHUSETTS......................... 50.00 320,466,492 325,273,489 14,210,660,000 0 14,210,660,000 2,243,788,421 2,243,788,421 325,273,489
MICHIGAN.............................. 66.32 278,438,100 282,614,672 13,523,842,000 364,144,000 13,159,698,000 1,928,021,733 1,928,021,733 282,614,672
MISSISSIPPI........................... 73.05 160,233,246 162,636,745 5,094,327,000 321,190,000 4,773,137,000 685,361,490 685,361,490 162,636,745
MISSOURI.............................. 62.03 497,773,773 505,240,380 9,279,932,000 684,657,000 8,595,275,000 1,278,828,483 1,278,828,483 505,240,380
NEVADA................................ 63.10 48,595,328 49,324,258 2,092,603,000 77,014,000 2,015,589,000 298,670,057 298,670,057 49,324,258
NEW HAMPSHIRE......................... 50.00 168,217,088 170,740,344 1,340,075,000 124,810,000 1,215,265,000 191,883,947 191,883,947 170,740,344
NEW JERSEY............................ 50.00 676,394,441 686,540,358 13,682,358,000 1,207,107,000 12,475,251,000 1,969,776,474 1,969,776,474 686,540,358
NEW YORK.............................. 50.00 1,687,702,633 1,713,018,172 67,240,475,000 3,373,800,000 63,866,675,000 10,084,211,842 10,084,211,842 1,713,018,172
NORTH CAROLINA........................ 65.78 309,959,394 314,608,785 13,134,561,000 478,361,000 12,656,200,000 1,857,623,286 1,857,623,286 314,608,785
OHIO.................................. 63.02 426,850,861 433,253,624 19,534,779,000 0 19,534,779,000 2,895,527,493 2,895,527,493 433,253,624
PENNSYLVANIA.......................... 53.52 589,710,881 598,556,544 21,451,173,000 732,037,000 20,719,136,000 3,204,879,071 3,204,879,071 598,556,544
RHODE ISLAND.......................... 50.11 68,296,138 69,320,580 2,302,742,000 137,098,000 2,165,644,000 341,706,914 341,706,914 69,320,580
SOUTH CAROLINA........................ 70.57 344,107,463 349,269,075 5,582,305,000 474,540,000 5,107,765,000 738,511,134 738,511,134 349,269,075
TENNESSEE \2\......................... 65.29 na na na na na na na 0
TEXAS................................. 58.69 1,004,741,257 1,019,812,376 37,675,429,000 2,991,551,000 34,683,878,000 5,231,775,883 5,231,775,883 1,019,812,376
VERMONT\5\............................ 56.76 23,640,971 23,995,586 1,536,190,000 37,449,000 1,498,741,000 228,065,789 228,065,789 23,995,586
VIRGINIA.............................. 50.00 92,050,138 93,430,890 8,287,311,000 243,321,000 8,043,990,000 1,270,103,684 1,270,103,684 93,430,890
WASHINGTON............................ 50.00 194,381,315 197,297,035 7,949,059,000 456,511,000 7,492,548,000 1,183,033,895 1,183,033,895 197,297,035
WEST VIRGINIA......................... 71.09 70,922,912 71,986,756 3,534,234,000 70,185,000 3,464,049,000 500,103,388 500,103,388 71,986,756
---------------------------------------------------------------------------------------------------------------------------------------------------------
TOTAL............................. .......... 10,244,637,203 10,398,306,761 424,148,883,000 15,426,569,000 408,722,314,000 62,783,822,812 62,783,822,812 11,130,266,762
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
LOW DSH STATES
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
ALASKA................................ 50.00 21,402,636 21,723,676 1,583,467,000 20,638,000 1,562,829,000 246,762,473.68 246,762,474 21,723,676
ARKANSAS.............................. 70.10 45,325,292 46,005,171 4,549,145,000 43,820,000 4,505,325,000 652,302,821 652,302,821 46,005,171
DELAWARE.............................. 55.31 9,512,282 9,654,966 1,620,151,000 16,804,000 1,603,347,000 245,710,799 245,710,799 9,654,966
HAWAII \3\............................ 51.85 10,240,000 10,393,600 1,940,694,000 0 1,940,694,000 303,011,243.86 303,011,244 10,393,600
IDAHO................................. 71.64 17,271,044 17,530,110 1,867,605,000 23,451,000 1,844,154,000 265,825,337.14 265,825,337 17,530,110
IOWA.................................. 57.93 41,378,149 41,998,821 3,852,612,000 53,536,000 3,799,076,000 574,997,969 574,997,969 41,998,821
MINNESOTA............................. 50.00 78,476,334 79,653,479 10,571,446,000 154,792,000 10,416,654,000 1,644,734,842 1,644,734,842 79,653,479
MONTANA............................... 66.33 11,926,371 12,105,267 1,078,653,000 18,023,000 1,060,630,000 155,387,273 155,387,273 12,105,267
NEBRASKA.............................. 54.74 29,733,219 30,179,217 2,060,181,000 41,391,000 2,018,790,000 310,272,058 310,272,058 30,179,217
NEW MEXICO............................ 69.20 21,402,636 21,723,676 3,598,324,000 21,380,000 3,576,944,000 519,282,220 519,282,220 21,723,676
NORTH DAKOTA.......................... 50.00 10,036,360 10,186,905 844,103,000 1,600,000 842,503,000 133,026,789 133,026,789 10,186,905
OKLAHOMA.............................. 64.02 38,049,129 38,619,866 5,219,568,000 58,140,000 5,161,428,000 762,248,260 762,248,260 38,619,866
OREGON................................ 63.14 47,561,414 48,274,835 6,163,918,000 71,176,000 6,092,742,000 902,688,455 902,688,455 48,274,835
SOUTH DAKOTA.......................... 53.54 11,604,719 11,778,790 843,570,000 1,476,000 842,094,000 130,242,791 130,242,791 11,778,790
UTAH.................................. 70.34 20,612,808 20,922,000 2,089,446,000 29,583,000 2,059,863,000 298,026,939 298,026,939 20,922,000
WISCONSIN............................. 59.06 99,326,563 100,816,461 7,532,985,000 159,936,000 7,373,049,000 1,110,375,539 1,110,375,539 100,816,461
[[Page 11441]]
WYOMING............................... 50.00 237,807 241,374 568,307,000 463,000 567,844,000 89,659,579 89,659,579 241,374
---------------------------------------------------------------------------------------------------------------------------------------------------------
TOTAL LOW DSH STATES.............. .......... 514,096,763 521,808,214 55,984,175,000 716,209,000 55,267,966,000 8,344,555,389 8,344,555,389 521,808,214
---------------------------------------------------------------------------------------------------------------------------------------------------------
TOTAL......................... .......... 10,758,733,966 10,920,114,975 480,133,058,000 16,142,778,000 463,990,280,000 71,128,378,201 71,128,378,201 11,652,074,976
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Louisiana's FY 2014 DSH allotment is determined under the provisions of section 1923(f)(3)(C) and (D) of the Act.
\2\ Tennessee's DSH allotment for FY 2014, determined under section 1923(f)(6)(A) of the Act, is 0.
\3\ Begining FY 2013, under section 1923(f)(6)(B)(II) of the Act, Hawaii's DSH allotment for a fiscal year is determined as for low-DSH states. This means Hawaii's DSH alloment for a fiscal
year is determined as for all States, by increasing the previous fiscal year allotment by the percentage increase in the CPIU for the previous fiscal year.
\4\ Expenditures based on the amounts reported by States on the Form CMS-37.
\5\ FMAP for Vermont for FY 2014 determined in accordance with section 1905(z)(1)(A) of the Act.
[[Page 11442]]
Key to ADDENDUM 2--Preliminary IMD DSH Limits for FY 2014
------------------------------------------------------------------------
Column Description
------------------------------------------------------------------------
The preliminary FY 2014 IMD DSH Limits for the Non-Low DSH States are
presented in the top section of this addendum and the preliminary FY
2014 IMD DSH Limits for the Low-DSH States are presented in the bottom
section of the addendum.
------------------------------------------------------------------------
Column A................. State.
Column B................. Inpatient Hospital Services FY 95 DSH Total
Computable.
This column contains the States' total
computable FY 1995 inpatient hospital DSH
expenditures as reported on the Form CMS-64.
Column C................. IMD and Mental Health Services FY 95 DSH
Total.
Computable. This column contains the total
computable FY 1995 mental health facility
DSH expenditures as reported on the Form CMS-
64 as of January 1, 1997.
Column D................. Total Inpatient Hospital & IMD & Mental
Health FY 95 DSH Total.
Computable, Col. B + C. This column contains
the total computation of all inpatient
hospital DSH expenditures and mental health
facility DSH expenditures for FY 1995 as
reported on the Form CMS-64 as of January 1,
1997 (representing the sum of Column B and
Column C).
Column E................. Applicable Percentage, Col. C/D.
This column contains the ``applicable
percentage'' representing the total
Computable FY 1995 mental health facility
DSH expenditures divided by total computable
all inpatient hospital and mental health
facility DSH expenditures for FY 1995 (the
amount in Column C divided by the amount in
Column D) Per section 1923(h)(2)(A)(ii)(III)
of the Act, for FYs after FY 2002, the
applicable percentage can be no greater than
33 percent.
Column F................. FY 2014 Federal Share DSH Allotment.
This column contains the states' preliminary
FY 2014 DSH allotments from Column J
Addendum 1.
Column G................. FY 2014 FMAP.
Column H................. FY 2014 DSH Allotments in Total Computable,
Col. F/G.
This column contains states' FY 2014 total
computable DSH allotment (determined as
Column F/Column G).
Column I................. Applicable Percentage Applied to FY 2014
Allotments in TC, Col E x Col H.
This column contains the applicable
percentage of FY 2013 total computable DSH
allotment (calculated as the percentage in
Column E multiplied by the amount in Column
H).
Column J................. FY 2014 TC IMD DSH Limit. Lesser of Col.
I or C. This column contains the total
computable FY 2014 TC IMD DSH Limit equal to
the lesser of the amount in Column I or
Column C.
Column K................. FY 2014 IMD DSH Limit in Federal Share, Col.
G x J.
This column contains the FY 2014 Federal
Share IMD DSH limit determined by converting
the total computable FY 2014 IMD DSH Limit
from Column J into a federal share amount by
multiplying it by the FY 2014 FMAP in Column
G.
------------------------------------------------------------------------
[[Page 11443]]
Addendum 2--Preliminary IMD DSH Limit for Fiscal Year 2014
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Applicable
IMD and Total inpatient & percentage
Inpatient mental health IMD & mental Applicable FY 2014 FY 2014 applied to FY FY 2014 TC IMD FY 2014 IMD
State hospital services services FY 95 health FY 95 DSH percent FY 2014 FMAPs allotments in 2014 limit (lesser limit in FS
FY 95 DSH total DSH total total computable col C/D allotment in FS (percent) TC col F/G allotments iin of col I or Col col G x J
computable computable col B + C TC col E x C)
Col H
A B C D E F G H I J K
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
ALABAMA....................... $413,006,229 $4,451,770 $417,457,999 1.07 $327,939,666 68.12 $481,414,659 $5,133,804 $4,451,770 $3,032,546
ARIZONA....................... 93,916,100 28,474,900 122,391,000 23.27 107,980,135 67.23 160,613,022 37,367,451 28,474,900 19,143,675
CALIFORNIA.................... 2,189,879,543 1,555,919 2,191,435,462 0.07 1,169,118,239 50.00 2,338,236,478 1,660,148 1,555,919 777,960
COLORADO...................... 173,900,441 594,776 174,495,217 0.34 98,648,517 50.00 197,297,034 672,497 594,776 297,388
CONNECTICUT................... 303,359,275 105,573,725 408,933,000 25.82 213,294,091 50.00 426,588,182 110,131,741 105,573,725 52,786,863
DISTRICT OF COLUMBIA.......... 39,532,234 6,545,136 46,077,370 14.20 65,321,315 70.00 93,316,164 13,255,248 6,545,136 4,581,595
FLORIDA....................... 184,468,014 149,714,986 334,183,000 33.00 213,294,091 58.79 362,806,755 119,726,229 119,726,229 70,387,050
GEORGIA....................... 407,343,557 0 407,343,557 0.00 286,613,936 65.93 434,724,611 0 0 0
ILLINOIS...................... 315,868,508 89,408,276 405,276,784 22.06 229,291,148 50.00 458,582,296 101,168,027 89,408,276 44,704,138
INDIANA....................... 79,960,783 153,566,302 233,527,085 33.00 227,958,061 66.92 340,642,649 112,412,074 112,412,074 75,226,160
KANSAS........................ 11,587,208 76,663,508 88,250,716 33.00 43,991,907 56.91 77,300,838 25,509,277 25,509,277 14,517,329
KENTUCKY...................... 158,804,908 37,443,073 196,247,981 19.08 154,638,217 69.83 221,449,545 42,251,398 37,443,073 26,146,498
LOUISIANA..................... 1,078,512,169 132,917,149 1,211,429,318 10.97 731,960,000 60.98 1,200,327,976 131,699,118 131,699,118 80,310,122
MAINE......................... 99,957,958 60,958,342 160,916,300 33.00 111,979,398 61.55 181,932,409 60,037,695 60,037,695 36,953,201
MARYLAND...................... 22,226,467 120,873,531 143,099,998 33.00 81,318,372 50.00 162,636,744 53,670,126 53,670,126 26,835,063
MASSACHUSETTS................. 469,653,946 105,635,054 575,289,000 18.36 325,273,489 50.00 650,546,978 119,453,988 105,635,054 52,817,527
MICHIGAN...................... 133,258,800 304,765,552 438,024,352 33.00 282,614,672 66.32 426,137,925 140,625,515 140,625,515 93,262,842
MISSISSIPPI................... 182,608,033 0 182,608,033 0.00 162,636,745 73.05 222,637,570 0 0 0
MISSOURI...................... 521,946,524 207,234,618 729,181,142 28.42 505,240,380 62.03 814,509,721 231,485,157 207,234,618 128,547,634
NEVADA........................ 73,560,000 0 73,560,000 0.00 49,324,258 63.10 78,168,396 0 0 0
NEW HAMPSHIRE................. 92,675,916 94,753,948 187,429,864 33.00 170,740,344 50.00 341,480,688 112,688,627 94,753,948 47,376,974
NEW JERSEY.................... 736,742,539 357,370,461 1,094,113,000 32.66 686,540,358 50.00 1,373,080,716 448,489,771 357,370,461 178,685,231
NEW YORK...................... 2,418,869,368 605,000,000 3,023,869,368 20.01 1,713,018,172 50.00 3,426,036,344 685,463,469 605,000,000 302,500,000
NORTH CAROLINA................ 193,201,966 236,072,627 429,274,593 33.00 314,608,785 65.78 478,274,225 157,830,494 157,830,494 103,820,899
OHIO.......................... 535,731,956 93,432,758 629,164,714 14.85 433,253,624 63.02 687,485,916 102,093,623 93,432,758 58,881,324
PENNSYLVANIA.................. 388,207,319 579,199,682 967,407,001 33.00 598,556,544 53.52 1,118,379,193 369,065,134 369,065,134 197,523,660
RHODE ISLAND.................. 108,503,167 2,397,833 110,901,000 2.16 69,320,580 50.11 138,336,819 2,991,033 2,397,833 1,201,554
SOUTH CAROLINA................ 366,681,364 72,076,341 438,757,705 16.43 349,269,075 70.57 494,925,712 81,303,266 72,076,341 50,864,274
TENNESSEE *................... 0 0 0 0.00 0 65.29 0 0 0 0
TEXAS......................... 1,220,515,401 292,513,592 1,513,028,993 19.33 1,019,812,376 58.69 1,737,625,449 335,934,780 292,513,592 171,676,227
VERMONT **.................... 19,979,252 9,071,297 29,050,549 31.23 23,995,586 56.76 42,275,521 13,200,914 9,071,297 5,148,868
VIRGINIA...................... 129,313,480 7,770,268 137,083,748 5.67 93,430,890 50.00 186,861,780 10,591,818 7,770,268 3,885,134
WASHINGTON.................... 171,725,815 163,836,435 335,562,250 33.00 197,297,035 50.00 394,594,070 130,216,043 130,216,043 65,108,022
WEST VIRGINIA................. 66,962,606 18,887,045 85,849,651 22.00 71,986,756 71.09 101,261,438 22,277,660 18,887,045 13,426,800
-----------------------------------------------------------------------------------------------------------------------------------------------------------------
TOTAL..................... 13,402,460,846 4,118,758,904 17,521,219,750 .......... 11,130,266,762 .......... 19,837,936,852 3,778,134,755 3,440,982,495 1,930,546,450
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
LOW DSH STATES
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
ALASKA........................ 2,506,827 17,611,765 20,118,592 33.00 21,723,676 50.00 43,447,352 14,337,626 14,337,626 7,168,813
ARKANSAS...................... 2,422,649 819,351 3,242,000 25.27 46,005,171 70.10 65,627,919 16,586,151 819,351 574,365
DELAWARE...................... 0 7,069,000 7,069,000 33.00 9,654,966 55.31 17,456,095 5,760,511 5,760,511 3,186,139
HAWAII........................ 0 0 0 0.00 10,393,600 51.85 20,045,516 0 0 0
IDAHO......................... 2,081,429 0 2,081,429 0.00 17,530,110 71.64 24,469,724 0 0 0
IOWA.......................... 12,011,250 0 12,011,250 0.00 41,998,821 57.93 72,499,259 0 0 0
MINNESOTA..................... 24,240,000 5,257,214 29,497,214 17.82 79,653,479 50.00 159,306,958 28,392,877 5,257,214 2,628,607
MONTANA....................... 237,048 0 237,048 0.00 12,105,267 66.33 18,250,063 0 0 0
NEBRASKA...................... 6,449,102 1,811,337 8,260,439 21.93 30,179,217 54.74 55,131,927 12,089,248 1,811,337 991,526
NEW MEXICO.................... 6,490,015 254,786 6,744,801 3.78 21,723,676 69.20 31,392,595 1,185,861 254,786 176,312
NORTH DAKOTA.................. 214,523 988,478 1,203,001 33.00 10,186,905 50.00 20,373,810 6,723,357 988,478 494,239
OKLAHOMA...................... 20,019,969 3,273,248 23,293,217 14.05 38,619,866 64.02 60,324,689 8,477,046 3,273,248 2,095,533
OREGON........................ 11,437,908 19,975,092 31,413,000 33.00 48,274,835 63.14 76,456,818 25,230,750 19,975,092 12,612,273
SOUTH DAKOTA.................. 321,120 751,299 1,072,419 33.00 11,778,790 53.54 21,999,981 7,259,994 751,299 402,245
UTAH.......................... 3,621,116 934,586 4,555,702 20.51 20,922,000 70.34 29,744,100 6,101,896 934,586 657,388
WISCONSIN..................... 6,609,524 4,492,011 11,101,535 33.00 100,816,461 59.06 170,701,763 56,331,582 4,492,011 2,652,982
[[Page 11444]]
WYOMING....................... 0 0 0 0.00 241,374 50.00 482,748 0 0 0
-----------------------------------------------------------------------------------------------------------------------------------------------------------------
TOTAL LOW DSH STATES...... 98,662,480 63,238,167 161,900,647 .......... 521,808,214 .......... 887,711,318 188,476,899 58,655,539 33,640,422
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
TOTAL................. 13,501,123,326 4,181,997,071 17,683,120,397 .......... 11,652,074,976 .......... 20,724,648,170 3,966,611,654 3,499,638,034 1,964,186,872
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
FOOTNOTES:
* Tennessee's DSH allotment for FY 2014, determined under section 1923(f)(6)(A) of the Act, is $0.
** Vermont's FMAP for FY 2014 determined in accordance with section 1905(z)(1)(A) of the Act.
[[Page 11445]]
[FR Doc. 2014-04032 Filed 2-27-14; 8:45 am]
BILLING CODE 4120-01-P
