Medicaid Program; Final FY 2016 and Preliminary FY 2018 Disproportionate Share Hospital Allotments, and Final FY 2016 and Preliminary FY 2018 Institutions for Mental Diseases Disproportionate Share Hospital Limits, 31536-31555 [2018-14533]
Download as PDF
<![CDATA[
31536
Federal Register / Vol. 83, No. 130 / Friday, July 6, 2018 / Notices
FEDERAL COMMUNICATIONS
COMMISSION
[GN Docket No. 17–83]
Meeting of the Broadband Deployment
Advisory Committee
Federal Communications
Commission.
ACTION: Notice.
AGENCY:
In this document, the
Commission announces and provides an
agenda for the next meeting of
Broadband Deployment Advisory
Committee (BDAC).
DATES: Thursday, July 26, 2018 and
Friday, July 27, 2018. The meeting will
come to order at 9:00 a.m. each day.
ADDRESSES: Federal Communications
Commission, 445 12th Street SW, Room
TW–C305, Washington, DC 20554.
FOR FURTHER INFORMATION CONTACT: Paul
D’Ari, Designated Federal Authority
(DFO) of the BDAC, at paul.dari@fcc.gov
or 202–418–1550; Jiaming Shang,
Deputy DFO of the BDAC, at
jiaming.shang@fcc.gov or 202–418–
1303; or Deborah Salons, Deputy DFO of
the BDAC, at deborah.salons@fcc.gov or
202–418–0637. The TTY number is:
(202) 418–0484.
SUPPLEMENTARY INFORMATION: This
meeting is open to members of the
general public. The FCC will
accommodate as many participants as
possible; however, admittance will be
limited to seating availability. The
Commission will also provide audio
and/or video coverage of the meeting
over the internet from the FCC’s web
page at www.fcc.gov/live. Oral
statements at the meeting by parties or
entities not represented on the BDAC
will be permitted to the extent time
permits, at the discretion of the BDAC
Chair and the DFO. Members of the
public may submit comments to the
BDAC in the FCC’s Electronic Comment
Filing System, ECFS, at www.fcc.gov/
ecfs. Comments to the BDAC should be
filed in Docket 17–83.
Open captioning will be provided for
this event. Other reasonable
accommodations for people with
disabilities are available upon request.
Requests for such accommodations
should be submitted via email to
fcc504@fcc.gov or by calling the
Consumer & Governmental Affairs
Bureau at (202) 418–0530 (voice), (202)
418–0432 (TTY). Such requests should
include a detailed description of the
accommodation needed. In addition,
please include a way for the FCC to
contact the requester if more
information is needed to fill the request.
Please allow at least five days’ advance
daltland on DSKBBV9HB2PROD with NOTICES
SUMMARY:
VerDate Sep<11>2014
18:25 Jul 05, 2018
Jkt 244001
notice; last minute requests will be
accepted but may not be possible to
accommodate.
Proposed Agenda: At this meeting,
the BDAC will consider and vote on
reports and recommendations from its
Harmonization Working Group to
harmonize the Model Code for
Municipalities and Model Code for
States adopted by the BDAC on April
25, 2018. In addition, the Ad Hoc
Committee for Rates and Fees will give
a presentation. The BDAC will also
discuss its next steps. This agenda may
be modified at the discretion of the
BDAC Chair and the DFO.
Federal Communications Commission.
Daniel Kahn,
Chief, Competition Policy Division, Wireline
Competition Bureau.
[FR Doc. 2018–14494 Filed 7–5–18; 8:45 am]
BILLING CODE 6712–01–P
Georgia 30341, Telephone: (770) 488–6511,
kva5@cdc.gov.
The Director, Management Analysis and
Services Office, has been delegated the
authority to sign Federal Register notices
pertaining to announcements of meetings and
other committee management activities, for
both the Centers for Disease Control and
Prevention and the Agency for Toxic
Substances and Disease Registry.
Elaine Baker
Director, Management Analysis and Services
Office, Centers for Disease Control and
Prevention.
[FR Doc. 2018–14492 Filed 7–5–18; 8:45 am]
BILLING CODE 4163–18–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–2414–N]
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Disease Control and
Prevention
Notice of Closed Meeting
Pursuant to section 10(d) of the
Federal Advisory Committee Act, as
amended, notice is hereby given of the
following meeting.
The meeting will be closed to the
public in accordance with the
provisions set forth in sections
552b(c)(4) and 552b(c)(6), Title 5 U.S.C.,
as amended, and the Determination of
the Director, Management Analysis and
Services Office, CDC, pursuant to Public
Law 92–463. The grant applications and
the discussions could disclose
confidential trade secrets or commercial
property such as patentable material,
and personal information concerning
individuals associated with the grant
applications, the disclosure of which
would constitute a clearly unwarranted
invasion of personal privacy.
Name of Committee: Disease, Disability,
and Injury Prevention and Control Special
Emphasis Panel (SEP)—DP19–001, Health
Promotion and Disease Prevention Research
Centers.
Dates: August 26–30, 2018.
Times: August 26, 2018, 4:00 p.m.–7:00
p.m., EDT and August 27–30, 2018, 8:30
a.m.–6:30 p.m., EDT.
Place: Centers for Disease Control and
Prevention, 1600 Clifton Road NE, Global
Communications Center, Auditorium B,
Atlanta, Georgia 30333.
Agenda: To review and evaluate grant
applications.
For Further Information Contact: Jaya
Raman Ph.D., Scientific Review Officer, CDC,
4770 Buford Highway, Mailstop F80, Atlanta,
PO 00000
Frm 00011
Fmt 4703
Sfmt 4703
RIN 0938–ZB48
Medicaid Program; Final FY 2016 and
Preliminary FY 2018 Disproportionate
Share Hospital Allotments, and Final
FY 2016 and Preliminary FY 2018
Institutions for Mental Diseases
Disproportionate Share Hospital Limits
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice.
AGENCY:
This notice announces the
final federal share disproportionate
share hospital (DSH) allotments for
federal fiscal year (FY) 2016 and the
preliminary federal share DSH
allotments for FY 2018. This notice also
announces the final FY 2016 and the
preliminary FY 2018 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 applicable August
6, 2018. 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:
SUMMARY:
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
E:\FR\FM\06JYN1.SGM
06JYN1
Federal Register / Vol. 83, No. 130 / Friday, July 6, 2018 / Notices
daltland on DSKBBV9HB2PROD with NOTICES
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) of the Act 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 2016 and FY
2018 under section 1923(f)(7) of the Act,
as amended, this notice contains only
the state-specific final FY 2016 DSH
allotments and preliminary FY 2018
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 2016 IMD DSH limits and
preliminary FY 2018 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
VerDate Sep<11>2014
18:25 Jul 05, 2018
Jkt 244001
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
PO 00000
Frm 00012
Fmt 4703
Sfmt 4703
31537
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 2016
Federal Share State DSH Allotments,
and the Preliminary FY 2018 Federal
Share State DSH Allotments
1. Final FY 2016 Federal Share State
DSH Allotments
Addendum 1 to this notice provides
the states’ final FY 2016 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 2016
DSH allotments, the preceding final
fiscal year DSH allotments (for FY 2015)
were published in the November 3, 2017
Federal Register (82 FR 51259). For
purposes of calculating the states’ final
FY 2016 DSH allotments we are using
the actual Medicaid expenditures for FY
2016. Finally, for purposes of
calculating the states’ final FY 2016
DSH allotments, the applicable
historical percentage change in the CPI–
U for the previous FY (FY 2015) was 0.3
percent; we note that this is the same as
the estimated 0.3 percentage change in
the CPI–U for FY 2015 that was
available and used in the calculation of
the preliminary FY 2016 DSH
allotments which were published in the
October 26, 2016 Federal Register (81
FR 74432).
2. Calculation of the Preliminary FY
2018 Federal Share State DSH
Allotments
Addendum 2 to this notice provides
the preliminary FY 2018 DSH
allotments determined in accordance
with section 1923(f)(3) of the Act. The
preliminary FY 2018 DSH allotments
contained in this notice were
determined based on the most recent
available estimates from states of their
FY 2018 total computable Medicaid
expenditures. Also, the preliminary FY
2018 allotments contained in this notice
were determined by increasing the
preliminary FY 2017 DSH allotments.
The estimated percentage increase in
the CPI–U for FY 2017 was 2.4 percent
(CMS originally published the
preliminary FY 2017 DSH allotments in
the November 3, 2017 Federal Register
(82 FR 51259)).
E:\FR\FM\06JYN1.SGM
06JYN1
31538
Federal Register / Vol. 83, No. 130 / Friday, July 6, 2018 / Notices
We will publish states’ final FY 2018
DSH allotments in a future notice based
on the states’ four quarterly Medicaid
expenditure reports (Form CMS–64) for
FY 2018 available following the end of
FY 2018 utilizing the actual change in
the CPI–U for FY 2017.
B. Calculation of the Final FY 2016 and
Preliminary FY 2018 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
2016 and the preliminary FY 2018 IMD
DSH limits determined in accordance
with the provisions discussed above.
Addendums 3 and 4 to this notice
detail each state’s final FY 2016 and
preliminary FY 2018 IMD DSH limit,
respectively, determined in accordance
with section 1923(h) of the Act.
daltland on DSKBBV9HB2PROD with NOTICES
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
VerDate Sep<11>2014
18:25 Jul 05, 2018
Jkt 244001
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 2016 DSH allotments
being published in this notice are
approximately $11 million more than
the preliminary FY 2016 DSH
allotments published in the October 26,
2016 Federal Register (81 FR 74432).
The increase in the final FY 2016 DSH
allotments is a result of being calculated
by multiplying the actual increase in the
CPI–U for 2015 by the final FY 2015
DSH allotments, while the preliminary
FY 2016 DSH allotments were
calculated by multiplying the estimated
CPI–U for 2015 by the preliminary FY
2015 DSH allotments. Although the
estimated and actual increase in the
CPI–U remained the same at 0.3 percent,
the preliminary FY 2015 DSH
allotments were lower than the final FY
2015 DSH allotments and therefore the
final FY 2016 DSH allotments are higher
than the preliminary FY 2016 DSH
allotments. The final FY 2016 IMD DSH
limits being published in this notice are
approximately $14 million more than
the preliminary FY 2016 IMD DSH
limits published in the October 26, 2016
Federal Register (81 FR 74432). 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 final FY
2016 DSH allotments were increased as
compared to the preliminary FY 2016
DSH allotments, the associated FY 2016
IMD DSH limits for some states were
also increased.
The preliminary FY 2018 DSH
allotments being published in this
notice have been increased by
approximately $288 million more than
the preliminary FY 2017 DSH
allotments published in the November
3, 2017 Federal Register (82 FR 51259).
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
2018 IMD DSH limits being published
in this notice are approximately $24
million more than the preliminary FY
2017 IMD DSH limits published in the
November 3, 2017 Federal Register (82
FR 51259). The increases in the IMD
PO 00000
Frm 00013
Fmt 4703
Sfmt 4703
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 2018
DSH allotments are greater than the
preliminary FY 2017 DSH allotments,
the associated preliminary FY 2018 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 $7.0 million to $34.5
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
E:\FR\FM\06JYN1.SGM
06JYN1
31539
Federal Register / Vol. 83, No. 130 / Friday, July 6, 2018 / Notices
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.
TABLE 1—ACCOUNTING STATEMENT:
CLASSIFICATION OF ESTIMATED EXPENDITURES, FROM THE FY 2017 TO
FY 2018
A. Alternatives Considered
[In millions]
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 https://
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 2017 to FY 2018.
Category
Annualized Monetized
Transfers.
From Whom To
Whom?
Transfers
$288.
Federal Government
to States.
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: May 30, 2018.
Seema Verma,
Administrator, Centers for Medicare &
Medicaid Services.
Dated June 28, 2018.
Alex M. Azar II,
Secretary, Department of Health and Human
Services.
KEY TO ADDENDUM 1—FINAL DSH ALLOTMENTS FOR FY 2015
The Final FY 2016 DSH Allotments for the NON-Low DSH States are presented in the top section of this addendum, and the Final FY 2016
DSH Allotments for the Low-DSH States are presented in the bottom section of this addendum.
Column
Column
Column
Column
Column
A
B
C
D
Description
..........
..........
.........
.........
Column E ..........
Column F ..........
Column G .........
Column H .........
Column I ...........
daltland on DSKBBV9HB2PROD with NOTICES
Column J ..........
VerDate Sep<11>2014
State.
FY 2016 FMAPs. This column contains the States’ FY 2016 Federal Medical Assistance Percentages.
Prior FY (2015) DSH Allotments. This column contains the States’ prior FY 2015 DSH Allotments.
Prior FY (2015) DSH Allotments (Col C) × (100 percent + Percentage Increase in CPIU): 100.3 percent. This column contains
the amount in Column C increased by 1 plus the percentage increase in the CPI–U for the prior FY (100.3 percent).
FY 2016 TC MAP Exp. Including DSH. This column contains the amount of the States’ FY 2016 total computable (TC) medical assistance expenditures including DSH expenditures.
FY 2016 TC DSH Expenditures. This column contains the amount of the States’ FY 2016 total computable DSH expenditures.
FY 2016 TC MAP Exp. Net of DSH. This column contains the amount of the States’ FY 2016 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 2015 Allotment or 12 percent Limit. This column contains the greater of the State’s prior FY (FY 2015) DSH allotment or the amount of the 12 percent Limit, determined as the maximum of the amount in Column C or Column H.
FY 2016 DSH Allotment. This column contains the States’ final FY 2016 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.
19:39 Jul 05, 2018
Jkt 244001
PO 00000
Frm 00014
Fmt 4703
Sfmt 4725
E:\FR\FM\06JYN1.SGM
06JYN1
daltland on DSKBBV9HB2PROD with NOTICES
31540
VerDate Sep<11>2014
STATE
Jkt 244001
ALABAMA
FY 2016
FMAPs
(percent)
Prior FY (20 15)
DSH
allotments
69.87
$333,514,963
Prior FY (2015)
DSH allotment
(Col C) x 100%
+
Pet Increase in
CPIU:
100.3%
$334,515,508
FY 2016 TC MAP
Exp. including
DSH
$5,435,036,771
FY 2016
TC DSH
expenditures
$478,107,126
FY 2016
TC MAP EXP.
net OfDSH
ColE- F
$4,956,929,645
"12% Amount" =
Col Gx
.12/(1-.12/Col B)'
(In FS)
Greater of
Col H Or Col C
(12% Limit, 2015
allotment)
FY2016 DSH
allotment
MIN Coli, ColD
$718,176,619
$718,176,619
$334,515,508
PO 00000
Frm 00015
Fmt 4703
ARIZONA
68.92
109,815,903
110,145,351
11,118,985,133
189,441,573
10,929,543,560
1,588,048,086
1,588,048,086
110,145,351
CALIFORNIA
50.00
1,188,994,401
1,192,561,384
83,175,819,924
2,294,310,296
80,881,509,628
12,770,764,678
12,770,764,678
1,192,561,384
COLORADO
50.72
100,325,639
100,626,616
7,885,768,808
191,712,503
7,694,056,305
1,209,429,346
1,209,429,346
100,626,616
CONNECTICUT
50.00
216,920,301
217,571,062
7,344,137,284
199,756,136
7,144,381,148
1,128,060,181
1,128,060,181
217,571,062
DISTRICT OF
COLUMBIA
FLORIDA
70.00
66,431,842
66,631,138
2,761,584,285
39,648,028
2,721,936,257
394,211 ,458
394,211 ,458
66,631,138
60.67
216,920,301
217,571,062
21,689,957,388
357,672,706
21,332,284,682
3,191,032,780
3,191,032,780
217,571,062
Sfmt 4725
E:\FR\FM\06JYN1.SGM
GEORGIA
67.55
291,486,655
292,361,115
9,723,814,007
432,380,982
9,291,433,025
1,355,829,993
1,355,829,993
292,361,115
ILLINOIS
50.89
233,189,324
233,888,892
19,178,940,763
470,855,203
18,708,085,560
2,937,684,158
2,937,684,158
233,888,892
INDIANA
66.60
231,833,5 73
232,529,074
10,371,904,061
351,344,249
10,020,559,812
1,466,745,678
1,466,745,678
232,529,074
KANSAS
55.96
44,739,812
44,874,031
3,252,725,194
66,439,556
3,186,285,638
486,727,600
486,727,600
44,874,031
KENTUCKY
70.32
157,267,219
157,739,021
9,609,364,927
226,104,508
9,383,260,419
1,357,676,693
1,357,676,693
157,739,021
LOUISIANA
62.21
743,671,360
745,902,374
8,536,666,882
1,283,724,677
7,252,942,205
1 ,078,364,154
1,078,364,154
745,902,374
MAINE
62.67
113,883,158
114,224,807
2,490,164,925
42,332,641
2,447,832,284
363,305,268
363,305,268
114,224,807
06JYN1
MARYLAND
50.00
82,700,865
82,948,968
10,398,319,397
119,001,246
10,279,318,151
1,623,050,234
1,623,050,234
82,948,968
MASSACHUSE
TTS
MICHIGAN
50.00
330,803,459
331,795,869
16,990,908,511
0
16,990,908,511
2,682,775,028
2,682,775,028
331 '795,869
65.60
287,419,400
288,281,658
16,714,754,874
415,106,163
16,299,648,711
2,393,858,855
2,393,858,855
288,281,658
MISSISSIPPI
74.17
165,401,730
165,897,935
5,397,714,759
223,355,122
5,174,359,637
740,773,211
740,773,211
165,897,935
513,829,963
515,371,453
9,811,515,212
661,694,759
9,149,820,453
1,354,915,690
1,354,915,690
515,371,453
63.28
64.93
50,162,819
50,313,307
3,335,480,165
77,412,264
3,258,067,901
479,606,308
479,606,308
50,313,307
NEW
HAMPSHIRE
NEW JERSEY
50.00
173,643,098
174,164,027
1,948,727,991
248,325,661
1,700,402,330
268,484,578
268,484,5 78
17 4, 164,027
50.00
698,212,220
700,306,857
14,319,021,372
1,083,026,899
13,235,994,473
2,089,893,864
2,089,893,864
700,306,857
NEW YORK
EN06JY18.009</GPH>
MISSOURI
NEVADA
50.00
1,742,141,169
1,747,367,593
60,995,857,591
3,395,485,268
57,600,372,323
9,094, 795,630
9,094,795,630
1,7 47,367,593
Federal Register / Vol. 83, No. 130 / Friday, July 6, 2018 / Notices
18:25 Jul 05, 2018
ADDENDUM 1: FINAL DSH ALLOTMENTS FOR FISCAL YEAR: 2016
daltland on DSKBBV9HB2PROD with NOTICES
VerDate Sep<11>2014
Jkt 244001
PO 00000
FY 2016
FMAPs
(percent)
Prior FY (20 15)
DSH
allotments
NORTH
CAROLINA
OHIO
66.24
319,957,444
62.47
440,619,363
441,941,221
21,473,065,804
702,913,525
20,770,152,279
PENNSYLVANI
A
RHODE ISLAND
52.01
608,732,595
610,558,793
27,350,279,117
923,597,202
26,426,681,915
STATE
+
Pet Increase in
CPIU:
320,917,316
FY 2016 TC MAP
Exp. including
DSH
12,157,764,904
FY 2016
TC DSH
expenditures
459,922,639
FY 2016
TC MAP EXP.
net OfDSH
ColE- F
11,697,842,265
"12% Amount" =
Col Gx
.12/(1-.12/Col B)*
(In FSl
1,714,303,256
Greater of
Col H Or Col C
(12% Limit, 2015
allotment)
1,714,303,256
FY2016 DSH
allotment
MIN Coli, ColD
3,085,028,126
3,085,028,126
441,941,221
4,122,324,598
4,122,324,598
610,558,793
320,917,316
Frm 00016
5Q.42
70,499,098
70,710,595
2,411,382,026
139,680,713
2,271,701,313
357,748,611
357,748,611
70,710,595
71.08
355,206,993
356,272,614
5,941,185,838
532,052,436
5,409,133,402
780,936,768
780,936,768
356,272,614
Na
53,100,000
na
na
na
na
na
na
53,100,000
TEXAS
57.13
1,037, 150,191
1,040,261,642
39,563,147,154
2,820,435,388
36,742,711,766
5,581,505,313
5,581,505,313
1,040,261,642
VERMONT
54.45
$24,403,535
24,476,746
1,679,425,056
37,448,781
1,641,976,275
252,736,702
252,736,702
24,476,746
SOUTH
CAROLINA
TENNESSEE
Fmt 4703
Sfmt 4725
VIRGINIA
50.00
$95,019,307
95,304,365
8,498,905,069
177,422,312
8,321,482,757
1,313,918,330
1,313,918,330
95,304,365
WASHINGTON
50.00
$200,651,279
201,253,233
10,787,810,275
429,732,157
10,358,078,118
1,635,486,019
1,635,486,019
201,253,233
WEST VIRGINIA
71.42
$73,210,602
73,430,234
3,655,890,862
73,502,498
3,582,388,364
516,703,151
516,703,151
73,430,234
0.00
11,371,859,581
11,352,715,860
476,006,026,329
19,143,945,217
456,862,081,112
70,134,900,964
70,134,900,964
11,405,815,861
TOTAL
E:\FR\FM\06JYN1.SGM
ALASKA
50.00
22,092,999
22,159,278
1 ,785,355,973
23,183,505
1,762,172,468
278,237,758.11
278,237,758
22,159,278
ARKANSAS
70.00
46,787,305
46,927,667
5,955,864,929
41,908,658
5,913,956,271
856,504,012
856,504,012
46,927,667
DELAWARE
54.83
9,819,111
9,848,568
1 ,883,220,982
0
1 ,883,220,982
289,302,843
289,302,843
9,848,568
06JYN1
LOW DSH STATES
HAWAII
53.98
10,570,301
10,602,012
2,156,012,061
8,107,072
2,164,119,133
333,928,015.62
333,928,016
10,602,012
IDAHO
71.24
17,828,139
17,881,623
1 ,689,500,076
23,288,276
1 ,666,211 ,800
240,447,525.93
240,447,526
17,881,623
IOWA
54.91
42,712,842
42,840,981
4,716,461 ,091
35,224,693
4,681 ,236,398
718,844,1 59
718,844,159
42,840,981
MINNESOTA
50.00
81,007,666
81,250,689
10,893,812,759
4,956,777
10,888,855,982
1,719,293,050
1,719,293,050
81,250,689
MONTANA
65.24
12,311,068
12,348,001
1 ,361,662,906
18,908,411
1 ,342,754,495
197,448,467
197,448,467
12,348,001
NEBRASKA
51.16
30,692,294
30,784,371
1,968,891,548
39,394,164
1 ,929,497,384
302,491 ,582
302,491 ,582
30,784,371
NEW MEXICO
70.37
22,092,999
22,159,278
5,339, 766,195
16,101,218
5,323,664,977
770,175,716
770,175,716
Federal Register / Vol. 83, No. 130 / Friday, July 6, 2018 / Notices
18:25 Jul 05, 2018
Prior FY (2015)
DSH allotment
(Col C) X 100%
22,159,278
31541
EN06JY18.010</GPH>
daltland on DSKBBV9HB2PROD with NOTICES
31542
VerDate Sep<11>2014
Jkt 244001
10,360,093
60.99
39,276,442
OREGON
64.38
51.61
FY2016 DSH
allotment
MIN Coli, ColD
1,385,593
39,394,271
4,460,334,118
44,416,344
4,415,917,774
659,710,533
659,71 0,533
39,394,271
49,095,555
49,242,842
8,316,707,109
127,373,075
8,189,334,034
1,207,856,415
1,207,856,415
49,242,842
SOUTH
DAKOTA
UTAH
11,979,041
12,014,978
832,399,125
1,496,978
830,902,147
129,915,253
129,915,253
12,014,978
70.24
21,277,695
21,341,528
2,100,346,398
33,093,465
2,067,252,933
299,183,749
299,183,749
21,341,528
WISCONSIN
58.23
102,530,441
102,838,032
7,626,998,105
39,461,949
7,587,536,156
1 '146,845,504
1'146,845,504
102,838,032
WYOMING
50.00
245,478
246,214
573,809,794
462,433
573,347,361
90,528,531
90,528,531
246,214
0.00
530,679,469
532,271,507
62,824,047,413
442,548,467
62,381,498,946
9,424,110,794
9,424,110,794
532,271,506
0.00%
11,902,539,050
11,884,987,367
538,830,073,742
19,586,493,684
519,243,580,058
79,559,011,758
79,559,011,758
11,938,087,367
Frm 00017
1,162,904,244
E:\FR\FM\06JYN1.SGM
06JYN1
EN06JY18.011</GPH>
TOTAL LOW
DSH STATES
TOTAL
FY 2016
TC DSH
expenditures
Greater of
Col H Or Col C
(12% Limit, 2015
allotment)
183,397,682
Sfmt 4725
50.00
NORTH
DAKOTA
OKLAHOMA
FY 2016 TC MAP
Exp. including
DSH
"12% Amount" =
Col Gx
.12/(1-.12/Col B)*
(In FS)
183,397,682
FY 2016
TC MAP EXP.
net OfDSH
ColE- F
1,161,518,651
Fmt 4703
PO 00000
Prior FY (20 15)
DSH
allotments
STATE
FOOTNOTES:
/1 Tennessee's DSH allotment for FY 2016, determined under section 1923(f)(6)(A) of the Social Security Act, is $53,100,000.
/2 Per 1905(z)(1)(A) of Act, Vermont's regular FMAP is increased by 2.2 percentage points for the period 1/1/2014 -12/31/2015.
10,391,173
Federal Register / Vol. 83, No. 130 / Friday, July 6, 2018 / Notices
18:25 Jul 05, 2018
FY 2016
FMAPs
(percent)
Prior FY (2015)
DSH allotment
(Col C) x 100%
+
Pet Increase in
CPIU:
10,391 '173
Federal Register / Vol. 83, No. 130 / Friday, July 6, 2018 / Notices
31543
KEY TO ADDENDUM 2—PRELIMINARY DSH ALLOTMENTS FOR FY 2018
The Preliminary FY 2018 DSH Allotments for the NON-Low DSH States are presented in the top section of this addendum, and the Preliminary
FY 2018 DSH Allotments for the Low-DSH States are presented in the bottom section of this addendum.
Column
Column
Column
Column
Column
A
B
C
D
Description
..........
..........
.........
.........
Column E ..........
Column F ..........
Column G .........
Column H .........
Column I ...........
daltland on DSKBBV9HB2PROD with NOTICES
Column J ..........
VerDate Sep<11>2014
State.
FY 2018 FMAPs. This column contains the States’ FY 2018 Federal Medical Assistance Percentages.
Prior FY (2017) DSH Allotments. This column contains the States’ prior preliminary FY 2017 DSH Allotments.
Prior FY (2017) DSH Allotments (Col C) × (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).
FY 2018 TC MAP Exp. Including DSH. This column contains the amount of the States’ projected FY 2018 total computable
(TC) medical assistance expenditures including DSH expenditures.
FY 2018 TC DSH Expenditures. This column contains the amount of the States’ projected FY 2018 total computable DSH expenditures.
FY 2018 TC MAP Exp. Net of DSH. This column contains the amount of the States’ projected FY 2018 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 2017 Allotment or 12 percent Limit. This column contains the greater of the State’s preliminary prior FY (FY
2017) DSH allotment or the amount of the 12 percent Limit, determined as the maximum of the amount in Column C or
Column H.
FY 2018 DSH Allotment. This column contains the States’ preliminary FY 2018 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.
18:25 Jul 05, 2018
Jkt 244001
PO 00000
Frm 00018
Fmt 4703
Sfmt 4703
E:\FR\FM\06JYN1.SGM
06JYN1
daltland on DSKBBV9HB2PROD with NOTICES
31544
VerDate Sep<11>2014
18:25 Jul 05, 2018
ADDENDUM 2: PRELIMINARY DSH ALLOTMENTS FOR FISCAL YEAR: 2018
PO 00000
Prior FY (2017)
DSH Allotments
71.44
$337,526,148
Prior FY (2017)
DSH Allotment
(Col C) x
100% +Pet
Increase in
CPIU:
FY 2018
TC MAP Exp.
Including DSH
FY 2018
TC DSH
Expenditures
FY 2018
TC MAP EXP.
Net OfDSH
ColE- F
"12% Amount"
=Col G x
.12/(1-.12/Col B)*
(In FS)
Greater of Col H
Or Col C (12%
Limit, FY 2017
allotment)
FY 2018 DSH
allotment MIN
Coli, ColD
102.4%
ALABAMA
$345,626,776
6,438,602,000
477,896,000
$5,960,706,000
$859,689,441
$859,689,441
$345,626,776
Frm 00019
ARIZONA
69.89
111,136,659
113,803,939
12,761 ,090,000
131 ,593,000
12,629,497,000
1,829,695,378
1,829,695,378
113,803,939
CALIFORNIA
50.00
1,203,294,436
1 ,232,173,502
95,266,251 ,000
96,560,000
95,169,691 ,000
15,026,793,316
15,026,793,316
1,232,173,502
Fmt 4703
Sfmt 4725
COLORADO
50.00
101 ,532,256
103,969,030
9,012,198,000
202,670,000
8,809,528,000
1,390,978, 105
1,390,978, 105
103,969,030
CONNECTICUT
50.00
219,529,202
224,797,903
7,595,837,000
134,842,000
7,460,995,000
1,178,051,842
1,178,051 ,842
224,797,903
DISTRICT OF
COLUMBIA
FLORIDA
70.00
67,230,818
68,844,358
2,923,831 ,000
43,077,000
2,880,754,000
417,212,648
417,212,648
68,844,358
61.79
219,529,202
224,797,903
25,048,032,000
354,933,000
24,693,099,000
3,677,332,606
3,677,332,606
224,797,903
GEORGIA
68.50
294,992,365
302,072,182
11 ,076,453,000
434,088,000
10,642,365,000
1,548,322,837
1,548,322,837
302,072,182
ILLINOIS
50.74
235,993,892
241,657,745
20,479,620,000
442,416,000
20,037,204,000
3,149,265,042
3,149,265,042
241,657,745
240,252,760
E:\FR\FM\06JYN1.SGM
06JYN1
INDIANA
65.59
234,621 ,836
240,252,760
11,343,341,000
81,086,000
11 ,262,255,000
1,654,095, 105
1,654,095, 105
KANSAS
54.74
45,277.897
46,364,567
3,337,185,000
80,472,000
3.256,713,000
500,531 ,033
500,531,033
46,364,567
KENTUCKY
71.17
159,158,672
162,978,480
9,852,595,000
227,396,000
9,625,199,000
1,389,269,047
1,389,269,047
162,978,480
LOUISIANA
63.69
752,615,495
770,678,267
12,160,406,000
1,032,353,000
11.128,053,000
1,645,375,962
1,645,375,962
770,678,267
MAINE
64.34
115,252,830
118,018,898
2,653,122,000
42,529,000
2.610,593,000
385,094,888
385,094,888
118,018,898
MARYLAND
50.00
83,695,509
85,704,201
12,383,588,000
136,614,000
12.246,974,000
1,933,732,737
1,933,732,737
85,704,201
MASSACHUSETTS
50.00
334,782,032
342,816,801
19,026,584,000
0
19,026,584,000
3,004,197,474
3,004,197,474
342,816,801
MICHIGAN
64.78
290,876.193
297,857,222
18,494,528,000
365,564,000
18.128,964,000
2.670,089,325
2,670,089,325
297,857,222
MISSISSIPPI
MISSOURI
75.65
167,391,016
171 ,408,400
5,660,629,000
226,579,000
5,434,050,000
775,024,445
775,024,445
171,408,400
64.61%
520,009,796
532,490,031
11 ,596,997,000
652,923,000
10,944,074,000
1,612,841 ,561
1,612,841,561
532,490,031
NEVADA
50,766,127
51,984,514
3,807,476,000
91,764,000
3,715,712,000
545,431 ,957
545,431 ,957
51,984,514
50.00
175,731,503
179,949,059
2,168,807,000
180,511,000
1 ,988,296,000
313,941,474
313,941 ,47 4
179,949,059
NEW JERSEY
EN06JY18.012</GPH>
65.75
NEW HAMPSHIRE
50.00
706,609,619
723,568,250
15,882,292,000
784,079,000
15,098,213,000
2,383,928,368
2,383,928,368
723,568,250
Federal Register / Vol. 83, No. 130 / Friday, July 6, 2018 / Notices
Jkt 244001
STATE
FY 2018
FMAPs
(percent)
daltland on DSKBBV9HB2PROD with NOTICES
VerDate Sep<11>2014
Prior FY (2017)
DSH Allotments
Prior FY (2017)
DSH Allotment
(Col C) x
100% +Pet
Increase in
CPIU:
FY 2018
TC MAP Exp.
Including DSH
FY 2018
TC DSH
Expenditures
FY 2018
TC MAP EXP.
Net OfDSH
ColE- F
"12% Amount"
=Col G x
.12/(1-.12/Col B)'
(In FS)
Greater of Col H
Or Col C (12%
Limit, FY 2017
allotment)
FY 2018 DSH
allotment MIN
Coli, ColD
Jkt 244001
102.4%
PO 00000
Frm 00020
Fmt 4703
Sfmt 4725
E:\FR\FM\06JYN1.SGM
NEW YORK
50.00
1,763,093.901
1 ,805,408,155
77,129,127,000
6,859,300,000
70.269,827,000
11.095,235,842
11 ,095,235,842
NORTH CAROLINA
67.61
323,805.572
331 ,576,906
13,674,561,000
595,840,000
13.078.721,000
1.908,115,073
1,908,115,073
331 ,5 76,906
OHIO
62.78
445,918.692
456,620,741
23,543,753,000
0
23.543,753,000
3.492,895,187
3,492,895,187
456,620,741
PENNSYLVANIA
51.82
616,053.822
630,839,114
28,987,279,000
977,385,000
28.009.894,000
4.374,101,578
4,37 4,1 01 ,578
630,839,114
RHODE ISLAND
51.45
71,346.990
73,059,318
2,635,184,000
139,704,000
2.495,480,000
390,547,364
390,547,364
73,059,318
SOUTH CAROLINA
71.58
359,4 79.068
368,106,566
6,340,892,000
530,923,000
5.809,969,000
837,618,491
837,618,491
368,106,566
TENNESSEE /1
65.82
na
na
na
na
na
na
na
53,100,000
TEXAS
56.88
1,049,623.997
1 ,07 4,814,973
40,052,765,000
1,889,603,000
38.163,162,000
5.804,065,921
5,804,065,921
1,074,814,973
VERMONT
53.47
24,697.037
25,289,766
1,641,243,000
27,449,000
1.613,794,000
249,692,496
249,692,496
25,289,766
VIRGINIA
50.00
96,162.104
98,469,994
9,786,362,000
233,386,000
9.552,976,000
1.508,364,632
1,508,364,632
98,469,994
WASHINGTON
50.00
203,064.512
207,938,060
14,685,096,000
487,940,000
14.197.156,000
2.241 ,656,211
2,241,656,211
207,938,060
WEST VIRGINIA
73.24
74,091,106
75,869,293
4,158,425,000
74,018,000
4,084,407,000
586,169,762
586,169,762
75,869,293
18,035,493,000
523,568,658,000
80,379,357 '149
80,379,357,149
11,782,907,674
TOTAL
11,454,890,304
11,729,807,671
541,604,151,000
1,805,408,155
LOW DSH STATES
50.00
22,358,712
22,895,321
2,321 ,499,000
19,711,000
2,301 ,788,000
363,440,21 0.53
363,440,211
22,895,321
ARKANSAS
70.87
47,350,016
48,486,416
6,744,319,000
52,850,000
6,691 ,469,000
966,654,136
966,654,136
48,486,416
DELAWARE
56.43
9,937,205
10,175,698
2,332,230,000
14,062,000
2,318,168,000
353,313,221
353,313,221
10,175,698
HAWAII
54.78
10,697,430
10,954,168
2,444,830,000
0
2,444,830,000
375,67 4,017.95
375,674,018
10,954,168
IDAHO
71.17
18,042,558
18,475,579
2,134,805,000
25,206,000
2,109,599,000
304,492,467.46
304,492,467
18,475,579
IOWA
58.48
43,226,550
44,263,987
4,428,123,000
45,204,000
4,382,919,000
661,737,788
661,737,788
44,263,987
MINNESOTA
50.00
81,981,945
83,949,512
12,542,446,000
536,000
12,541 ,910,000
1,980,301 ,579
1,980,301,579
83,949,512
MONTANA
06JYN1
ALASKA
65.38
12,459,133
12,758,152
1 ,633,918,000
19,745,000
1,614,173,000
237,245,330
237,245,330
Federal Register / Vol. 83, No. 130 / Friday, July 6, 2018 / Notices
18:25 Jul 05, 2018
STATE
FY 2018
FMAPs
(percent)
12,758,152
31545
EN06JY18.013</GPH>
daltland on DSKBBV9HB2PROD with NOTICES
31546
VerDate Sep<11>2014
Jkt 244001
52.55
31,061,430
31,806,904
2,338,039,000
37,064,000
2,300,975,000
357,828,566
357,828,566
31,806,904
NEW MEXICO
72.16
22,358,712
22,895,321
5,395,007,000
34,484,000
5.360,523,000
771,573,151
771 ,573,151
22,895,321
NORTH DAKOTA
50.00
10,484,694
10,736,327
1 ,385,355,000
2,002,000
1 .383,353,000
218,424,158
218,424,158
10,736,327
OKLAHOMA
58.57
39,748,819
40,702,791
5,193,661 ,000
43,978,000
5.149,683,000
777,196,307
777,196,307
40,702,791
OREGON
63.62
49,686,028
50,878,493
9,712,803,000
61,563,000
9.651 ,240,000
1.427,381 ,377
1,427,381 ,377
50,878,493
SOUTH DAKOTA
55.34
12,123,113
12,414,068
943,669,000
1,577,000
942,092,000
144,352,666
144,352,666
12,414,068
PO 00000
NEBRASKA
STATE
FY 2018
TC MAP Exp.
Including DSH
FY 2018
TC DSH
Expenditures
FY 2018
TC MAP EXP.
Net OfDSH
ColE- F
"12% Amount"
=Col G x
.12/(1-.12/Col B)'
(In FS)
Prior FY (2017)
DSH Allotments
Greater of Col H
Or Col C (12%
Limit, FY 2017
allotment)
FY 2018 DSH
allotment MIN
Coli, ColD
Frm 00021
102.4%
Fmt 4703
Sfmt 4725
E:\FR\FM\06JYN1.SGM
UTAH
70.26
21,533,602
22,050,408
2,610,371 ,000
30,619,000
2.579,752,000
373,333,420
373,333,420
22,050,408
WISCONSIN
58.77
103,763,574
106,253,900
8,687,664,000
102,737,000
8.584,927,000
1.294,512,277
1,294,512,277
106,253,900
WYOMING
50.00
248,430
254,392
615,509,000
482,000
615,027,000
97,109,526
97,109,526
254,392
537,061,951
549,951,438
71,464,248,000
491,820,000
70,972,428,000
10,704,570,196
10,704,570,196
549,951,437
11,991,952,255
12,279,759,109
613,068,399,000
18,527,313,000
594,541,086,000
91,083,927,346
91,083,927,346
12,332,859,111
TOTAL LOW DSH
STATES
TOTAL
06JYN1
FOOTNOTES:
/1 Tennessee's DSH allotment for FY 2018, determined under section 1923(f)(6)(A) of the Social Security Act, is $53,100,000.
Federal Register / Vol. 83, No. 130 / Friday, July 6, 2018 / Notices
18:25 Jul 05, 2018
EN06JY18.014</GPH>
Prior FY (2017)
DSH Allotment
(Col C) x
100% +Pet
Increase in
CPIU:
FY 2018
FMAPs
(percent)
Federal Register / Vol. 83, No. 130 / Friday, July 6, 2018 / Notices
31547
KEY TO ADDENDUM 3—FINAL IMD DSH LIMITS FOR FY 2016
The final FY 2016 IMD DSH Limits for the Non-Low DSH States are presented in the top section of this addendum and the preliminary FY 2016
IMD DSH Limits for the Low-DSH States are presented in the bottom section of the addendum.
Column
Description
Column A ..........
Column B ..........
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 as of January 1, 1997.
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 2016 Federal Share DSH Allotment. This column contains the states’ FY 2016 DSH allotments from Addendum 1, Column
J.
FY 2016 FMAP.
FY 2016 DSH Allotments in Total Computable, Col. F/G. This column contains states’ FY 2016 total computable DSH allotment (determined as Column F/Column G).
Applicable Percentage Applied to FY 2016 Allotments in TC, Col E × Col H. This column contains the applicable percentage
of FY 2016 total computable DSH allotment (calculated as the percentage in Column E multiplied by the amount in Column
H).
FY 2016 TC IMD DSH Limit. Lesser of Col. I or C. This column contains the total computable FY 2016 TC IMD DSH Limit
equal to the lesser of the amount in Column I or Column C.
FY 2016 IMD DSH Limit in Federal Share, Col. G × J. This column contains the FY 2016 Federal Share IMD DSH limit determined by converting the total computable FY 2016 IMD DSH Limit from Column J into a federal share amount by multiplying it by the FY 2016 FMAP in Column G.
Column C .........
Column D .........
Column E ..........
Column F ..........
Column G .........
Column H .........
Column I ...........
Column J ..........
daltland on DSKBBV9HB2PROD with NOTICES
Column K ..........
VerDate Sep<11>2014
18:25 Jul 05, 2018
Jkt 244001
PO 00000
Frm 00022
Fmt 4703
Sfmt 4703
E:\FR\FM\06JYN1.SGM
06JYN1
daltland on DSKBBV9HB2PROD with NOTICES
31548
VerDate Sep<11>2014
STATE
Jkt 244001
ALABAMA
PO 00000
ARIZONA
CALIFORNIA
Applicable
Percent
CoiCID
FY 2016
Allotment In FS
$4,451,770
Total Inpatient
& IMD & Mental
Health FY95
DSH Total
Computable
Col B + C
$417,457,999
1.07
$334,515,508
69.87
$478,768,439
Applicable
Percentage
Applied to FY
2013
Allotments in
TC ColE x Col
H
$5,105,584
$4,451,770
$3,110,452
28,474,900
122,391 ,000
23.27
11 0,145,351
68.92
159,816,238
37,182,075
28,474,900
19,624,901
1,555,919
2,191 ,435,462
0.07
1'1 92,561 ,384
50.00
2,385,122,768
1,693,437
1,555,919
777,960
Inpatient
Hospital
Services FY 95
DSH total
computable
IMD And Mental
Health Services
FY 95 DSH total
computable
$413,006,229
93,916,100
2,189,879,543
FY 2016
FMAPs
(percent)
FY 2016
Allotments in
TC Col FIG
FY2016 TC
IMD Limit
(Lesser Of Col
I or Col C)
FY 2016 IMD
Limit In FS
Col G x J
Frm 00023
Fmt 4703
COLORADO
173,900,441
594,776
174,495,217
0.34
100,626,616
50.72
198,396,325
676,244
594,776
301,670
CONNECTICUT
303,359,275
105,573,725
408,933,000
25.82
217,571 ,062
50.00
435,142,124
112,340,1 02
105,573,725
52,786,863
39,532,234
6,545,136
46,077,370
14.20
66,631,138
70.00
95,187,340
13,521,043
6,545,136
4,581,595
184,468,014
149,714,986
334,183,000
33.00
217,571 ,062
60.67
358,613,915
118,342,592
118,342,592
71,798,450
DISTRICT OF
COLUMBIA
FLORIDA
Sfmt 4725
GEORGIA
407,343,557
0
407,343,557
0.00
292,361 '115
67.55
432,806,980
0
0
0
ILLINOIS
315,868,508
89,408,276
405,276,784
22.06
233,888,892
50.89
459,596,958
101 ,391 ,872
89,408,276
45,499,872
INDIANA
79,960,783
153,566,302
233,527,085
33.00
232,529,074
66.60
349,142,754
115,217,109
115,217,109
76,734,594
E:\FR\FM\06JYN1.SGM
11,587,208
76,663,508
88,250,716
33.00
44,874,031
55.96
80,189,476
26,462,527
26,462,527
14,808,430
KENTUCKY
158,804,908
37,443,073
196,247,981
19.08
157,739,021
70.32
224,316,014
42,798,305
37,443,073
26,329,969
LOUISIANA
1,078,512,169
132,917,149
1 ,211 ,429,318
10.97
745,902,374
62.21
1'1 99,007,192
131 ,554,202
131 ,554,202
81,839,869
37,694,186
KANSAS
06JYN1
MAINE
99,957,958
60,958,342
160,916,300
33.00
114,224,807
62.67
182,263,933
60,147,098
60,147,098
MARYLAND
22,226,467
120,873,531
143,099,998
33.00
82,948,968
50.00
165,897,936
54,746,319
54,746,319
27,373,159
MASSACHUSETTS
469,653,946
105,635,054
575,289,000
18.36
331,795,869
50.00
663,591 ,738
121 ,849,278
105,635,054
52,817,527
MICHIGAN
133,258,800
304,765,552
438,024,352
33.00
288,281 ,658
65.60
439,453,747
145,019,736
145,019,736
95,132,947
MISSISSIPPI
182,608,033
0
182,608,033
0.00
165,897,935
74.17
223,672,556
0
0
0
MISSOURI
521 ,946,524
207,234,618
729,181,142
28.42
515,371 ,453
63.28
814,430,235
231 ,462,567
207,234,618
131,138,066
NEVADA
73,560,000
0
73,560,000
0.00
50,313,307
64.93
77,488,537
0
0
0
NEW HAMPSHIRE
92,675,916
94,753,948
187,429,864
33.00
174,164,027
50.00
348,328,054
114,948,258
94,753,948
47,376,974
736,742,539
357,370,461
1 ,094,113,000
32.66
700,306,857
50.00
1,400,613,714
457,482,882
357,370,461
178,685,231
2,418,869,368
605,000,000
3,023,869,368
20.01
1,747,367,593
50.00
3,494,735,186
699,208,375
605,000,000
302,500,000
NEW JERSEY
NEW YORK
EN06JY18.015</GPH>
Federal Register / Vol. 83, No. 130 / Friday, July 6, 2018 / Notices
18:25 Jul 05, 2018
ADDENDUM 3: FINAL IMD DSH LIMIT FOR FY: 2016
daltland on DSKBBV9HB2PROD with NOTICES
VerDate Sep<11>2014
Jkt 244001
IMD And Mental
Health Services
FY 95 DSH total
computable
193,201 ,966
236,072,627
Total Inpatient
& IMD & Mental
Health FY95
DSH Total
Computable
Col B + C
429,274,593
Applicable
Percent
CoiCID
FY 2016
Allotment In FS
FY 2016
FMAPs
(percent)
33.00
320,917,316
66.24
FY 2016
Allotments in
TC Col FIG
484,476,624
Applicable
Percentage
Applied to FY
2013
Allotments in
TC ColE x Col
H
159,877,286
FY2016 TC
IMD Limit
(Lesser Of Col
I or Col C)
159,877,286
FY 2016 IMD
Limit In FS
Col G x J
PO 00000
NORTH
CAROLINA
OHIO
105,902,714
535,731 ,956
93,432,758
629,164,714
14.85
441 ,941 ,221
62.47
707,445,527
105,057,683
93,432,758
58,367,444
PENNSYLVANIA
388,207,319
579,199,682
967,407,001
33.00
610,558,793
52.01
1'173,925, 770
387,395,504
387,395,504
201,484,402
Frm 00024
RHODE ISLAND
108,503,167
2,397,833
110,901 ,000
2.16
70,710,595
50.42
140,243,148
3,032,251
2,397,833
1,208,987
SOUTH
CAROLINA
TENNESSEE
366,681,364
72,076,341
438,757,705
16.43
356,272,614
71.08
501,227,651
82,338,509
72,076,341
51,231,863
TEXAS
0
0
0
0.00
53,100,000
65.05
81,629,516
0
0
0
1,220,515,401
292,513,592
1 ,513,028,993
19.33
1,040,261 ,642
57.13
1,820,867,569
352,027,962
292,513,592
167,113,015
Fmt 4703
Sfmt 4725
19,979,252
9,071,297
$29,050,549
31.23
$24,476,746
54.45
44,952,702
14,036,888
9,071,297
4,939,321
VIRGINIA
129,313,480
7,770,268
137,083,748
5.67
$95,304,365
50.00
190,608,730
10,804,205
7,770,268
3,885,134
WASHINGTON
171,725,815
163,836,435
335,562,250
33.00
$201 ,253,233
50.00
402,506,466
132,827,134
132,827' 134
66,413,567
22.00
$73,430,234
71.42
VERMONT
E:\FR\FM\06JYN1.SGM
66,962,606
18,887,045
85,849,651
13,402,460,846
4,118,758,904
17,521,219,750
ALASKA
2,506,827
17,611,765
20,118,592
33.00
22,159,278
50.00
ARKANSAS
2,422,649
819,351
3,242,000
25.27
46,927,667
70.00
DELAWARE
0
7,069,000
7,069,000
33.00
9,848,568
54.83
17,962,006
WEST VIRGINIA
TOTAL
102,814,665
22,619,372
18,887,045
13,489,128
20,317,280,526
11,405,815,861
3,861,166,398
3,471,780,297
1,944,948,290
44,318,556
14,625,123
14,625,123
7,312,562
67,039,524
16,942,906
819,351
573,546
5,927,462
5,927,462
3,250,027
LOW DSH STATES
HAWAII
0
0
0.00
10,602,012
53.98
19,640,630
0
0
0
2,081,429
0
2,081 ,429
0.00
17,881,623
71.24
25,100,538
0
0
0
IOWA
12,011,250
0
12,011,250
0.00
42,840,981
54.91
78,020,362
0
0
0
MINNESOTA
24,240,000
5,257,214
29,497,214
17.82
81,250,689
50.00
162,501 ,378
28,962,210
5,257,214
2,628,607
237,048
0
237,048
0.00
12,348,001
65.24
18,927,040
0
0
0
NEBRASKA
6,449,102
1,811,337
8,260,439
21.93
30,784,371
51.16
60,172,735
13,194,589
1,811,337
926,680
NEW MEXICO
06JYN1
0
IDAHO
6,490,015
254,786
6,744,801
3.78
22,159,278
70.37
31,489,666
1,189,527
254,786
179,293
214,523
988,478
1,203,001
33.00
10,391,173
50.00
20,782,346
6,858,174
988,478
Federal Register / Vol. 83, No. 130 / Friday, July 6, 2018 / Notices
18:25 Jul 05, 2018
STATE
Inpatient
Hospital
Services FY 95
DSH total
computable
494,239
MONTANA
NORTH DAKOTA
31549
EN06JY18.016</GPH>
daltland on DSKBBV9HB2PROD with NOTICES
31550
VerDate Sep<11>2014
Jkt 244001
PO 00000
Frm 00025
Fmt 4703
Sfmt 4725
E:\FR\FM\06JYN1.SGM
FY 2016
Allotment In FS
FY 2016
FMAPs
(percent)
14.05
39,394,271
60.99
64,591,361
Applicable
Percentage
Applied to FY
2013
Allotments in
TC ColE x Col
H
9,076,614
31,413,000
33.00
49,242,842
64.38
76,487,794
1 ,072,419
33.00
12,014,978
51.61
23,280,329
934,586
4,555,702
20.51
21,341,528
70.24
6,609,524
4,492,011
11,101,535
33.00
102,838,032
0
0
0
0.00
246,214
98,662,480
63,238,167
161,900,647
13,501,123,326
4,181,997,071
17,683,120,397
IMD And Mental
Health Services
FY 95 DSH total
computable
OKLAHOMA
20,019,969
3,273,248
Total Inpatient
& IMD & Mental
Health FY95
DSH Total
Computable
Col B + C
23,293,217
OREGON
11,437,908
19,975,092
321,120
751,299
UTAH
3,621,116
WISCONSIN
STATE
SOUTH DAKOTA
WYOMING
TOTAL LOW DSH
STATES
TOTAL
FY 2016
Allotments in
TC Col FIG
FY2016 TC
IMD Limit
(Lesser Of Col
I or Col C)
FY 2016 IMD
Limit In FS
Col G x J
3,273,248
1,996,354
25,240,972
19,975,092
12,859,964
7,682,509
751,299
387,745
30,383,724
6,233,113
934,586
656,453
58.23
176,606,615
58,280,183
4,492,011
2,615,698
50.00
492,428
0
0
0
532,271,506
917,797,033
194,213,384
59,109,988
33,881,168
11,938,087,367
21,235,077,559
4,055,379,782
3,530,890,285
1,978,829,458
06JYN1
Federal Register / Vol. 83, No. 130 / Friday, July 6, 2018 / Notices
18:25 Jul 05, 2018
EN06JY18.017</GPH>
Applicable
Percent
Col C/O
Inpatient
Hospital
Services FY 95
DSH total
computable
Federal Register / Vol. 83, No. 130 / Friday, July 6, 2018 / Notices
31551
KEY TO ADDENDUM 4—PRELIMINARY IMD DSH LIMITS FOR FY 2018
The preliminary FY 2018 IMD DSH Limits for the Non-Low DSH States are presented in the top section of this addendum and the preliminary
FY 2018 IMD DSH Limits for the Low-DSH States are presented in the bottom section of the addendum.
Column
Description
Column A ..........
Column B ..........
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 as of January 1, 1997.
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 2018 Federal Share DSH Allotment. This column contains the states’ preliminary FY 2017 DSH allotments from Addendum 1, Column J.
FY 2018 FMAP.
FY 2018 DSH Allotments in Total Computable, Col. F/G. This column contains states’ FY 2018 total computable DSH allotment (determined as Column F/Column G).
Applicable Percentage Applied to FY 2018 Allotments in TC, Col E × Col H. This column contains the applicable percentage
of FY 2018 total computable DSH allotment (calculated as the percentage in Column E multiplied by the amount in Column
H).
FY 2018 TC IMD DSH Limit. Lesser of Col. I or C. This column contains the total computable FY 2018 TC IMD DSH Limit
equal to the lesser of the amount in Column I or Column C.
FY 2018 IMD DSH Limit in Federal Share, Col. G × J. This column contains the FY 2018 Federal Share IMD DSH limit determined by converting the total computable FY 2018 IMD DSH Limit from Column J into a federal share amount by multiplying it by the FY 2018 FMAP in Column G.
Column C .........
Column D .........
Column E ..........
Column F ..........
Column G .........
Column H .........
Column I ...........
Column J ..........
daltland on DSKBBV9HB2PROD with NOTICES
Column K ..........
VerDate Sep<11>2014
18:25 Jul 05, 2018
Jkt 244001
PO 00000
Frm 00026
Fmt 4703
Sfmt 4703
E:\FR\FM\06JYN1.SGM
06JYN1
daltland on DSKBBV9HB2PROD with NOTICES
31552
VerDate Sep<11>2014
STATE
Jkt 244001
ALABAMA
PO 00000
ARIZONA
Inpatient
Hospital
Services FY 95
DSH
Total
Computable
IMDAnd
Mental Health
Services FY 95
DSH
Total
Computable
Total Inpatient
&IMD&
Mental Health
FY 95 DSH
Total
Computable
Col B + C
Applicab
le
Percent
FY 2018
Allotment
In FS
FY
2018
FMAP
s
FY 2018
Allotments
inTC
Col F/G
CoiC/D
Applicable
Percentage
Applied to FY
2018
Allotments in
TC
ColE x Col H
FY 2018
TC IMD Limit
(Lesser Of
Col I or Col C)
FY 2018
IMD Limit
In FS
Col G X J
$413,006,229
$4,451,770
$417.457,999
1.07
345,626,776
71.44
$483,800.078
$5,159,242
$4.451,770
$3,180,344
93,916,100
28,474,900
122,391 ,000
23.27
113,803,939
69.89
162,832.936
37,883,926
28,474,900
19,901,108
Frm 00027
Fmt 4703
2,189,879,543
1,555,919
2,191.435,462
0.07
1,232,173,502
50.00
2.464,347.004
1,749,686
1.555,919
777,960
COLORADO
173,900,441
594,776
174,495,217
0.34
103,969,030
50.00
207,938.060
708,768
594,776
297,388
CONNECTICUT
303,359,275
105,573,725
408,933,000
25.82
224,797,903
50.00
449,595.806
116,071,591
105.573,725
52,786,863
39,532,234
6,545,136
46,077,370
14.20
68,844,358
70.00
98,349.083
13,970,158
6.545,136
4,581,595
184,468,014
149,714,986
334,183,000
33.00
224,797,903
61.79
363,809.521
120,057,142
120.057,142
74,183,308
CALIFORNIA
DISTRICT OF
COLUMBIA
FLORIDA
Sfmt 4725
GEORGIA
407,343,557
0
407,343,557
0.00
302,072,182
68.50
440,981 ,288
0
0
0
ILLINOIS
315,868,508
89,408,276
405,276,784
22.06
241,657,745
50.74
476,266.742
105,069,400
89,408,276
45,365,759
INDIANA
79,960,783
153,566,302
233,527,085
33.00
240,252,760
65.59
366,294,801
120,877,284
120,877,284
79,283,411
KANSAS
11,587,208
76,663,508
88,250,716
33.00
46,364,567
54.74
84,699.611
27,950,872
27.950,872
15,300,307
E:\FR\FM\06JYN1.SGM
KENTUCKY
158,804,908
37,443,073
196,247,981
19.08
162,978,480
71.17
228,998,848
43,691,765
37,443,073
26,648,235
LOUISIANA
1,078,512,169
132,917,149
1 ,211,429,318
10.97
770,678,267
63.69
1 .210,045.952
132,765,367
132.765,367
84,558,262
MAINE
99,957,958
60,958,342
160,916,300
33.00
118,018,898
64.34
183,430,056
60,531,918
60,531,918
38,946,236
MARYLAND
22,226,467
120,873,531
143,099,998
33.00
85,704,201
50.00
171 ,408,402
56,564,773
56.564,773
28,282,386
MASSACHUSETTS
469,653,946
105,635,054
575,289,000
18.36
342,816,801
50.00
685,633,602
125,896,623
105,635,054
52,817,527
MICHIGAN
133,258,800
304,765,552
438,024,352
33.00
297,857,222
64.78
459,798.120
151 ,733,380
151.733,380
98,292,883
06JYN1
MISSISSIPPI
182,608,033
0
182,608,033
0.00
171,408,400
75.65
226,580,833
0
0
0
MISSOURI
521 ,946,524
207,234,618
729,181 '142
28.42
532,490,031
64.61
824,160.395
234,227,896
207.234,618
133,894,287
NEVADA
73,560,000
0
73,560,000
0.00
51,984,514
65.75
79,063,900
0
0
0
NEW HAMPSHIRE
92,675,916
94,753,948
187,429,864
33.00
179,949,059
50.00
359,898.118
118,766,379
94.753,948
47,376,974
736,742,539
357,370,461
1 ,094,113,000
32.66
723,568,250
50.00
1 ,447,136,500
472,678,634
357,370,461
178,685,231
2,418,869,368
605,000,000
3,023.869,368
20.01
1,805,408,155
50.00
3.610,816.310
722,433,281
605.000,000
302,500,000
NEW JERSEY
NEW YORK
EN06JY18.018</GPH>
Federal Register / Vol. 83, No. 130 / Friday, July 6, 2018 / Notices
18:25 Jul 05, 2018
ADDENDUM 4: PRELIMINARY IMD DSH LIMIT FOR FISCAL YEAR: 2018
daltland on DSKBBV9HB2PROD with NOTICES
VerDate Sep<11>2014
IMDAnd
Mental Health
Services FY 95
DSH
Total
Computable
Total Inpatient
&IMD&
Mental Health
FY 95 DSH
Total
Computable
Col B + C
Applicab
le
Percent
FY 2018
Allotment
FY
2018
FMAP
In FS
s
FY 2018
Allotments
inTC
Col F/G
Col C/D
Applicable
Percentage
Applied to FY
2018
Allotments in
TC
ColE x Col H
FY 2018
TC IMD Limit
(Lesser Of
Col I or Col C)
FY 2018
IMD Limit
In FS
Col G x J
Jkt 244001
NORTH CAROLINA
193,201 ,966
236,072,627
429,274,593
33.00
331,576,906
67.61
490,425,833
161 ,840,525
161 ,840,525
OHIO
535,731,956
93,432,758
629,164,714
14.85
456,620,7 41
62.78
727,334,726
108,011 ,285
93,432,758
109,420,379
58,657,085
PENNSYLVANIA
388,207,319
579,199,682
967,407,001
33.00
630,839,114
51.82
1 ,217,366, 102
401 ,730,814
401 ,730,814
208,176,908
PO 00000
RHODE ISLAND
108,503,167
2,397,833
110,901,000
2.16
73,059,318
51.45
142,000,618
3,070,250
2,397,833
1,233,685
SOUTH CAROLINA
366,681 ,364
72,076,341
438,757,705
16.43
368,106,566
71.58
514,258,963
84,479,210
72,076,341
51,592,245
Frm 00028
TENNESSEE*
TEXAS
VERMONT**
0
0
0
0.00
53,100,000
65.82
80,674,567
0
0
0
1 ,220,515,401
292,513,592
1 ,513,028,993
19.33
1,074,814,973
56.88
1 ,889,618,448
365,319,556
292,513,592
166,381,731
Fmt 4703
19,979,252
9,071,297
29,050,549
31.23
25,289,766
53.47
47,297,112
14,768,952
9,071,297
4,850,423
VIRGINIA
129,31 3,480
7,770,268
137,083,748
5.67
98,469,994
50.00
196,939,988
11,163,077
7,770,268
3,885,134
WASHINGTON
171,725,815
163,836,435
335,562,250
33.00
207,938,060
50.00
415,876,120
137,239,120
137,239,120
68,619,560
66,962,606
18,887,045
85,849,651
22.00
75,869,293
73.24
103,589,969
22,789,940
18,887,045
13,832,872
13,402,460,846
4, 118,758,904
17,521,219,750
20,911,268,411
3,979,200,811
3,511,481,984
1,974,310,086
ALASKA
2,506,827
17,611,765
20,118,592
33.00
22,895,321
50.00
45,790,642
15,110,912
15,110,912
7,555,456
ARKANSAS
2,422,649
819,351
3,242,000
25.27
48,486,416
70.87
68,415,995
17,290,782
819,351
580,674
DELAWARE
0
7,069,000
7,069,000
33.00
10,175,698
56.43
18,032,426
5,950,701
5,950,701
3,357,980
HAWAII
0
0
0
0.00
10,954,168
54.78
19,996,656
0
0
0
WEST VIRGINIA
Sfmt 4725
TOTAL
11,782,907,674
E:\FR\FM\06JYN1.SGM
LOW DSH STATES
2,081,429
0
2,081,429
0.00
18,475,579
71.17
25,959,785
0
0
0
12,011,250
0
12,011,250
0.00
44,263,987
58.48
75,690,812
0
0
0
MINNESOTA
24,240,000
5,257,214
29,497,214
17.82
83,949,512
50.00
167,899,024
29,924,219
5,257,214
2,628,607
237,048
0
237,048
0.00
12,758,152
65.38
19,513,845
0
0
0
NEBRASKA
6,449,102
1,811,337
8,260,439
21.93
31,806,904
52.55
60,526,934
13,272,258
1,811,337
951,858
NEW MEXICO
06JYN1
IDAHO
IOWA
6,490,015
254,786
6,744,801
3.78
22,895,321
72.16
31,728,549
1,198,551
254,786
183,854
214,523
988,478
1,203,001
33.00
10,736,327
50.00
21,472,654
7,085,976
988,478
Federal Register / Vol. 83, No. 130 / Friday, July 6, 2018 / Notices
18:25 Jul 05, 2018
STATE
Inpatient
Hospital
Services FY 95
DSH
Total
Computable
494,239
MONTANA
NORTH DAKOTA
31553
EN06JY18.019</GPH>
daltland on DSKBBV9HB2PROD with NOTICES
31554
VerDate Sep<11>2014
Jkt 244001
PO 00000
Frm 00029
Fmt 4703
Sfmt 9990
E:\FR\FM\06JYN1.SGM
06JYN1
EN06JY18.020</GPH>
IMD And
Mental Health
Services FY 95
DSH
Total
Computable
Total Inpatient
&IMD&
Mental Health
FY95 DSH
Total
Computable
Col B + C
FY 2018
Allotment
In FS
40,702,791
31 ,413,000
33.00
1,072,419
33.00
20,019,969
3,273,248
23,293,217
OREGON
11,437,908
19,975,092
321,120
751,299
FY
2018
FMAP
s
FY 2018
Allotments
in TC
Col F/G
Col C/D
14.05
OKLAHOMA
SOUTH DAKOTA
Applicab
le
Percent
Applicable
Percentage
Applied to FY
2018
Allotments in
TC
ColE x Col H
FY 2018
TC IMD Limit
(Lesser Of
Col I or Col C)
FY 2018
IMD Limit
In FS
Col G xJ
58.57
69,494,265
9,765,588
3,273,248
1,917,141
50,878,493
63.62
79,972,482
26,390,919
19,975,092
12,708,154
12,414,068
55.34
22,432,360
7,402,679
751,299
415,769
UTAH
3,621,116
934,586
4,555,702
20.51
22,050,408
70.26
31,384,014
6,438,318
934,586
656,640
WISCONSIN
6,609,524
4,492,011
11,101,535
33.00
106,253,900
58.77
180,796,155
59,662,731
4,492,011
2,639,955
0
0
0
000
254,392
50.00
WYOMING
TOTAL LOW DSH
STATES
TOTAL
98,662,480
63,238,167
13,501,123,326
4,181,997,071
508,784
0
0
0
161,900,647
549,951,437
939,615,382
199,493,634
59,619,014
34,090,327
17,683,120,397
12,332,859,111
21,850,883,793
4,178,694,444
3,571,100,998
2,008,400,413
Federal Register / Vol. 83, No. 130 / Friday, July 6, 2018 / Notices
18:25 Jul 05, 2018
STATE
Inpatient
Hospital
Services FY 95
DSH
Total
Computable
31555
Federal Register / Vol. 83, No. 130 / Friday, July 6, 2018 / Notices
[FR Doc. 2018–14533 Filed 7–5–18; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Administration for Children and
Families
Submission for OMB Review;
Comment Request
Title: Healthy Marriage and
Responsible Fatherhood performance
measures and additional data collection
(part of the Fatherhood and Marriage
Local Evaluation and Cross-Site (FaMLE
Cross-Site) Project)—Extension.
OMB No.: 0970–0460.
Description
Background
For decades various organizations and
agencies have been developing and
operating programs to strengthen
families through healthy marriage and
relationship education and responsible
fatherhood programming. The
Administration for Children and
Families (ACF), Office of Family
Assistance (OFA), has had
administrative responsibility for federal
funding of such programs since 2006
through the Healthy Marriage (HM) and
Responsible Fatherhood (RF) Grant
Programs. The authorizing legislation
for the programs may be found in
Section 403(a)(2) of the Social Security
Act [1].
Extension of Current Approval
The Offices of Family Assistance
(OFA) and Planning, Research and
Evaluation (OPRE) in the
Administration for Children and
Families (ACF), U.S. Department of
Health and Human Services (HHS) are
proposing to extend performance
measure and other data collection
activities, in service to the HM and RF
programs. This data collection is part of
the Fatherhood and Marriage Local
Evaluation and Cross-Site (FaMLE
Cross-Site) project, whose purpose is to
support high quality data collection,
strengthen local evaluations, and
conduct cross-site analysis for the
Responsible Fatherhood and Healthy
Marriage grantees.
ACF is requesting comment on the
following data collection, which has
been ongoing under OMB #0970–0460
since 2016. There are no changes
proposed to the information collection,
we are only requesting an extension to
continue data collection with the
current grantees for another three years.
Performance measures. ACF is
proposing to extend collection of a set
of performance measures that are
collected by all grantees. These
measures collect standardized
information in the following areas:
• Applicant characteristics;
• Program operations (including
program characteristics and service
delivery); and
• Participant outcomes:
Æ Entrance survey, with four
versions: (1)Healthy Marriage Program
Pre-Program Survey for Adult-Focused
Programs; (2) Healthy Marriage Program
Pre-Program Survey for Youth-Focused
Programs; (3) Responsible Fatherhood
Program Pre-Program Survey for
Community-Based-Fathers; and
(4)Responsible Fatherhood Program PreProgram Survey for Incarcerated
Fathers.
Æ Exit survey, with four versions: (1)
Healthy Marriage Program Post-Program
Survey for Adult-Focused Programs; (2)
Healthy Marriage Program Post-Program
Survey for Youth-Focused Programs; (3)
Responsible Fatherhood Program PostProgram Survey for Community-BasedFathers; and (4) Responsible Fatherhood
Program Post-Program Survey for
Incarcerated Fathers.
These measures were developed per
extensive review of the research
literature and grantees’ past measures.
Grantees are required to submit data
on these standardized measures on a
regular basis (e.g., quarterly). In addition
to the performance measures mention
above, ACF proposes to extend
collection for these data submissions:
• Semi-annual Performance Progress
Report (PPR), with two versions: (1)
Performance Progress Report for Healthy
Marriage Programs, and (2) Performance
Progress Report for Responsible
Fatherhood Programs; and
• Quarterly Performance Report
(QPR), with two versions: (1) Quarterly
Performance Progress Report for Healthy
Marriage Programs, and (2)Quarterly
Performance Progress Report for
Responsible Fatherhood Programs.
A management information system
has been implemented which improves
efficiency and the quality of data, and
makes reporting easier.
Additional data collection. We also
seek to extend the approval to collect
information from a sub-set of grantees
on how they designed and implemented
their programs (information on
outcomes associated with programs will
also be assessed), per the following
protocols:
• Staff interview protocol on program
design (will be collected from about half
of all grantees);
• Staff interview protocols on
program implementation (will be
collected from about 20 grantees); and
• Program participant focus group
protocol (will be conducted with about
20 grantees).
Respondents: Responsible Fatherhood
and Healthy Marriage Program grantees
(e.g., grantee staff) and program
applicants and participants—
participants are called ‘‘clients.’’
ANNUAL BURDEN ESTIMATES
Instrument
Total number
of respondents
Respondent
Annual
number of
respondents
Number of
responses per
respondent
Average
burden
hours per
response
Annual
burden hours
Data Collection by Grantees
(DCS, or Data Collected by Sites)
daltland on DSKBBV9HB2PROD with NOTICES
Instrument DCS–1: Applicant characteristics.
Instrument DCS–2:Grantee program
operations.
Instrument DCS–3: Service receipt in
MIS.
Instrument DCS–4:Entrance and Exit
Surveys.
VerDate Sep<11>2014
18:25 Jul 05, 2018
Program applicants .............................
265,838
88,613
1
0.25
22,153
Program staff ......................................
Program staff ......................................
360
120
360
120
246
1
0.10
0.75
8,856
90
Program staff ......................................
239,493
79,831
15
0.033
39,916
Program clients (Entrance Survey; 4
versions).
Program clients (Exit Survey; 4
versions).
Program staff (Entrance and Exit surveys on paper).
239,493
79,831
1
0.42
33,529
132,087
44,029
1
0.42
18,492
60
20
1,285
0.30
7,710
Jkt 244001
PO 00000
Frm 00030
Fmt 4703
Sfmt 4703
E:\FR\FM\06JYN1.SGM
06JYN1
]]>Agencies
[Federal Register Volume 83, Number 130 (Friday, July 6, 2018)]
[Notices]
[Pages 31536-31555]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-14533]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-2414-N]
RIN 0938-ZB48
Medicaid Program; Final FY 2016 and Preliminary FY 2018
Disproportionate Share Hospital Allotments, and Final FY 2016 and
Preliminary FY 2018 Institutions for Mental Diseases Disproportionate
Share Hospital Limits
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: This notice announces the final federal share disproportionate
share hospital (DSH) allotments for federal fiscal year (FY) 2016 and
the preliminary federal share DSH allotments for FY 2018. This notice
also announces the final FY 2016 and the preliminary FY 2018
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 applicable August 6, 2018. 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
[[Page 31537]]
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) of the Act 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 2016 and
FY 2018 under section 1923(f)(7) of the Act, as amended, this notice
contains only the state-specific final FY 2016 DSH allotments and
preliminary FY 2018 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 2016
IMD DSH limits and preliminary FY 2018 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 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 2016 Federal Share State DSH Allotments,
and the Preliminary FY 2018 Federal Share State DSH Allotments
1. Final FY 2016 Federal Share State DSH Allotments
Addendum 1 to this notice provides the states' final FY 2016 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 2016 DSH allotments, the
preceding final fiscal year DSH allotments (for FY 2015) were published
in the November 3, 2017 Federal Register (82 FR 51259). For purposes of
calculating the states' final FY 2016 DSH allotments we are using the
actual Medicaid expenditures for FY 2016. Finally, for purposes of
calculating the states' final FY 2016 DSH allotments, the applicable
historical percentage change in the CPI-U for the previous FY (FY 2015)
was 0.3 percent; we note that this is the same as the estimated 0.3
percentage change in the CPI-U for FY 2015 that was available and used
in the calculation of the preliminary FY 2016 DSH allotments which were
published in the October 26, 2016 Federal Register (81 FR 74432).
2. Calculation of the Preliminary FY 2018 Federal Share State DSH
Allotments
Addendum 2 to this notice provides the preliminary FY 2018 DSH
allotments determined in accordance with section 1923(f)(3) of the Act.
The preliminary FY 2018 DSH allotments contained in this notice were
determined based on the most recent available estimates from states of
their FY 2018 total computable Medicaid expenditures. Also, the
preliminary FY 2018 allotments contained in this notice were determined
by increasing the preliminary FY 2017 DSH allotments. The estimated
percentage increase in the CPI-U for FY 2017 was 2.4 percent (CMS
originally published the preliminary FY 2017 DSH allotments in the
November 3, 2017 Federal Register (82 FR 51259)).
[[Page 31538]]
We will publish states' final FY 2018 DSH allotments in a future
notice based on the states' four quarterly Medicaid expenditure reports
(Form CMS-64) for FY 2018 available following the end of FY 2018
utilizing the actual change in the CPI-U for FY 2017.
B. Calculation of the Final FY 2016 and Preliminary FY 2018 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 2016
and the preliminary FY 2018 IMD DSH limits determined in accordance
with the provisions discussed above.
Addendums 3 and 4 to this notice detail each state's final FY 2016
and preliminary FY 2018 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 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 2016 DSH allotments being published in this notice are
approximately $11 million more than the preliminary FY 2016 DSH
allotments published in the October 26, 2016 Federal Register (81 FR
74432). The increase in the final FY 2016 DSH allotments is a result of
being calculated by multiplying the actual increase in the CPI-U for
2015 by the final FY 2015 DSH allotments, while the preliminary FY 2016
DSH allotments were calculated by multiplying the estimated CPI-U for
2015 by the preliminary FY 2015 DSH allotments. Although the estimated
and actual increase in the CPI-U remained the same at 0.3 percent, the
preliminary FY 2015 DSH allotments were lower than the final FY 2015
DSH allotments and therefore the final FY 2016 DSH allotments are
higher than the preliminary FY 2016 DSH allotments. The final FY 2016
IMD DSH limits being published in this notice are approximately $14
million more than the preliminary FY 2016 IMD DSH limits published in
the October 26, 2016 Federal Register (81 FR 74432). 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 final
FY 2016 DSH allotments were increased as compared to the preliminary FY
2016 DSH allotments, the associated FY 2016 IMD DSH limits for some
states were also increased.
The preliminary FY 2018 DSH allotments being published in this
notice have been increased by approximately $288 million more than the
preliminary FY 2017 DSH allotments published in the November 3, 2017
Federal Register (82 FR 51259). 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 2018 IMD DSH limits being published in this notice are
approximately $24 million more than the preliminary FY 2017 IMD DSH
limits published in the November 3, 2017 Federal Register (82 FR
51259). 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 2018 DSH allotments are
greater than the preliminary FY 2017 DSH allotments, the associated
preliminary FY 2018 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 $7.0 million to $34.5 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
[[Page 31539]]
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 https://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 2017 to FY 2018.
Table 1--Accounting Statement: Classification of Estimated Expenditures,
From the FY 2017 to FY 2018
[In millions]
------------------------------------------------------------------------
Category Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers............ $288.
From Whom To Whom? Federal Government to
States.
------------------------------------------------------------------------
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: May 30, 2018.
Seema Verma,
Administrator, Centers for Medicare & Medicaid Services.
Dated June 28, 2018.
Alex M. Azar II,
Secretary, Department of Health and Human Services.
Key to ADDENDUM 1--Final DSH Allotments for FY 2015
------------------------------------------------------------------------
The Final FY 2016 DSH Allotments for the NON-Low DSH States are
presented in the top section of this addendum, and the Final FY 2016 DSH
Allotments for the Low-DSH States are presented in the bottom section of
this addendum.
-------------------------------------------------------------------------
Column Description
------------------------------------------------------------------------
Column A................. State.
Column B................. FY 2016 FMAPs. This column contains the
States' FY 2016 Federal Medical Assistance
Percentages.
Column C................. Prior FY (2015) DSH Allotments. This column
contains the States' prior FY 2015 DSH
Allotments.
Column D................. Prior FY (2015) DSH Allotments (Col C) x (100
percent + Percentage Increase in CPIU):
100.3 percent. This column contains the
amount in Column C increased by 1 plus the
percentage increase in the CPI-U for the
prior FY (100.3 percent).
Column E................. FY 2016 TC MAP Exp. Including DSH. This
column contains the amount of the States' FY
2016 total computable (TC) medical
assistance expenditures including DSH
expenditures.
Column F................. FY 2016 TC DSH Expenditures. This column
contains the amount of the States' FY 2016
total computable DSH expenditures.
Column G................. FY 2016 TC MAP Exp. Net of DSH. This column
contains the amount of the States' FY 2016
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 2015 Allotment or 12 percent
Limit. This column contains the greater of
the State's prior FY (FY 2015) 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 2016 DSH Allotment. This column contains
the States' final FY 2016 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 31540]]
[GRAPHIC] [TIFF OMITTED] TN06JY18.009
[[Page 31541]]
[GRAPHIC] [TIFF OMITTED] TN06JY18.010
[[Page 31542]]
[GRAPHIC] [TIFF OMITTED] TN06JY18.011
[[Page 31543]]
Key to ADDENDUM 2--Preliminary DSH Allotments for FY 2018
------------------------------------------------------------------------
The Preliminary FY 2018 DSH Allotments for the NON-Low DSH States are
presented in the top section of this addendum, and the Preliminary FY
2018 DSH Allotments for the Low-DSH States are presented in the bottom
section of this addendum.
-------------------------------------------------------------------------
Column Description
------------------------------------------------------------------------
Column A................. State.
Column B................. FY 2018 FMAPs. This column contains the
States' FY 2018 Federal Medical Assistance
Percentages.
Column C................. Prior FY (2017) DSH Allotments. This column
contains the States' prior preliminary FY
2017 DSH Allotments.
Column D................. Prior FY (2017) 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 2018 TC MAP Exp. Including DSH. This
column contains the amount of the States'
projected FY 2018 total computable (TC)
medical assistance expenditures including
DSH expenditures.
Column F................. FY 2018 TC DSH Expenditures. This column
contains the amount of the States' projected
FY 2018 total computable DSH expenditures.
Column G................. FY 2018 TC MAP Exp. Net of DSH. This column
contains the amount of the States' projected
FY 2018 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 2017 Allotment or 12 percent
Limit. This column contains the greater of
the State's preliminary prior FY (FY 2017)
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 2018 DSH Allotment. This column contains
the States' preliminary FY 2018 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 31544]]
[GRAPHIC] [TIFF OMITTED] TN06JY18.012
[[Page 31545]]
[GRAPHIC] [TIFF OMITTED] TN06JY18.013
[[Page 31546]]
[GRAPHIC] [TIFF OMITTED] TN06JY18.014
[[Page 31547]]
Key to ADDENDUM 3--Final IMD DSH Limits for FY 2016
------------------------------------------------------------------------
The final FY 2016 IMD DSH Limits for the Non-Low DSH States are
presented in the top section of this addendum and the preliminary FY
2016 IMD DSH Limits for the Low-DSH States are presented in the bottom
section of the addendum.
-------------------------------------------------------------------------
Column Description
------------------------------------------------------------------------
Column A................. State.
Column B................. Inpatient Hospital Services FY 95 DSH Total
Computable. This column contains the States'
total computable FY 1995 inpatient hospital
DSH expenditures as reported on the Form CMS-
64 as of January 1, 1997.
Column C................. IMD and Mental Health Services FY 95 DSH
Total Computable. This column contains the
total computable FY 1995 mental health
facility DSH expenditures as reported on the
Form CMS-64 as of January 1, 1997.
Column D................. Total Inpatient Hospital & IMD & Mental
Health FY 95 DSH Total Computable, Col. B +
C. This column contains the total
computation of all inpatient hospital DSH
expenditures and mental health facility DSH
expenditures for FY 1995 as reported on the
Form CMS-64 as of January 1, 1997
(representing the sum of Column B and Column
C).
Column E................. Applicable Percentage, Col. C/D. This column
contains the ``applicable percentage''
representing the total Computable FY 1995
mental health facility DSH expenditures
divided by total computable all inpatient
hospital and mental health facility DSH
expenditures for FY 1995 (the amount in
Column C divided by the amount in Column D)
Per section 1923(h)(2)(A)(ii)(III) of the
Act, for FYs after FY 2002, the applicable
percentage can be no greater than 33
percent.
Column F................. FY 2016 Federal Share DSH Allotment. This
column contains the states' FY 2016 DSH
allotments from Addendum 1, Column J.
Column G................. FY 2016 FMAP.
Column H................. FY 2016 DSH Allotments in Total Computable,
Col. F/G. This column contains states' FY
2016 total computable DSH allotment
(determined as Column F/Column G).
Column I................. Applicable Percentage Applied to FY 2016
Allotments in TC, Col E x Col H. This column
contains the applicable percentage of FY
2016 total computable DSH allotment
(calculated as the percentage in Column E
multiplied by the amount in Column H).
Column J................. FY 2016 TC IMD DSH Limit. Lesser of Col. I or
C. This column contains the total computable
FY 2016 TC IMD DSH Limit equal to the lesser
of the amount in Column I or Column C.
Column K................. FY 2016 IMD DSH Limit in Federal Share, Col.
G x J. This column contains the FY 2016
Federal Share IMD DSH limit determined by
converting the total computable FY 2016 IMD
DSH Limit from Column J into a federal share
amount by multiplying it by the FY 2016 FMAP
in Column G.
------------------------------------------------------------------------
[[Page 31548]]
[GRAPHIC] [TIFF OMITTED] TN06JY18.015
[[Page 31549]]
[GRAPHIC] [TIFF OMITTED] TN06JY18.016
[[Page 31550]]
[GRAPHIC] [TIFF OMITTED] TN06JY18.017
[[Page 31551]]
Key to ADDENDUM 4--Preliminary IMD DSH Limits for FY 2018
------------------------------------------------------------------------
The preliminary FY 2018 IMD DSH Limits for the Non-Low DSH States are
presented in the top section of this addendum and the preliminary FY
2018 IMD DSH Limits for the Low-DSH States are presented in the bottom
section of the addendum.
-------------------------------------------------------------------------
Column Description
------------------------------------------------------------------------
Column A................. State.
Column B................. Inpatient Hospital Services FY 95 DSH Total
Computable. This column contains the States'
total computable FY 1995 inpatient hospital
DSH expenditures as reported on the Form CMS-
64 as of January 1, 1997.
Column C................. IMD and Mental Health Services FY 95 DSH
Total Computable. This column contains the
total computable FY 1995 mental health
facility DSH expenditures as reported on the
Form CMS-64 as of January 1, 1997.
Column D................. Total Inpatient Hospital & IMD & Mental
Health FY 95 DSH Total Computable, Col. B +
C. This column contains the total
computation of all inpatient hospital DSH
expenditures and mental health facility DSH
expenditures for FY 1995 as reported on the
Form CMS-64 as of January 1, 1997
(representing the sum of Column B and Column
C).
Column E................. Applicable Percentage, Col. C/D. This column
contains the ``applicable percentage''
representing the total Computable FY 1995
mental health facility DSH expenditures
divided by total computable all inpatient
hospital and mental health facility DSH
expenditures for FY 1995 (the amount in
Column C divided by the amount in Column D)
Per section 1923(h)(2)(A)(ii)(III) of the
Act, for FYs after FY 2002, the applicable
percentage can be no greater than 33
percent.
Column F................. FY 2018 Federal Share DSH Allotment. This
column contains the states' preliminary FY
2017 DSH allotments from Addendum 1, Column
J.
Column G................. FY 2018 FMAP.
Column H................. FY 2018 DSH Allotments in Total Computable,
Col. F/G. This column contains states' FY
2018 total computable DSH allotment
(determined as Column F/Column G).
Column I................. Applicable Percentage Applied to FY 2018
Allotments in TC, Col E x Col H. This column
contains the applicable percentage of FY
2018 total computable DSH allotment
(calculated as the percentage in Column E
multiplied by the amount in Column H).
Column J................. FY 2018 TC IMD DSH Limit. Lesser of Col. I or
C. This column contains the total computable
FY 2018 TC IMD DSH Limit equal to the lesser
of the amount in Column I or Column C.
Column K................. FY 2018 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 2018 IMD
DSH Limit from Column J into a federal share
amount by multiplying it by the FY 2018 FMAP
in Column G.
------------------------------------------------------------------------
[[Page 31552]]
[GRAPHIC] [TIFF OMITTED] TN06JY18.018
[[Page 31553]]
[GRAPHIC] [TIFF OMITTED] TN06JY18.019
[[Page 31554]]
[GRAPHIC] [TIFF OMITTED] TN06JY18.020
[[Page 31555]]
[FR Doc. 2018-14533 Filed 7-5-18; 8:45 am]
BILLING CODE 4120-01-P
