Medicaid Program; Final FY 2017 and Preliminary FY 2019 Disproportionate Share Hospital Allotments, and Final FY 2017 and Preliminary FY 2019 Institutions for Mental Diseases Disproportionate Share Hospital Limits, 3169-3185 [2019-01928]
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Federal Register / Vol. 84, No. 28 / Monday, February 11, 2019 / Notices
the offices of the Board of Governors.
Interested persons may express their
views in writing to the Reserve Bank
indicated for that notice or to the offices
of the Board of Governors. Comments
must be received not later than February
27, 2019.
A. Federal Reserve Bank of Chicago
(Colette A. Fried, Assistant Vice
President) 230 South LaSalle Street,
Chicago, Illinois 60690–1414:
1. Richard Molepske, as trustee of
Richard S. Molepske Trust, Belleair,
Florida, together with Michael B.
Molepske and Amy H. Molepske, as
trustees of the Michael B. Molepske and
Amy H. Molepske Trust and Michael B.
Molepske, as trustee of the Nicholas JA
Molespke Gift Trust, all of Manitowoc,
Wisconsin; Kim Burke Molepske of
Belleair, Florida: Kay F. Schroeder of
Manitowoc, Wisconsin; Mark R.
Molespke, as trustee of the Mark R.
Molespke Trust, Chicago, Illinois; Amy
E. Molepske, as trustee of the Amy E.
Molepske Trust, Chicago, Illinois; Scott
J. and Sarah J. Molepske, as trustee of
the Scott J. and Sarah J. Molepske trust,
Cedarburg, Wisconsin, as a group acting
in concert; to acquire voting shares of
Bank First National Corporation and
thereby indirectly acquire Bank First
National Association, both of
Manitowoc, Wisconsin.
B. Federal Reserve Bank of
Minneapolis (Mark A. Rauzi, Vice
President), 90 Hennepin Avenue,
Minneapolis, Minnesota 55480–0291:
1. Mark A. Manion; the 2016 Mark A.
Manion and Shelly M Manion Joint
Revocable Trust—Bank Stock (and its
trustees Mark A. Manion and Shelly M.
Manion); John Manion; Mary Jon
Manion; and Gerald J. Manion; all of
Superior, Wisconsin; to retain voting
shares of NATCOM Bancshares, Inc.,
Superior, Wisconsin (NATCOM), and
thereby indirectly retain shares of
National Bank of Commerce, Superior,
Wisconsin, and Republic Bancshares,
Inc. Duluth, Minnesota, and it
subsidiary bank, Republic Bank, Duluth,
Minnesota.
C. Federal Reserve Bank of Kansas
City (Dennis Denney, Assistant Vice
President) 1 Memorial Drive, Kansas
City, Missouri 64198–0001:
1. Carroll D. Esry, Sarasota, Florida,
The Nancy Marie Esry Irrevocable Trust,
Independence, Missouri, The William C.
Esry Family Trust and William C. Esry,
Independence, Missouri, individually
and as trustee, The David Reich Esry
Family Trust and David R. Esry, Lee’s
Summit, Missouri, individually, as
custodian, and as trustee, Marcie Esry
Johnson, Sarasota, Florida, The Carolyn
Marcile Weir Irrevocable Trust,
Independence, Missouri, Weir Farm
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LLC, Independence, Missouri, Robert K.
Weir, Independence, Missouri, William
N. Weir, Blue Springs, Missouri, Susan
Weir Carter, Bay Village, Ohio, and
Geoffrey D. Carter, Bay Village, Ohio; to
become members of the Reich Family
Group, and thereby retain shares of Blue
Ridge Bancshares and its subsidiary,
Bank and Trust Co., both of
Independence, Missouri.
Board of Governors of the Federal Reserve
System, February 6, 2019.
Yao-Chin Chao,
Assistant Secretary of the Board.
[FR Doc. 2019–01842 Filed 2–8–19; 8:45 am]
BILLING CODE 6210–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–2417–N]
RIN 0938–ZB50
Medicaid Program; Final FY 2017 and
Preliminary FY 2019 Disproportionate
Share Hospital Allotments, and Final
FY 2017 and Preliminary FY 2019
Institutions for Mental Diseases
Disproportionate Share Hospital Limits
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) 2017 and the
preliminary federal share DSH
allotments for FY 2019. This notice also
announces the final FY 2017 and the
preliminary FY 2019 limitations on
aggregate DSH payments that states may
make to institutions for mental disease
and other mental health facilities. In
addition, this notice includes
background information describing the
methodology for determining the
amounts of states’ FY DSH allotments.
DATES: This notice is effective March 13,
2019. The final allotments and
limitations set forth in this notice are
applicable for the fiscal years specified.
FOR FURTHER INFORMATION CONTACT:
Stuart Goldstein, (410) 786–0694 and
Richard Cuno, (410) 786–1111.
SUPPLEMENTARY INFORMATION:
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
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state’s DSH payments to DSH hospitals
in the state for the FY. The amount of
such allotment is determined in
accordance with the provisions of
section 1923(f)(3) of the Social Security
Act (the Act), with some state-specific
exceptions as specified in section
1923(f) of the Act. Under such
provisions, in general a state’s FY DSH
allotment is calculated by increasing the
amount of its DSH allotment for the
preceding FY by the percentage change
in the Consumer Price Index for all
Urban Consumers (CPI–U) for the
previous FY.
The Patient Protection and Affordable
Care Act of 2010 (Pub. L. 111–148), as
amended by the Health Care and
Education Reconciliation Act of 2010
(Pub. L. 111–152) (collectively, the
Affordable Care Act), amended
Medicaid DSH provisions, adding
section 1923(f)(7) of the Act. Section
1923(f)(7) would have required
reductions to states’ FY DSH allotments
from FY 2014 through FY 2020, the
calculation of which was described in
the Disproportionate Share Hospital
Payment Reduction final rule published
in the September 18, 2013 Federal
Register (78 FR 57293). Subsequent
legislation, most recently by the
Bipartisan Budget Act of 2018 (Pub. L.
115–123, enacted February 9, 2018),
delayed the start of these reductions
until FY 2020. A proposed rule
delineating a revised methodology for
the calculation of DSH allotment
reductions previously scheduled to
begin in FY 2018 was published in the
July 28, 2017 Federal Register (82 FR
35155).
Because there are no reductions to
DSH allotments for FY 2017 and FY
2019 under section 1923(f)(7) of the Act,
as amended, this notice contains only
the state-specific final FY 2017 DSH
allotments and preliminary FY 2019
DSH allotments, as calculated under the
statute without application of the
reductions that would have been
imposed under the Affordable Care Act
provisions beginning with FY 2014.
This notice also provides information
on the calculation of such FY DSH
allotments, the calculation of the states’
institutions for mental diseases (IMDs)
DSH limits, and the amounts of states’
final FY 2017 IMD DSH limits and
preliminary FY 2019 IMD DSH limits.
B. Determination of Fiscal Year DSH
Allotments
Generally, in accordance with the
methodology specified under section
1923(f)(3) of the Act, a state’s FY DSH
allotment is calculated by increasing the
amount of its DSH allotment for the
preceding FY by the percentage change
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in the CPI–U for the previous FY. Also
in accordance with section 1923(f)(3) of
the Act, a state’s DSH allotment for a FY
is subject to the limitation that an
increase to a state’s DSH allotment for
a FY cannot result in the DSH allotment
exceeding the greater of the state’s DSH
allotment for the previous FY or 12
percent of the state’s total medical
assistance expenditures for the
allotment year (this is referred to as the
12 percent limit).
Furthermore, under section 1923(h) of
the Act, federal financial participation
(FFP) for DSH payments to IMDs and
other mental health facilities is limited
to state-specific aggregate amounts.
Under this provision, the aggregate limit
for DSH payments to IMDs and other
mental health facilities is the lesser of
a state’s FY 1995 total computable (state
and federal share) IMD and other mental
health facility DSH expenditures
applicable to the state’s FY 1995 DSH
allotment (as reported on the Form
CMS–64 as of January 1, 1997), or the
amount equal to the product of the
state’s current year total computable
DSH allotment and the applicable
percentage specified in section 1923(h)
of the Act.
In general, we determine states’ DSH
allotments for a FY and the IMD DSH
limits for the same FY using the most
recent available estimates of or actual
medical assistance expenditures,
including DSH expenditures in their
Medicaid programs and the most recent
available change in the CPI–U used for
the FY in accordance with the
methodology prescribed in the statute.
The indicated estimated or actual
expenditures are obtained from states
for each relevant FY from the most
recent available quarterly Medicaid
budget reports (Form CMS–37) or
quarterly Medicaid expenditure reports
(Form CMS–64), respectively, submitted
by the states. For example, as part of the
initial determination of a state’s FY DSH
allotment (referred to as the preliminary
DSH allotments) that is determined
before the beginning of the FY for which
the DSH allotments and IMD DSH limits
are being determined, we use estimated
expenditures for the FY obtained from
the August submission of the CMS–37
submitted by states prior to the
beginning of the FY; such estimated
expenditures are subject to update and
revision during the FY before such
actual expenditure data become
available. We also use the most recent
available estimated CPI–U percentage
change that is available before the
beginning of the FY for determining the
states’ preliminary FY DSH allotments;
such estimated CPI–U percentage
change is subject to update and revision
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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.
We will publish states’ final FY 2019
DSH allotments in a future notice based
on the states’ four quarterly Medicaid
expenditure reports (Form CMS–64) for
FY 2019 available following the end of
FY 2019 utilizing the actual change in
the CPI–U for FY 2018.
II. Provisions of the Notice
B. Calculation of the Final FY 2017 and
Preliminary FY 2019 IMD DSH Limits
Section 1923(h) of the Act specifies
the methodology to be used to establish
the limits on the amount of DSH
payments that a state can make to IMDs
and other mental health facilities. FFP
is not available for DSH payments to
IMDs or other mental health facilities
that exceed the IMD DSH limits. In this
notice, we are publishing the final FY
2017 and the preliminary FY 2019 IMD
DSH limits determined in accordance
with the provisions discussed above.
Addendums 3 and 4 to this notice
detail each state’s final FY 2017 and
preliminary FY 2019 IMD DSH limit,
respectively, determined in accordance
with section 1923(h) of the Act.
A. Calculation of the Final FY 2017
Federal Share State DSH Allotments,
and the Preliminary FY 2019 Federal
Share State DSH Allotments
1. Final FY 2017 Federal Share State
DSH Allotments
Addendum 1 to this notice provides
the states’ final FY 2017 DSH allotments
determined in accordance with section
1923(f)(3) of the Act. As described in the
background section, in general, the DSH
allotment for a FY is calculated by
increasing the FY DSH allotment for the
preceding FY by the CPI–U increase for
the previous fiscal year. For purposes of
calculating the states’ final FY 2017
DSH allotments, the preceding final
fiscal year DSH allotments (for FY 2016)
were published in the July 6, 2018
Federal Register (83 FR 31536). For
purposes of calculating the states’ final
FY 2017 DSH allotments we are using
the actual Medicaid expenditures for FY
2017. Finally, for purposes of
calculating the states’ final FY 2017
DSH allotments, the applicable
historical percentage change in the CPI–
U for the previous FY (FY 2016) was 0.9
percent; we note that this is the same as
the estimated 0.9 percentage change in
the CPI–U for FY 2016 that was
available and used in the calculation of
the preliminary FY 2017 DSH
allotments which were published in the
November 3, 2017 Federal Register (82
FR 51259).
2. Calculation of the Preliminary FY
2019 Federal Share State DSH
Allotments
Addendum 2 to this notice provides
the preliminary FY 2019 DSH
allotments determined in accordance
with section 1923(f)(3) of the Act. The
preliminary FY 2019 DSH allotments
contained in this notice were
determined based on the most recent
available estimates from states of their
FY 2019 total computable Medicaid
expenditures. Also, the preliminary FY
2019 allotments contained in this notice
were determined by increasing the
preliminary FY 2018 DSH allotments.
The estimated percentage increase in
the CPI–U for FY 2018 was 2.4 percent
(CMS originally published the
preliminary FY 2018 DSH allotments in
the July 6, 2018 Federal Register (83 FR
31536)).
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III. Collection of Information
Requirements
As it relates to the Paperwork
Reduction Act of 1995 (44 U.S.C. 3501
et seq.), this notice does not impose any
new or revised collection of information
requirements or burden. While
discussed in section I.B. and in
Addendums 3 and 4 of this notice, the
requirements and burden associated
with Form CMS–37 and Form CMS–64
are unaffected by this notice. Both forms
are approved by the Office of
Management and Budget (OMB) under
control number 0938–1265. Since this
notice will not impose any new or
revised requirements/burden, we are not
making any changes under that control
number.
IV. Regulatory Impact Analysis
We have examined the impact of this
notice as required by Executive Order
12866 on Regulatory Planning and
Review (September 1993), the
Regulatory Flexibility Act (RFA)
(September 19, 1980, Pub. L. 96–354),
section 1102(b) of the Act, section 202
of the Unfunded Mandates Reform Act
of 1995 (Pub. L. 104–4; enacted on
March 22, 1995) (UMRA ‘95), Executive
Order 13132 on Federalism (August 4,
1999) and the Congressional Review Act
(5 U.S.C. 804(2)), and Executive Order
13771 on Reducing Regulation and
Controlling Regulatory Costs (January
30, 2017).
Executive Order 12866 directs
agencies to assess all costs and benefits
of available regulatory alternatives and,
if regulation is necessary, to select
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Federal Register / Vol. 84, No. 28 / Monday, February 11, 2019 / Notices
regulatory approaches that maximize
net benefits (including potential
economic, environmental, public health
and safety effects, distributive impacts,
and equity). A regulatory impact
analysis (RIA) must be prepared for
major rules with economically
significant effects ($100 million or more
in any 1 year). This notice reaches the
$100 million economic threshold and
thus is considered a major rule under
the Congressional Review Act.
The final FY 2017 DSH allotments
being published in this notice are equal
to the preliminary FY 2017 DSH
allotments published in the November
3, 2017 Federal Register (82 FR 51259).
This is due to the actual percentage
change in the CPI–U for FY 2016 used
in the calculation of the final FY 2017
allotments (0.9 percent) being equal to
the estimated percentage change in the
CPI–U for FY 2016 used in the
calculation of the preliminary FY 2017
allotments (0.9 percent). The final FY
2017 IMD DSH limits being published
in this notice are also equal to the
preliminary FY 2017 IMD DSH limits
published in the November 3, 2017
Federal Register (82 FR 51259). Since
the final FY 2017 DSH allotments were
equal to the preliminary FY 2017 DSH
allotments, the associated FY 2017 IMD
DSH limits also remained the same.
The preliminary FY 2019 DSH
allotments being published in this
notice have been increased by
approximately $295 million more than
the preliminary FY 2018 DSH
allotments published in the July 6, 2018
Federal Register (83 FR 31536). The
increase in the DSH allotments is due to
the application of the statutory formula
for calculating DSH allotments under
which the prior fiscal year allotments
are increased by the percentage increase
in the CPI–U for the prior fiscal year.
The preliminary FY 2019 IMD DSH
limits being published in this notice are
approximately $24 million more than
the preliminary FY 2018 IMD DSH
limits published in the July 6, 2018
Federal Register (83 FR 31536). The
increases in the IMD DSH limits are
because the DSH allotment for a FY is
a factor in the determination of the IMD
DSH limit for the FY. Since the
preliminary FY 2019 DSH allotments
are greater than the preliminary FY 2018
DSH allotments, the associated
preliminary FY 2019 IMD DSH limits
for some states also increased.
The RFA requires agencies to analyze
options for regulatory relief of small
businesses, if a rule has a significant
impact on a substantial number of small
entities. For purposes of the RFA, small
entities include small businesses,
nonprofit organizations, and small
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governmental jurisdictions. Most
hospitals and most other providers and
suppliers are small entities, either by
nonprofit status or by having revenues
of less than $7.5 million to $38.5
million in any one year. Individuals and
states are not included in the definition
of a small entity. We are not preparing
an analysis for the RFA because the
Secretary has determined that this
notice will not have significant
economic impact on a substantial
number of small entities. Specifically,
any impact on providers is due to the
effect of the various controlling statutes;
providers are not impacted as a result of
the independent regulatory action in
publishing this notice. The purpose of
the notice is to announce the latest DSH
allotments and IMD DSH limits, as
required by the statute.
In addition, section 1102(b) of the Act
requires us to prepare a regulatory
impact analysis if a rule may have a
significant impact on the operations of
a substantial number of small rural
hospitals. This analysis must conform to
the provisions of section 604 of the
RFA. For purposes of section 1102(b) of
the Act, we define a small rural hospital
as a hospital that is located outside of
a Core-Based Statistical Area for
Medicaid payment regulations and has
fewer than 100 beds. We are not
preparing analysis for section 1102(b) of
the Act because the Secretary has
determined that this notice will not
have a significant impact on the
operations of a substantial number of
small rural hospitals.
The Medicaid statute specifies the
methodology for determining the
amounts of states’ DSH allotments and
IMD DSH limits; and as described
previously, the application of the
methodology specified in statute results
in the decreases or increases in states’
DSH allotments and IMD DSH limits for
the applicable FYs. The statute
applicable to these allotments and limits
does not apply to the determination of
the amounts of DSH payments made to
specific DSH hospitals; rather, these
allotments and limits represent an
overall limit on the total of such DSH
payments. For this reason, we do not
believe that this notice will have a
significant economic impact on a
substantial number of small entities.
Section 202 of the Unfunded
Mandates Reform Act of 1995 also
requires that agencies assess anticipated
costs and benefits before issuing any
rule whose mandates require spending
in any 1 year of $100 million in 1995
dollars, updated annually for inflation.
In 2018, that threshold is approximately
$150 million. This notice will have no
consequential effect on spending by
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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 2018 to FY 2019.
TABLE 1—ACCOUNTING STATEMENT:
CLASSIFICATION OF ESTIMATED EXPENDITURES, FROM THE FY 2018 TO
FY 2019
[in Millions]
Category
Annualized Monetized
Transfers.
From Whom To
Whom?
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Transfers
$295.
Federal Government
to States.
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C. Congressional Review Act
This proposed regulation is subject to
the Congressional Review Act
provisions of the Small Business
Regulatory Enforcement Fairness Act of
1996 (5 U.S.C. 801 et seq.) and has been
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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.
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Dated: January 9, 2019.
Seema Verma,
Administrator, Centers for Medicare &
Medicaid Services.
Dated: January 18, 2019.
Alex M. Azar II,
Secretary, Department of Health and Human
Services.
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Column J ........................
Column I .........................
Column H ........................
Column G .......................
Column F ........................
Column E ........................
Column D ........................
Column C ........................
Column A ........................
Column B ........................
Column
State.
FY 2017 FMAPs.
This column contains the States’ FY 2017 Federal Medical Assistance Percentages.
Prior FY (2016) DSH Allotments.
This column contains the States’ prior FY 2016 DSH Allotments.
Prior FY (2016) DSH Allotments (Col C) × (100 percent + Percentage Increase in CPIU): 100.9 percent.
This column contains the amount in Column C increased by 1 plus the percentage increase in the CPI–U for the prior FY (100.9 percent).
FY 2017 TC MAP Exp. Including DSH.
This column contains the amount of the States’ FY 2017 total computable (TC) medical assistance expenditures including DSH expenditures.
FY 2017 TC DSH Expenditures.
This column contains the amount of the States’ FY 2017 total computable DSH expenditures.
FY 2017 TC MAP Exp. Net of DSH.
This column contains the amount of the States’ FY 2017 total computable medical assistance expenditures net of DSH expenditures, calculated as the amount in
Column E minus the amount in Column F.
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 2016 Allotment or 12 percent Limit.
This column contains the greater of the State’s prior FY (FY 2016) DSH allotment or the amount of the 12 percent Limit, determined as the greater of the amount
in Column C or Column H.
FY 2017 DSH Allotment.
This column contains the States’ final FY 2017 DSH allotments, determined as the lesser of the amount in Column I or Column D.
For states with ‘‘na’’ in Columns I or D, refer to the footnotes in the addendum.
Description
KEY TO ADDENDUM 1—FINAL DSH ALLOTMENTS FOR FY 2017
[The Final FY 2017 DSH Allotments for the NON-Low DSH States are presented in the top section of this addendum, and the Final FY 2017 DSH Allotments for the Low-DSH States are
presented in the bottom section of this addendum.]
Federal Register / Vol. 84, No. 28 / Monday, February 11, 2019 / Notices
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B
c
STATE
FY 2017
FMAPs
Prior FY 2016
DSH Allotments
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11FEN1
ALABAMA
ARIZONA
CALIFORNIA
COLORADO
CONNECTICUT
DISTRICT OF
COLUMBIA
FLORIDA
GEORGIA
ILLINOIS
INDIANA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MISSISSIPPI
MISSOURI
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW YORK
NORTH CAROLINA
OHIO
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
TENNESSEE/1
TEXAS
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
TOTAL
f~~Q.JJ\!c$-:rAl
ALASKA
ARKANSAS
DELAWARE
HAWAII
IDAHO
IOWA
MINNESOTA
MONTANA
70.16%
69.24%
50.00%
50.02%
50.00%
$334,515,508
$110,145,351
$1.192.561.384
$100,626,616
$217,571,062
D
Prior FY 2016
DSH Allotment
(Col C)x
100% +Pet
Increase in
CPIU:
100.9%
$337,526,148
$111,136,659
$1.203.294,436
$101,532,256
$219,529,202
70.00%
61.10%
67.89%
51.30%
66.74%
56.21%
70.46%
62.28%
64.38%
50.00%
50.00%
65.15%
74.63%
63.21%
64.67%
50.00%
50.00%
50.00%
66.88%
62.32%
51.78%
51.02%
71.30%
$66,631,138
$217,571,062
$292,361,115
$233,888,892
$232,529,074
$44,874,031
$157,739,021
$745,902,374
$114,224,807
$82,948,968
$331,795,869
$288,281,658
$165,897,935
$515,371,453
$50,313,307
$174,164,027
$700,306,857
$1,747,367,593
$320,917,316
$441,941,221
$610,558,793
$70,710,595
$356,272,614
$67,230,818
$219,529,202
$294,992,365
$235,993,892
$234,621,836
$45,277,897
$159,158,672
$752,615,495
$115,252,830
$83,695,509
$334,782,032
$290,876,193
$167,391,016
$520,009,796
$50,766,127
$175,731,503
$706,609,619
$1,763,093,901
$323,805,572
$445,918,692
$616,053,822
$71,346,990
$359,4 79,068
Na
E
F
FY 2017
TC MAP Exp.
Including DSH
FY 2017
TCDSH
Expenditures
$5,562,217,922
$11,823,748,029
$82.384.159.833
$7,805,267,931
$7,401,263,576
$480,408,569
$164,081,775
-$886.530,175
$207,925,056
$132,567,167
FY 2017
TC MAP EXP.
Net Of DSH
ColE- F
$5,081,809,353
$11,659,666,254
$83,270,690,008
$7,597,342,875
$7,268,696,409
$2,783,205,645
$23,169,178,008
$10,105,996,059
$15,054,073,075
$11,106,189,855
$3,214,420,673
$9,527,255,650
$10,913,541,197
$2,565,081,585
$11,161,406,671
$17,120,855,005
$16,711,203,272
$5,462,308,168
$10,095,843,109
$3,530,342,184
$2,055,4 79,922
$14,743,851,829
$76,398,082,879
$13,336,810,348
$23,055,842,742
$28,081,163,760
$2,623,111,291
$5,963,952,005
$49,184,071
$356,602,255
$434,087,521
$431,810,683
$496,410,518
$66,201,160
$217,299,749
$1,151,159,009
$42,099,548
$144,378,107
$0
$268,324,716
$224,073,780
$667,708,187
$58,894,271
$252,267,168
$801 ,494,014
$2,953,053,712
$512,847,227
$1,328,804,378
$873,072,746
$139,686,367
$495,775,952
$2,734,021,574
$22,812,575,753
$9,671,908,538
$14,622,262,392
$10,609,779,337
$3,148,219,513
$9,309,955,901
$9,762,382,188
$2,522,982,037
$11,017,028,564
$17,120,855,005
$16,442,878,556
$5,238,234,388
$9,428,134,922
$3,471,447,913
$1,803,212,754
$13,942,357,815
$73,445,029,167
$12,823,963,121
$21,727,038,364
$27,208,091,014
$2,483,424,924
$5,468,176,053
na
na
na
na
na
56.18%
54.46%
50.00%
50.00%
71.80%
0.00%
$1 ,040,261,642
$24,476,746
$95,304,365
$201 ,253,233
$73,430,234
$11 ,405,815,861
$1,049,623,997
$24,697,037
$96,162,104
$203,064,512
$74,091,106
$11 ""' RQn -.n,
$35,644,874,349
$1 ,600,236, 799
$8,987,642,645
$11 ,892,840,575
$4,000,838,793
$495,RR? ?R<; "<R•
$1,806,598,650
$37,448,780
$53,082,085
$388,819,411
$72,482,635
$14,422,119,092
$33,838,275,699
$1,562,788,019
$8,934,560,560
$11,504,021,164
$3,928,356,158
$481 ,460,166,292
50.00%
69.69%
54.20%
54.93%
71.51%
56.74%
50.00%
65.56%
$22,159,278
$46,927,667
$9,848,568
$1 0,602,012
$17,881 ,623
$42,840,981
$81 ,250,689
$12,348,001
t'],ijt';,i~
'""<<if• i'"f :;i;J ,,;i':'1if:'~"i'•5: •
$22,358,712
$4 7,350,016
$9,937,205
$10,697,430
$18,042,558
$43,226,550
$81 ,981 ,945
$12,459,133
iff:
H
I
J
"12% Amount"
=Col G x
.12/(1-.12/Col B)*
(In FS)
$735,639,087
$1,692,484,888
$13,148,003,685
$1,199,429,008
$1,147,688,907
Greater of
Col H Or Col C
(12% Limit, 2016
Allotment)
$735,639,087
$1,692,484,888
$13,148,003,685
$1,199,429,008
$1,147,688,907
FY 2017
Allotment
$395,961,745
$3,406,554,082
$1 ,409,824, 736
$2,290,449,040
$1,552,276,229
$480,329,569
$1 ,346,519,657
$1,451,076,761
$372,118,175
$1,739,530,826
$2,703,292 ,896
$2,418,634,516
$749,026,535
$1 ,396,490, 705
$511,483,281
$284,717,803
$2,201,424,918
$11,596,583,553
$1 ,875,364,403
$3,229,004,048
$4,249,879,194
$389,659,681
$788,966,514
$395,961,745
$3,406,554,082
$1 ,409,824, 736
$2,290,449,040
$1,552,276,229
$480,329,569
$1 ,346,519,657
$1,451,076,761
$372,118,175
$1,739,530,826
$2,703,292,896
$2,418,634,516
$749,026,535
$1 ,396,490, 705
$511 ,483,281
$284,717,803
$2,201,424,918
$11,596,583,553
$1 ,875,364,403
$3,229,004,048
$4,249,879,194
$389,659,681
$788,966,514
G
na
$5,163,515,606
$240,535,381
$1,410,720,088
$1,816,424,394
$565,998,606
$73, Qo;Q o;nR "16
":''>02°:";,,•3i< \;;;:;~ ''2:'./?:'i;;Y: ,:;fi·~:~:;: Xri: :~;-:;,c:~:·£
$1 ,961,572,200
$6,363,923,522
$2,133,796,292
$2,338,436,723
$1,822,302,321
$4,065,931,964
$11 ,351 ,993,115
$1,772,437,233
$19,537,769
$67,027,876
$27,886,500
$26,393,201
$26,501 ,457
$54,578,184
$85,897,820
$18,950,608
$1,942,034,431
$6,296,895,646
$2,105,909,792
$2,312,043,522
$1,795,800,864
$4,011,353,780
$11,266,095,295
$1,753,486,625
$306,637,015.42
$912,804,280
$324,569,604
$354,998,045.18
$258,950,199.53
$610,471,739
$1,778,857,152
$257,562,173
na
$5,163,515,606
$240,535,381
$1 ,41 0, 720,088
$1,816,424,394
$565,998,606
$73,Q"Q o;nR ~16
;t;,:{~:'y: •• t::
$306,637,015
$912,804,280
$324,569,604
$354,998,045
$258,950,200
$610,471,739
$1,778,857,152
$257,562,173
MIN Coli, ColD
$337,526,148
$111,136,659
$1 ,203,294,436
$101,532,256
$219,529,202
$67,230,818
$219,529,202
$294,992,365
$235,993,892
$234 621 836
$45 277 897
$159,158,672
$752,615,495
$115,252,830
$83,695,509
$334,782,032
$290,876,193
$167,391,016
$520,009,796
$50,766,127
$175,731,503
$706,609,619
$1,763,093,901
$323,805,572
$445,918,692
$616,053,822
$71,346,990
$359,4 79,068
$53,100,000
$1,049,623,997
$24,697,037
$96,162,104
$203,064,512
$74,091,106
$11,507,990,304
:"> 'ii•'ii'ZC ' :;0''\'F~pfj~.
$22,358,712
$4 7,350,016
$9,937,205
$1 0,697,430
$18,042,558
$43,226,550
$81,981,945
$12,459,133
Federal Register / Vol. 84, No. 28 / Monday, February 11, 2019 / Notices
18:05 Feb 08, 2019
EN11FE19.003</GPH>
ADDENDUM 1: FINAL DSH ALLOTMENTS FOR FISCAL YEAR: 2017
A
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FY 2017
FMAPs
Prior FY 201 S
DSH Allotments
FY 2017
TC MAP Exp.
Including DSH
FY 2017
TCDSH
Expenditures
"12% Amount"
=Col G x
.12/(1-.12/Col B)*
FY 2017
Allotment
Fmt 4703
Sfmt 4725
E:\FR\FM\11FEN1.SGM
11FEN1
Federal Register / Vol. 84, No. 28 / Monday, February 11, 2019 / Notices
18:05 Feb 08, 2019
STATE
DSH Allotment
(Col C)x
100% +Pet
Increase in
CPIU:
3175
EN11FE19.004</GPH>
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Column J ........................
Column I .........................
Column H ........................
Column G .......................
Column F ........................
Column E ........................
Column D ........................
Column C ........................
Column A ........................
Column B ........................
Column
State.
FY 2019 FMAPs.
This column contains the States’ FY 2019 Federal Medical Assistance Percentages.
Prior FY (2018) DSH Allotments.
This column contains the States’ prior preliminary FY 2018 DSH Allotments.
Prior FY (2018) 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 2019 TC MAP Exp. Including DSH.
This column contains the amount of the States’ projected FY 2019 total computable (TC) medical assistance expenditures including DSH expenditures.
FY 2019 TC DSH Expenditures.
This column contains the amount of the States’ projected FY 2019 total computable DSH expenditures.
FY 2019 TC MAP Exp. Net of DSH.
This column contains the amount of the States’ projected FY 2019 total computable medical assistance expenditures net of DSH expenditures, calculated as the
amount in Column E minus the amount in Column F.
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 2018 Allotment or 12 percent Limit.
This column contains the greater of the State’s preliminary prior FY (FY 2018) DSH allotment or the amount of the 12 percent Limit, determined as the greater of
the amount in Column C or Column H.
FY 2019 DSH Allotment.
This column contains the States’ preliminary FY 2018 DSH allotments, determined as the lesser of the amount in Column I or Column D.
For states with ‘‘na’’ in Columns I or D, refer to the footnotes in the addendum.
Description
KEY TO ADDENDUM 2—PRELIMINARY DSH ALLOTMENTS FOR FY 2019
[The Preliminary FY 2019 DSH Allotments for the NON-Low DSH States are presented in the top section of this addendum, and the Preliminary FY 2019 DSH Allotments for the Low-DSH
States are presented in the bottom section of this addendum.]
3176
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11FEN1
ALABAMA
ARIZONA
CALIFORNIA
COLORADO
CONNECTICUT
DISTRICT OF
COLUMBIA
FLORIDA
GEORGIA
ILLINOIS
INDIANA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MISSISSIPPI
MISSOURI
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW YORK
NORTH CAROLINA
OHIO
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
TENNESSEE 11
TEXAS
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
TOTAL
~~li;~~;lii~AT~it ..
ALASKA
ARKANSAS
DELAWARE
HAWAII
IDAHO
IOWA
MINNESOTA
c
B
FY 2019
FMAPs
71.88%
69.81%
50.00%
50.00%
50.00%
Prior FY (2018)
DSH Allotments
$345,626,776
$113,803,939
$1,232,173,502
$103,969,030
$224,797,903
D
Prior FY (2018)
DSH Allotment (Col
C)x
100% + Pet Increase
inCPIU:
102.4%
$353,921,819
$116,535,234
$1,261,745,666
$106,464,287
$230,193,053
70.00%
60.87%
67.62%
50.31%
65.96%
57.10%
71.67%
65.00%
64.52%
50.00%
50.00%
64.45%
76.39%
65.40%
64.87%
50.00%
50.00%
50.00%
67.16%
63.09%
52.25%
52.57%
71.22%
65.87%
58.19%
53.89%
50.00%
50.00%
74.34%
$68,844,358
$224,797,903
$302,072,182
$241,657,745
$240,252,760
$46,364,567
$162,978,480
$770,678,267
$118,018,898
$85,704,201
$342,816,801
$297,857,222
$171,408,400
$532,490,031
$51,984,514
$179,949,059
$723,568,250
$1,805,408,155
$331,576,906
$456,620,741
$630,839,114
$73,059,318
$368,106,566
$70,496,623
$230,193,053
$309,321,914
$247,457,531
$246,018,826
$47,477,317
$166,889,964
$789,174,545
$120,851,352
$87,761,102
$351,044,404
$305,005,795
$175,522,202
$545,269,792
$53,232,142
$184,267,836
$7 40,933,888
$1,848,737,951
$339,534,752
$467,579,639
$645,979,253
$74,812,742
$376,941 '124
na
na
$1,074,814,973
$25,289,766
$98,469,994
$207,938,060
$75,869,293
$11,729,807,674
$22,895,321
$48,486,416
$10175698
$10,954,168
$18,475,579
$44,263,987
$83,949,512
FY 2019
TCMAP Exp.
lncludin~ DSH
$6,280,192,000
$13,428,163,000
$1 04,583,960,000
$9,145,108,000
$8,330,063,000
$3,012,234,000
$25,053,776,000
$11 ,526,583,000
$19,952,428,000
$12,453,054,000
$3,840,852,000
$10,874,150,000
$13,129,744,000
$2 '726,913,000
$11,934,197,000
$19,818,664,000
$17,538,605,000
$5,921,982,000
$11 ,298,434,000
$4,040,258,000
$2,499,517,000
$16,527,927,000
$80,839,319,000
$14,215,223,000
$24,926,290,000
$32,670,599,000
$2,963,205,000
$6,215,440,000
na
$1,100,610,532
$25,896,720
$100,833,274
$212,928,573
$77,690,156
$12,011 ,323,058
%;; ,;;;rc.~'4~'l:'i
50.00%
70.51%
57.55%
53.92%
71.13%
59.93%
50.00%
E
$23,444,809
$49,650,090
$10 419 915
$11 ,217,068
$18,918,993
$45,326,323
$85,964,300
F
~ii;~~;,;.;;;;;;+;
$2,376,4 70,000
$6,576,660,000
$2,185,750,000
$2,247,589,000
$2,218,653,000
$4,919,113,000
$13,426,006,000
H
I
$480,000,000
$140,010,000
$0
$202,687,000
$136,286,000
FY 2019
TC MAP EXP.
Net of DSH
ColE- F
$5,800,192,000
$13,288,153,000
$104,583,960,000
$8,942,421,000
$8,193,777,000
"12% Amount"
=Col G x
.12(1-.12/Col B)*
(In FS)
$835,506,615
$1,925,575,425
$16,513,256,842
$1,411,961,211
$1 ,293, 754,263
Greater of
Col H or Col C
(12% Limit, FY
2018
Allotment)
$835,506,615
$1,925,575,425
$16,513,256,842
$1,411,961,211
$1,293,754,263
$40,891,000
$369,308,000
$440,981,000
$442,416,000
$170,025,000
$70,945,000
$244,000,000
$1,087,219,000
$40,799,000
$106,746,000
$0
$357,207,000
$235,007,000
$758,762,000
$74,138,000
$255,248,000
$805,473,000
$7,102,017,000
$575,038,000
$0
$943,669,000
$144,840,000
$526,257,000
$2,971,343,000
$24,684,468,000
$11,085,602,000
$19,510,012,000
$12,283,029,000
$3,769,907,000
$10,630,150,000
$12,042,525,000
$2,686,114,000
$11,827,451,000
$19,818,664,000
$17,181,398,000
$5,686,975,000
$10,539,672,000
$3,966,120,000
$2,244,269,000
$15,722,454,000
$73,737,302,000
$13,640,185,000
$24,926,290,000
$31,726,930,000
$2,818,365,000
$5,689,183,000
$430,332,434
$3,689,486,967
$1,617,278,117
$3,074,545,666
$1,801,753,728
$572,758,376
$1,532,152,540
$1,772,296,132
$395,981 ,893
$1,867,492,263
$3,129,262,737
$2,533,4 78,21 0
$809,618,923
$1 ,548,976,514
$583,958,096
$354,358,263
$2,482,492,737
$11,642,731,895
$1,992,911,149
$3,693,716,115
$4,942,306,860
$438,239,432
$821 ,040, 756
$430,332,434
$3,689,486,967
$1,617,278,117
$3,074,545,666
$1,801,753,728
$572,758,376
$1,532,152,540
$1,772,296,132
$395,981,893
$1,867,492,263
$3,129,262,737
$2,533,478,210
$809,618,923
$1,548,976,514
$583,958,096
$354,358,263
$2,482,492,737
$11,642,731,895
$1,992,911 '149
$3,693,716,115
$4,942,306,860
$438,239,432
$821,040,756
FY 2019
TCDSH
Expenditures
na
$42,514,296,000
$1,638,779,000
$9,889,307,000
$13,418,438,000
$4,1 03,344,000
$567,311,044,000
G
na
$1,888,401,000
$22,704,000
$209,477,000
$398,846,000
$73,000,000
$18,342,397,000
i;!{:·Wi-.ifg
$17,193,000
$48,379,000
$14,062,000
$0
$24,812,000
$75,692,000
$15,707,000
na
$40,625,895,000
$1,616,075,000
$9,679,830,000
$13,019,592,000
$4,030,344,000
~~d.R ~I:R 1:.1.7,000
cs;:l;c::•Y:i;t,
$2,359,277,000
$6,528,281,000
$2' 171 ,688,000
$2,247,589,000
$2,193,841,000
$4,843,421,000
$13,410,299,000
$6,141 ,643,204
$249,482,784
$1 ,528,394,211
$2,055,725,053
$5 76,738,735
~~ . ?~~ ?nR 1.1.~
ij'"L,: );I~ f·{i(.{(;i•)i:;ff:
$372,517,421.05
$944,062,403
$329,257,461
$346,917,935.73
$316,687,793.67
$726,725,359
$2,117,415,632
na
$6,141,643,204
$249,482' 784
$1,528,394,211
$2,055,725,053
$576,738,735
~Rd. ?~~ ?nR 1.1~
m.<w!:·;·;;:'ii
$372,517,421
$944,062,403
$329,257,461
$346,917,936
$316,687,794
$726,725,359
$2,117,415,632
J
FY 2019 DSH
Allotment
MIN Col I Col D
$353,921,819
$116,535,234
$1,261 '745,666
$106,464,287
$230,193,053
$70,496,623
$230 193 053
$309,321,914
$247,457,531
$246,018,826
$47,477,317
$166,889,964
$789,174,545
$120,851,352
$87,761,102
$351 044 404
$305,005,795
$175,522,202
$545,269,792
$53 232142
$184,267,836
$740,933,888
$1,848,737,951
$339,534,752
$467,579,639
$645,979,253
$74,812,742
$376,941,124
$53 100 000
$1 '100,610,532
$25,896,720
$100,833,274
$212,928,573
$77,690,156
$1? n~:, .1.?~,061
·::;
$23,444,809
$49,650,090
$10 419 915
$11,217,068
$18,918,993
$45,326,323
$85,964,300
Federal Register / Vol. 84, No. 28 / Monday, February 11, 2019 / Notices
18:05 Feb 08, 2019
ADDENDUM 2: PRELIMINARY DSH ALLOTMENTS FOR FISCAL YEAR: 2019
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STATE
MONTANA
NEBRASKA
NEW MEXICC
NORTH DAKOTA
•MA
c
B
FY 2019
FMAPs
65.54%
52.58%
5%
Prior FY (2018)
DSH Allotments
D
Prior FY (2018)
DSH Allotment (Col
C)x
100% + Pet Increase
inCPIU:
102.4%
~12,758,152
~13,064,348
~31 ,806,904
S32,570,270
FY 2019
TCMAP Exp.
lncludin~ DSH
~1 ,871,462,000
~2 ,246,3 70,000
lJ
H
G
FY 2019
TCDSH
Expenditures
$22,011,000
$41 ,905 '000
FY 2019
TC MAP EXP.
Net of DSH
ColE- F
~1 ,849,451,000
~2,204,465,000
$:
.3~
"12% Amount"
=Col G x
.12(1-.12/Col B)*
(In FS)
$271,676,545
$342,762,256
lSi
l3i
I
Greater of
Col H or Col C
(12% Limit, FY
2018
Allotment)
~271 ,676,545
~342,762,256
$43,9<
$'
Sl
F
E
~
$'
$'
$'
$'
$'
lAKOTA
-.1-N--
$•
$•
$;
$9,16€
$:
$;
$11
$9
FOOTNOTES: 11 Tennessee's DSH allotment for FY 2019, determined under section 1923(f)(6)(A) of the Social Security Act, is $53,100,000.
J
FY 2019 DSH
Allotment
MIN Coli, Col D
~13,064,348
S32,570,270
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Column K ........................
Column J ........................
Column I .........................
Column G .......................
Column H ........................
Column F ........................
Column E ........................
Column D ........................
Column C ........................
Column A ........................
Column B ........................
Column
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 2017 Federal Share DSH Allotment.
This column contains the states’ FY 2017 DSH allotments from Addendum 1, Column J.
FY 2017 FMAP.
FY 2017 DSH Allotments in Total Computable, Col. F/G.
This column contains states’ FY 2017 total computable DSH allotment (determined as Column F/Column G).
Applicable Percentage Applied to FY 2017 Allotments in TC, Col E × Col H.
This column contains the applicable percentage of FY 2017 total computable DSH allotment (calculated as the percentage in Column E multiplied by the amount
in Column H).
FY 2017 TC IMD DSH Limit. Lesser of Col. I or C.
This column contains the total computable FY 2017 TC IMD DSH Limit equal to the lesser of the amount in Column I or Column C.
FY 2017 IMD DSH Limit in Federal Share, Col. G × J.
This column contains the FY 2017 Federal Share IMD DSH limit determined by converting the total computable FY 2017 IMD DSH Limit from Column J into a
federal share amount by multiplying it by the FY 2016 FMAP in Column G.
Description
KEY TO ADDENDUM 3—FINAL IMD DSH LIMITS FOR FY 2017
[The final FY 2017 IMD DSH Limits for the Non-Low DSH States are presented in the top section of this addendum and the preliminary FY 2017 IMD DSH Limits for the Low-DSH States
are presented in the bottom section of the addendum.]
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11FEN1
STATE
ALABAMA
ARIZONA
CALIFORNIA
COLORADO
CONNECTICUT
DISTRICT OF
COLUMBIA
FLORIDA
GEORGIA
ILLINOIS
INDIANA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETIS
MICHIGAN
MISSISSIPPI
MISSOURI
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW YORK
NORTH CAROLINA
OHIO
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
TENNESSEE
TEXAS
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
TOTAL
B
EN11FE19.007</GPH>
D
E
Applic
able
Perc en
t
Col
CID
1.07%
23.27%
0.07%
0.34%
25.82%
Inpatient Hospital
Services FY 95
DSH
Total Computable
$413,006,229
$93,916,100
$2,189,879,543
$173,900,441
$303,359,275
IMD And Mental
Health Services
FY95 DSH
Total Computable
$4,451,770
$28,474,900
$1,555,919
$594,776
$105,573,725
Total Inpatient &
IMD&Mental
Health FY 95 DSH
Total Computable
$417,457,999
$122,391,000
$2,191,435,462
$174,495,217
$408,933,000
$39,532,234
$184,468,014
$407,343,557
$315,868,508
$79,960,783
$11,587,208
$158,804,908
$1,078,512,169
$99,957,958
$22,226,467
$469,653,946
$133,258,800
$182,608,033
$521,946,524
$73,560,000
$92,675,916
$736,742,539
$2,418,869,368
$193,201 ,966
$535,731,956
$388,207,319
$108,503,167
$366,681,364
$0
$1,220,515,401
$19,979,252
$129,313,480
$171,725,815
$66,962,606
$13,4(
$6,545,136
$149,714,986
$0
$89,408,276
$153,566,302
$76,663,508
$37,443,073
$132,917,149
$60,958,342
$120,873,531
$105,635,054
$304,765,552
$0
$207,234,618
$0
$94,753,948
$357,370,461
$605,000,000
$236,072,627
$93,432,758
$579,199,682
$2,397,833
$72,076,341
$0
$292,513,592
$9,071,297
$7,770,268
$163,836,435
$18,887,045
$4,118,758,904
$46,077,370
$334,183,000
$407,343,557
$405,276,784
$233,527,085
$88,250,716
$196,247,981
$1,211,429,318
$160,916,300
$143,099,998
$575,289,000
$438,024,352
$182,608,033
$729,181,142
$73,560,000
$187,429,864
$1,094,113,000
$3,023,869,368
$429,274,593
$629,164,714
$967,407,001
$110,901,000
$438,757 '705
$0
$1,513,028,993
$29,050,549
$137,083,748
$335,562,250
$85,849,651
$1:
i ~i:"" ;2;'2;i~·i;;'/y \';':::~,;z;ii
ALASKA
ARKANSAS
DELAWARE
HAWAII
IDAHO
IOWA
c
$2,506,827
$2,422,649
$0
$0
$2,081,429
$12,011,250
·>
$17,611,765
$819,351
$7,069,000
$0
$0
$0
14.20%
33.00%
0.00%
22.06%
33.00%
33.00%
19.08%
10.97%
33.00%
33.00%
18.36%
33.00%
0.00%
28.42%
0.00%
33.00%
32.66%
20.01%
33.00%
14.85%
33.00%
2.16%
16.43%
0.00%
19.33%
31.23%
5.67%
33.00%
22.00%
: <!';,·;:;tP>c:'
$20,118,592
$3,242,000
$7,069,000
$0
$2,081,429
$12,011,250
F
FY 2017
Allotment
In FS
$337,526,148
$111,136,659
$1,203,294,436
$101,532,256
$219,529,202
$67,230,818
$219,529,202
$294,992,365
$235,993,892
$234,621 ,836
$45,277,897
$159,158,672
$752,615,495
$115,252,830
$83,695,509
$334,782,032
$290,876,193
$167,391,016
$520,009,796
$50,766,127
$175,731,503
$706,609,619
$1 '763,093,901
$323,805,572
$445,918,692
$616,053,822
$71,346,990
$359,479,068
$53,100,000
$1,049,623,997
$24,697,037
$96,162,104
$203,064,512
$74,091,106
$11,507,990,304
,;!:if:;'!
33.00%
25.27%
33.00%
0.00%
0.00%
0.00%
G
FY 2017
FMAPS
70.16%
69.24%
50.00%
50.02%
50.00%
70.00%
61.10%
67.89%
51.30%
66.74%
56.21%
70.46%
62.28%
64.38%
50.00%
50.00%
65.15%
74.63%
63.21%
64.67%
50.00%
50.00%
50.00%
66.88%
62.32%
51.78%
51.02%
71.30%
64.96%
56.18%
54.46%
50.00%
50.00%
71.80%
FY 2017
Allotments
In TC
Col FIG
$481,080,599
$160,509,328
$2,406,588,872
$202,983,319
$439,058,404
I
Applicable
Percentage
Applied to
FY2017
Allotments in
TC
CoiExCoiH
$5,130,241
$37,343,327
$1,708,678
$691,879
$113,351,163
FY 2017
TCIMDLimit
(Lesser of
Col I or Col C)
$4,451,770
$28,474,900
$1,555,919
$594,776
$105,573,725
FY 2017
IMDLimit
In FS
CoiGxJ
$3,123 362
$19 716 021
$777,960
$297,507
$52,786,863
$96,044,026
$359,294,930
$434,515,194
$460,027,080
$351,546,053
$80,551,320
$225,885,143
$1,208,438,496
$179,019,618
$167,391,018
$669,564,064
$446,471,517
$224,294,541
$822,670,141
$78,500,274
$351 ,463,006
$1,413,219,238
$3,526,187,802
$484,159,049
$715,530,635
$1,189,752,457
$139,841,219
$504,178,216
$81,742,611
$1,868,323,241
$45,348,948
$192,324,208
$406,129,024
$103,190,955
$20,
$13,642,732
$118,567,327
$0
$101,486,761
$116,010,198
$26,581,936
$43,097,686
$132 ,588,998
$59,076,474
$55,239 '036
$122,945,921
$147,335,600
$0
$233,804,363
$0
$115,982,792
$461,600,228
$705,501,250
$159,772,486
$106,258,344
$392,618,311
$3,023,561
$82,823,209
$0
$361 ,202,558
$14,160,620
$10,901,443
$134,022,578
$22,702,157
$3,899,171 ,855
$6,545,136
$118,567,327
$0
$89,408,276
$116,010,198
$26,581,936
$37,443,073
$132,588,998
$59,076,474
$55,239,036
$105,635,054
$147,335,600
$0
$207,234,618
$0
$94,753,948
$357,370,461
$605,000,000
$159,772,486
$93,432,758
$392,618,311
$2,397,833
$72,076,341
$0
$292,513,592
$9,071,297
$7,770,268
$134,022,578
$18,887,045
733
$4,581,595
$72,444,637
$0
$45,866,446
$77,425,206
$14,941,706
$26,382,389
$82,576,428
$38 033434
$27,619,518
$52,817,527
$95,989,144
$0
$130,993,002
$0
$47,376,974
$178,685,231
$302,500,000
$106,855,839
$58,227,295
$203,297,761
$1,223 374
$51,390,431
$0
$164,334,136
$4,940,228
$3,885,134
$67,011,289
$13,560,898
$1 ,949,661 ,335
.;,';/(:;.; :z<ci~i 0?·::: ''··' ::•:•<'! ""
$14,756,750
$819,351
$6,050,328
$0
$0
$0
$7,378,375
$571,006
$3,279,278
$0
$0
$0
,<•(';/:i;,,i'i~f.i');:,
;•:;f;~}/i.;~g:
$22,358,712
$47,350,016
$9,937,205
$10,697,430
$18,042,558
$43,226,550
H
50.00%
69.69%
54.20%
54.93%
71.51%
56.74%
$44,717,424
$67,943,774
$18,334,327
$19,474,659
$25,230,818
$76,183,557
;;:.·
$14,756,750
$17,171,437
$6,050,328
$0
$0
$0
J
K
'>:;:::!:':;,
Federal Register / Vol. 84, No. 28 / Monday, February 11, 2019 / Notices
18:05 Feb 08, 2019
ADDENDUM 3: FINAL IMD DSH LIMIT FOR FY: 2017
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IMD And Mental
Health Services
FY95 DSH
Total Inpatient &
IMD&Mental
Health FY 95 DSH
FY 2017
FY 2017
Allotments
In TC
Applicable
Percentage
Applied to
FY2017
Allotments in
TC
FY 2017
FY 2017
IMDLimit
In FS
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11FEN1
Federal Register / Vol. 84, No. 28 / Monday, February 11, 2019 / Notices
18:05 Feb 08, 2019
Inpatient Hospital
Services FY 95
DSH
Applic
able
Percen
t
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Column K ........................
Column J ........................
Column I .........................
Column G .......................
Column H ........................
Column F ........................
Column E ........................
Column D ........................
Column C ........................
Column A ........................
Column B ........................
Column
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 2019 Federal Share DSH Allotment.
This column contains the states’ preliminary FY 2019 DSH allotments from Addendum 1, Column J.
FY 2019 FMAP.
FY 2019 DSH Allotments in Total Computable, Col. F/G.
This column contains states’ FY 2019 total computable DSH allotment (determined as Column F/Column G).
Applicable Percentage Applied to FY 2019 Allotments in TC, Col E × Col H.
This column contains the applicable percentage of FY 2019 total computable DSH allotment (calculated as the percentage in Column E multiplied by the amount
in Column H).
FY 2019 TC IMD DSH Limit. Lesser of Col. I or C.
This column contains the total computable FY 2019 TC IMD DSH Limit equal to the lesser of the amount in Column I or Column C.
FY 2019 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 2019 IMD DSH Limit from Column J into a
federal share amount by multiplying it by the FY 2018 FMAP in Column G.
Description
KEY TO ADDENDUM 4—PRELIMINARY IMD DSH LIMITS FOR FY 2019
[The preliminary FY 2019 IMD DSH Limits for the Non-Low DSH States are presented in the top section of this addendum and the preliminary FY 2019 IMD DSH Limits for the Low-DSH
States are presented in the bottom section of the addendum.]
3182
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11FEN1
STATE
ALABAMA
ARIZONA
CALIFORNIA
COLORADO
CONNECTICUT
DISTRICT OF
COLUMBIA
FLORIDA
GEORGIA
ILLINOIS
INDIANA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MISSISSIPPI
MISSOURI
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW YORK
NORTH CAROLINA
OHIO
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
TENNESSEE*
TEXAS
VERMONT**
VIRGINIA
WASHINGTON
WEST VIRGINIA
TOTAL
r~.mw::I:!Jt:rt;t;ft!'t
ALASKA
ARKANSAS
DELAWARE
HAWAII
IDAHO
IOWA
MINNESOTA
MONTANA
B
c
Inpatient Hospital
Services FY 95
DSH
Total Computable
$413,006,229
$93,916,100
$2,189,879,543
$173,900,441
$303,359,275
IMDAnd
Mental Health
Services FY 95
DSH
Total Computable
$4,451,770
$28,474,900
$1,555,919
$594,776
$105,573,725
D
Total Inpatient &
IMD&
Mental Health FY 95
DSH
Total Computable
Col B + C
$417,45 7,999
$122,391,000
$2,191,435,462
$174,495,217
$408,933,000
$6,545,136
$149,714,986
$0
$89,408,276
$153,566,302
$76,663,508
$37,443,073
$132,917,149
$60,958,342
$120,873,531
$105,635,054
$304,765,552
$0
$207,234,618
$0
$94,753,948
$357,370,461
$605,000,000
$236,072,627
$93,432,758
$579,199,682
$2,397,833
$72,076,341
$0
$292,513,592
$9,071,297
$7,770,268
$163,836,435
$18,887,045
~4,118, r58,904
$46,077,370
$334,183,000
$407,343,557
$405,276,784
$233,527,085
$88,250,716
$196,247,981
$1,211,429,318
$160,916,300
$143,099,998
$575,289,000
$438,024,352
$182,608,033
$729,181,142
$73,560,000
$187,429,864
$1,094,113,000
$3,023,869,368
$429,274,593
$629,164,714
$967,407,001
$110,901,000
$438,757,705
$0
$1,513,028,993
$29,050,549
$137,083,748
$335,562,250
$85,849,651
~1 ',521,219,750
$39,532,234
$184,468,014
$407,343,557
$315,868,508
$79,960,783
$11,587,208
$158,804,908
$1,078,512,169
$99,957,958
$22,226,467
$469,653,946
$133,258,800
$182,608,033
$521 ,946,524
$73,560,000
$92,675,916
$736,742,539
$2 ,418,869,368
$193,201,966
$535,731,956
$388,207,319
$108,503,167
$366,681,364
$0
$1,220,515,401
$19,979,252
$129,313,480
$171 '725,815
$66,962,606
~13,402,460,846
.:,';J:''''CJ!:{;f,:}c
$2,506,827
$2,422,649
$0
$0
$2,081,429
$12,011,250
$24,240,000
$237,048
E
CoiC/D
1.07%
23.27%
0.07%
0.34%
25.82%
In FS
$353,921,819
$116,535,234
$1 261 745 666
$1 06,464,287
$230,193,053
71.88%
69.81%
50.00%
50.00%
50.00%
$492,378,713
$166,932,007
$2,523,491,332
$212,928,57 4
$460,386,106
I
Applicable
Percentage
Applied to FY
2019
Allotments in TC
ColE x Col H
$5,250,724
$38,837,596
$1,791,679
$725,778
$118,857,310
14.20%
33.00%
0.00%
22.06%
33.00%
33.00%
19.08%
10.97%
33.00%
33.00%
18.36%
33.00%
0.00%
28.42%
0.00%
33.00%
32.66%
20.01%
33.00%
14.85%
33.00%
2.16%
16.43%
0.00%
19.33%
31.23%
5.67%
33.00%
22.00%
$70 496 623
$230,193,053
$309,321,914
$247,457,531
$246,01 8,826
$47,477,317
$166,889,964
$789,17 4,545
$120,851,352
$87,761,102
$351 ,044,404
$305,005,795
$175 522 202
$545,269,792
$53,232,142
$184,267,836
$7 40,933,888
$1,848,737,951
$339,534,752
$467 579 639
$645,979,253
$74,812,742
$376,941 '124
$53,100,000
$1 '1 00,61 0,532
$25,896,720
$100,833,274
$212,928,573
$77,690,156
70.00%
60.87%
67.62%
50.31%
65.96%
57.10%
71.67%
65.00%
64.52%
50.00%
50.00%
64.45%
76.39%
65.40%
64.87%
50.00%
50.00%
50.00%
67.16%
63.09%
52.25%
52.57%
71.22%
65.87%
58.19%
53.89%
50.00%
50.00%
74.34%
$100,709,461
$378,171,600
$45 7,441 ,458
$491,865,496
$372,981,847
$83,147,665
$232,858,887
$1,214,114,685
$187,308,357
$175,522,204
$702,088,808
$473,244,057
$229,771 '177
$833,745,859
$82,059,723
$368,535,672
$1,481,867,776
$3,697,475,902
$505,560,977
$741,131,144
$1 ,236,323,929
$142,310,713
$529,263,022
$80,613,329
$1,891,408,373
$48,054,778
$201,666,548
$425,857,146
$104,506,532
Applicable
Percent
F
FY 2019
Allotment
G
H
FY 2019
FMAPs
FY 2019
Allotments
inTC
Col FiG
~12,064,423,061
~21
!';'
$17,611,765
$819,351
$7,069,000
$0
$0
$0
$5,257,214
$0
$20,118,592
$3,242,000
$7,069,000
$0
$2,081,429
$12,011,250
$29,497,214
$237,048
J
K
FY 2019
TC IMD Limit
(Lesser Of
Col I or Col C)
FY 2019
IMDLimit
In FS
Col G xJ
$4,451,770
$28,474,900
$1,555,919
$594,776
$105,573,725
$3,199,932
$19,878,328
$777 960
$297,388
$52,786,863
$14,305,442
$124,796,628
$0
$108,510,647
$123,084,009
$27,438,730
$44,428,239
$133,211,785
$61,811,758
$57,922,327
$128,918,142
$156,170,539
$0
$236,952,102
$0
$121,616,772
$484,022,921
$739,771,679
$166,835,122
$110,060,093
$407,986,897
$3,076,954
$86,943,982
$0
$365,665,602
$15,005,540
$11,430,991
$140,532,858
$22,991,585
$6,545,136
$124,796,628
$0
$89,408,276
$123,084,009
$27,438,730
$37,443,073
$132,917,149
$60,958,342
$57,922,327
$105,635,054
$156,170,539
$0
$207,234,618
$0
$94,753,948
$357,370,461
$605,000,000
$166,835,122
$93,432,758
$407,986,897
$2,397,833
$72,076,341
$0
$292,513,592
$9,071,297
$7,770,268
$140,532,858
$18,887,045
~4,058,954,432
~3,538,833,391
$4 581 595
$75,963,707
$0
$44,981 ,304
$81,186,213
$15,667,515
$26,835,450
$66,396,147
$39,330,322
$28,961 '164
$52,817,527
$1 00,651 ,912
$0
$135,531,440
$0
$47,376,974
$178,685,231
$302,500,000
$112,046,468
$56 946 727
$213,173,153
$1,260,541
$51,332,770
$0
$170,213,659
$4,888,522
$3,885,134
$70,266,429
$14,040,629
~1 ,998,461 ,004
•.•,:r?'•s.X'c'-/'~'-Ui
i}'i
33.00%
25.27%
33.00%
0.00%
0.00%
0.00%
17.82%
0.00%
$23,444 809
$49,650,090
$10,419,915
$11,217,068
$18,918,993
$45 326 323
$85,964,300
$13,064,348
50.00%
70.51%
57.55%
53.92%
71.13%
59.93%
50.00%
65.54%
$46,889,618
$70,415,672
$18,105,847
$20,803,168
$26,597,769
$75,632,109
$171,928,600
$19,933,396
$15,473,574
$17,796,160
$5,974,930
$0
$0
$0
$30,642,400
$0
$15,473,574
$819,351
$5,974,930
$0
$0
$0
$5,257,214
$0
$: 736 787
$577,724
$3,436,572
$0
$0
$0
$2,628,607
$0
Federal Register / Vol. 84, No. 28 / Monday, February 11, 2019 / Notices
18:05 Feb 08, 2019
ADDENDUM 4: PRELIMINARY IMD DSH LIMIT FOR FISCAL YEAR: 2019
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18:05 Feb 08, 2019
EN11FE19.010</GPH>
FY 2019
FY 2019
IMDLimit
In FS
FY 2019
FMAPs
FY 2019
Allotment
Inpatient Hospital
Services FY 95
DSH
Federal Register / Vol. 84, No. 28 / Monday, February 11, 2019 / Notices
[FR Doc. 2019–01928 Filed 2–8–19; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–1721–FN]
Medicare Program; Approval of
Request for an Exception to the
Prohibition on Expansion of Facility
Capacity Under the Hospital
Ownership and Rural Provider
Exceptions to the Physician SelfReferral Prohibition
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Final notice.
AGENCY:
This final notice announces
our decision to approve the request of
St. James Behavioral Health Hospital Inc
for an exception to the prohibition on
expansion of facility capacity.
APPLICABLE DATES: This notice is
effective on February 11, 2019.
FOR FURTHER INFORMATION CONTACT:
POH-ExceptionRequests@cms.hhs.gov.
SUPPLEMENTARY INFORMATION:
SUMMARY:
I. Background
Section 1877 of the Social Security
Act (the Act), also known as the
physician self-referral law—(1) prohibits
a physician from making referrals for
certain ‘‘designated health services’’
(DHS) payable by Medicare to an entity
with which he or she (or an immediate
family member) has a financial
relationship (ownership or
compensation), unless the requirements
of an applicable exception are satisfied;
and (2) prohibits the entity from filing
claims with Medicare (or billing another
individual, entity, or third party payer)
for those DHS furnished as a result of a
prohibited referral.
Section 1877(d)(2) of the Act provides
an exception, known as the rural
provider exception, for physician
ownership or investment interests in
rural providers. In order for an entity to
qualify for the rural provider exception,
the DHS must be furnished in a rural
area (as defined in section 1886(d)(2)(D)
of the Act) and substantially all the DHS
furnished by the entity must be
furnished to individuals residing in a
rural area.
Section 1877(d)(3) of the Act provides
an exception, known as the hospital
ownership exception, for physician
ownership or investment interests held
in a hospital located outside of Puerto
Rico, provided that the referring
VerDate Sep<11>2014
18:05 Feb 08, 2019
Jkt 247001
physician is authorized to perform
services at the hospital and the
ownership or investment interest is in
the hospital itself (and not merely in a
subdivision of the hospital).
Section 6001(a)(3) of the Patient
Protection and Affordable Care Act
(Pub. L. 111–148) as amended by the
Health Care and Education
Reconciliation Act of 2010 (Pub. L. 111–
152) (hereafter referred to together as
‘‘the Affordable Care Act’’) amended the
rural provider and hospital ownership
exceptions to the physician self-referral
prohibition to impose additional
restrictions on physician ownership and
investment in hospitals. Since March
23, 2010, a physician-owned hospital
that seeks to avail itself of either
exception is prohibited from expanding
facility capacity unless it qualifies as an
‘‘applicable hospital’’ or ‘‘high Medicaid
facility’’ (as defined in sections
1877(i)(3)(E), (F) of the Act and our
regulations at 42 CFR 411.362(c)(2) and
(3)) and has been granted an exception
to the facility expansion prohibition by
the Secretary of the Department of
Health and Human Services (the
Secretary). Section 1877(i)(3)(A)(ii) of
the Act provides that individuals and
entities in the community in which the
provider requesting the exception is
located must have an opportunity to
provide input with respect to the
provider’s request for the exception.
Section 1877(i)(3)(H) of the Act states
that the Secretary shall publish in the
Federal Register the final decision with
respect to the request for an exception
to the prohibition against facility
expansion not later than 60 days after
receiving a complete application.
II. Exception Approval Process
On November 30, 2011, we published
a final rule in the Federal Register (76
FR 74122, 74517–74525) that, among
other things, finalized § 411.362(c),
which specified the process for
submitting, commenting on, and
reviewing a request for an exception to
the prohibition on expansion of facility
capacity. We published a subsequent
final rule in the Federal Register on
November 10, 2014 (79 FR 66770) that
made certain revisions. These revisions
include, among other things, permitting
the use of data from an external data
source or data from the Hospital Cost
Report Information System (HCRIS) for
specific eligibility criteria.
Our regulations at § 411.362(c)(5)
require us to solicit community input on
the request for an exception by
publishing a notice of the request in the
Federal Register. Individuals and
entities in the hospital’s community
will have 30 days to submit comments
PO 00000
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3185
on the request. Community input must
take the form of written comments and
may include documentation
demonstrating that the physician-owned
hospital requesting the exception does
or does not qualify as an applicable
hospital or high Medicaid facility, as
such terms are defined in § 411.362(c)(2)
and (3). In the November 30, 2011 final
rule (76 FR 74122), we gave examples of
community input, such as
documentation demonstrating that the
hospital does not satisfy one or more of
the data criteria or that the hospital
discriminates against beneficiaries of
Federal health programs; however, we
noted that these were examples only
and that we will not restrict the type of
community input that may be
submitted. If we receive timely
comments from the community, we will
notify the hospital, and the hospital will
have 30 days after such notice to submit
a rebuttal statement (§ 411.362(c)(5)(ii)).
A request for an exception to the
facility expansion prohibition is
considered complete as follows:
• If the request, any written
comments, and any rebuttal statement
include only HCRIS data: (1) The end of
the 30-day comment period if the
Centers for Medicare & Medicaid
Services (CMS) receives no written
comments from the community; or (2)
the end of the 30-day rebuttal period if
CMS receives written comments from
the community, regardless of whether
the physician-owned hospital
submitting the request submits a
rebuttal statement (§ 411.362(c)(5)(i)).
• If the request, any written
comments, or any rebuttal statement
include data from an external data
source, no later than—(1) 180 days after
the end of the 30-day comment period
if CMS receives no written comments
from the community; and (2) 180 days
after the end of the 30-day rebuttal
period if CMS receives written
comments from the community,
regardless of whether the physicianowned hospital submitting the request
submits a rebuttal statement
(§ 411.362(c)(5)(ii)).
If CMS grants the request for an
exception to the prohibition on
expansion of facility capacity, the
expansion may occur only in facilities
on the hospital’s main campus and may
not result in the number of operating
rooms, procedure rooms, and beds for
which the hospital is licensed to exceed
200 percent of the hospital’s baseline
number of operating rooms, procedure
rooms, and beds (§ 411.362(c)(6)). The
CMS decision to grant or deny a
hospital’s request for an exception to the
prohibition on expansion of facility
capacity must be published in the
E:\FR\FM\11FEN1.SGM
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]]>Agencies
[Federal Register Volume 84, Number 28 (Monday, February 11, 2019)]
[Notices]
[Pages 3169-3185]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-01928]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-2417-N]
RIN 0938-ZB50
Medicaid Program; Final FY 2017 and Preliminary FY 2019
Disproportionate Share Hospital Allotments, and Final FY 2017 and
Preliminary FY 2019 Institutions for Mental Diseases Disproportionate
Share Hospital Limits
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: This notice announces the final federal share disproportionate
share hospital (DSH) allotments for federal fiscal year (FY) 2017 and
the preliminary federal share DSH allotments for FY 2019. This notice
also announces the final FY 2017 and the preliminary FY 2019
limitations on aggregate DSH payments that states may make to
institutions for mental disease and other mental health facilities. In
addition, this notice includes background information describing the
methodology for determining the amounts of states' FY DSH allotments.
DATES: This notice is effective March 13, 2019. The final allotments
and limitations set forth in this notice are applicable for the fiscal
years specified.
FOR FURTHER INFORMATION CONTACT: Stuart Goldstein, (410) 786-0694 and
Richard Cuno, (410) 786-1111.
SUPPLEMENTARY INFORMATION:
I. Background
A. Fiscal Year DSH Allotments
A state's federal fiscal year (FY) disproportionate share hospital
(DSH) allotment represents the aggregate limit on the federal share
amount of the state's DSH payments to DSH hospitals in the state for
the FY. The amount of such allotment is determined in accordance with
the provisions of section 1923(f)(3) of the Social Security Act (the
Act), with some state-specific exceptions as specified in section
1923(f) of the Act. Under such provisions, in general a state's FY DSH
allotment is calculated by increasing the amount of its DSH allotment
for the preceding FY by the percentage change in the Consumer Price
Index for all Urban Consumers (CPI-U) for the previous FY.
The Patient Protection and Affordable Care Act of 2010 (Pub. L.
111-148), as amended by the Health Care and Education Reconciliation
Act of 2010 (Pub. L. 111-152) (collectively, the Affordable Care Act),
amended Medicaid DSH provisions, adding section 1923(f)(7) of the Act.
Section 1923(f)(7) would have required reductions to states' FY DSH
allotments from FY 2014 through FY 2020, the calculation of which was
described in the Disproportionate Share Hospital Payment Reduction
final rule published in the September 18, 2013 Federal Register (78 FR
57293). Subsequent legislation, most recently by the Bipartisan Budget
Act of 2018 (Pub. L. 115-123, enacted February 9, 2018), delayed the
start of these reductions until FY 2020. A proposed rule delineating a
revised methodology for the calculation of DSH allotment reductions
previously scheduled to begin in FY 2018 was published in the July 28,
2017 Federal Register (82 FR 35155).
Because there are no reductions to DSH allotments for FY 2017 and
FY 2019 under section 1923(f)(7) of the Act, as amended, this notice
contains only the state-specific final FY 2017 DSH allotments and
preliminary FY 2019 DSH allotments, as calculated under the statute
without application of the reductions that would have been imposed
under the Affordable Care Act provisions beginning with FY 2014. This
notice also provides information on the calculation of such FY DSH
allotments, the calculation of the states' institutions for mental
diseases (IMDs) DSH limits, and the amounts of states' final FY 2017
IMD DSH limits and preliminary FY 2019 IMD DSH limits.
B. Determination of Fiscal Year DSH Allotments
Generally, in accordance with the methodology specified under
section 1923(f)(3) of the Act, a state's FY DSH allotment is calculated
by increasing the amount of its DSH allotment for the preceding FY by
the percentage change
[[Page 3170]]
in the CPI-U for the previous FY. Also in accordance with section
1923(f)(3) of the Act, a state's DSH allotment for a FY is subject to
the limitation that an increase to a state's DSH allotment for a FY
cannot result in the DSH allotment exceeding the greater of the state's
DSH allotment for the previous FY or 12 percent of the state's total
medical assistance expenditures for the allotment year (this is
referred to as the 12 percent limit).
Furthermore, under section 1923(h) of the Act, federal financial
participation (FFP) for DSH payments to IMDs and other mental health
facilities is limited to state-specific aggregate amounts. Under this
provision, the aggregate limit for DSH payments to IMDs and other
mental health facilities is the lesser of a state's FY 1995 total
computable (state and federal share) IMD and other mental health
facility DSH expenditures applicable to the state's FY 1995 DSH
allotment (as reported on the Form CMS-64 as of January 1, 1997), or
the amount equal to the product of the state's current year total
computable DSH allotment and the applicable percentage specified in
section 1923(h) of the Act.
In general, we determine states' DSH allotments for a FY and the
IMD DSH limits for the same FY using the most recent available
estimates of or actual medical assistance expenditures, including DSH
expenditures in their Medicaid programs and the most recent available
change in the CPI-U used for the FY in accordance with the methodology
prescribed in the statute. The indicated estimated or actual
expenditures are obtained from states for each relevant FY from the
most recent available quarterly Medicaid budget reports (Form CMS-37)
or quarterly Medicaid expenditure reports (Form CMS-64), respectively,
submitted by the states. For example, as part of the initial
determination of a state's FY DSH allotment (referred to as the
preliminary DSH allotments) that is determined before the beginning of
the FY for which the DSH allotments and IMD DSH limits are being
determined, we use estimated expenditures for the FY obtained from the
August submission of the CMS-37 submitted by states prior to the
beginning of the FY; such estimated expenditures are subject to update
and revision during the FY before such actual expenditure data become
available. We also use the most recent available estimated CPI-U
percentage change that is available before the beginning of the FY for
determining the states' preliminary FY DSH allotments; such estimated
CPI-U percentage change is subject to update and revision during the FY
before the actual CPI-U percentage change becomes available. In
determining the final DSH allotments and IMD DSH limits for a FY we use
the actual expenditures for the FY and actual CPI-U percentage change
for the previous FY.
II. Provisions of the Notice
A. Calculation of the Final FY 2017 Federal Share State DSH Allotments,
and the Preliminary FY 2019 Federal Share State DSH Allotments
1. Final FY 2017 Federal Share State DSH Allotments
Addendum 1 to this notice provides the states' final FY 2017 DSH
allotments determined in accordance with section 1923(f)(3) of the Act.
As described in the background section, in general, the DSH allotment
for a FY is calculated by increasing the FY DSH allotment for the
preceding FY by the CPI-U increase for the previous fiscal year. For
purposes of calculating the states' final FY 2017 DSH allotments, the
preceding final fiscal year DSH allotments (for FY 2016) were published
in the July 6, 2018 Federal Register (83 FR 31536). For purposes of
calculating the states' final FY 2017 DSH allotments we are using the
actual Medicaid expenditures for FY 2017. Finally, for purposes of
calculating the states' final FY 2017 DSH allotments, the applicable
historical percentage change in the CPI-U for the previous FY (FY 2016)
was 0.9 percent; we note that this is the same as the estimated 0.9
percentage change in the CPI-U for FY 2016 that was available and used
in the calculation of the preliminary FY 2017 DSH allotments which were
published in the November 3, 2017 Federal Register (82 FR 51259).
2. Calculation of the Preliminary FY 2019 Federal Share State DSH
Allotments
Addendum 2 to this notice provides the preliminary FY 2019 DSH
allotments determined in accordance with section 1923(f)(3) of the Act.
The preliminary FY 2019 DSH allotments contained in this notice were
determined based on the most recent available estimates from states of
their FY 2019 total computable Medicaid expenditures. Also, the
preliminary FY 2019 allotments contained in this notice were determined
by increasing the preliminary FY 2018 DSH allotments. The estimated
percentage increase in the CPI-U for FY 2018 was 2.4 percent (CMS
originally published the preliminary FY 2018 DSH allotments in the July
6, 2018 Federal Register (83 FR 31536)).
We will publish states' final FY 2019 DSH allotments in a future
notice based on the states' four quarterly Medicaid expenditure reports
(Form CMS-64) for FY 2019 available following the end of FY 2019
utilizing the actual change in the CPI-U for FY 2018.
B. Calculation of the Final FY 2017 and Preliminary FY 2019 IMD DSH
Limits
Section 1923(h) of the Act specifies the methodology to be used to
establish the limits on the amount of DSH payments that a state can
make to IMDs and other mental health facilities. FFP is not available
for DSH payments to IMDs or other mental health facilities that exceed
the IMD DSH limits. In this notice, we are publishing the final FY 2017
and the preliminary FY 2019 IMD DSH limits determined in accordance
with the provisions discussed above.
Addendums 3 and 4 to this notice detail each state's final FY 2017
and preliminary FY 2019 IMD DSH limit, respectively, determined in
accordance with section 1923(h) of the Act.
III. Collection of Information Requirements
As it relates to the Paperwork Reduction Act of 1995 (44 U.S.C.
3501 et seq.), this notice does not impose any new or revised
collection of information requirements or burden. While discussed in
section I.B. and in Addendums 3 and 4 of this notice, the requirements
and burden associated with Form CMS-37 and Form CMS-64 are unaffected
by this notice. Both forms are approved by the Office of Management and
Budget (OMB) under control number 0938-1265. Since this notice will not
impose any new or revised requirements/burden, we are not making any
changes under that control number.
IV. Regulatory Impact Analysis
We have examined the impact of this notice as required by Executive
Order 12866 on Regulatory Planning and Review (September 1993), the
Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96-354),
section 1102(b) of the Act, section 202 of the Unfunded Mandates Reform
Act of 1995 (Pub. L. 104-4; enacted on March 22, 1995) (UMRA `95),
Executive Order 13132 on Federalism (August 4, 1999) and the
Congressional Review Act (5 U.S.C. 804(2)), and Executive Order 13771
on Reducing Regulation and Controlling Regulatory Costs (January 30,
2017).
Executive Order 12866 directs agencies to assess all costs and
benefits of available regulatory alternatives and, if regulation is
necessary, to select
[[Page 3171]]
regulatory approaches that maximize net benefits (including potential
economic, environmental, public health and safety effects, distributive
impacts, and equity). A regulatory impact analysis (RIA) must be
prepared for major rules with economically significant effects ($100
million or more in any 1 year). This notice reaches the $100 million
economic threshold and thus is considered a major rule under the
Congressional Review Act.
The final FY 2017 DSH allotments being published in this notice are
equal to the preliminary FY 2017 DSH allotments published in the
November 3, 2017 Federal Register (82 FR 51259). This is due to the
actual percentage change in the CPI-U for FY 2016 used in the
calculation of the final FY 2017 allotments (0.9 percent) being equal
to the estimated percentage change in the CPI-U for FY 2016 used in the
calculation of the preliminary FY 2017 allotments (0.9 percent). The
final FY 2017 IMD DSH limits being published in this notice are also
equal to the preliminary FY 2017 IMD DSH limits published in the
November 3, 2017 Federal Register (82 FR 51259). Since the final FY
2017 DSH allotments were equal to the preliminary FY 2017 DSH
allotments, the associated FY 2017 IMD DSH limits also remained the
same.
The preliminary FY 2019 DSH allotments being published in this
notice have been increased by approximately $295 million more than the
preliminary FY 2018 DSH allotments published in the July 6, 2018
Federal Register (83 FR 31536). The increase in the DSH allotments is
due to the application of the statutory formula for calculating DSH
allotments under which the prior fiscal year allotments are increased
by the percentage increase in the CPI-U for the prior fiscal year. The
preliminary FY 2019 IMD DSH limits being published in this notice are
approximately $24 million more than the preliminary FY 2018 IMD DSH
limits published in the July 6, 2018 Federal Register (83 FR 31536).
The increases in the IMD DSH limits are because the DSH allotment for a
FY is a factor in the determination of the IMD DSH limit for the FY.
Since the preliminary FY 2019 DSH allotments are greater than the
preliminary FY 2018 DSH allotments, the associated preliminary FY 2019
IMD DSH limits for some states also increased.
The RFA requires agencies to analyze options for regulatory relief
of small businesses, if a rule has a significant impact on a
substantial number of small entities. For purposes of the RFA, small
entities include small businesses, nonprofit organizations, and small
governmental jurisdictions. Most hospitals and most other providers and
suppliers are small entities, either by nonprofit status or by having
revenues of less than $7.5 million to $38.5 million in any one year.
Individuals and states are not included in the definition of a small
entity. We are not preparing an analysis for the RFA because the
Secretary has determined that this notice will not have significant
economic impact on a substantial number of small entities.
Specifically, any impact on providers is due to the effect of the
various controlling statutes; providers are not impacted as a result of
the independent regulatory action in publishing this notice. The
purpose of the notice is to announce the latest DSH allotments and IMD
DSH limits, as required by the statute.
In addition, section 1102(b) of the Act requires us to prepare a
regulatory impact analysis if a rule may have a significant impact on
the operations of a substantial number of small rural hospitals. This
analysis must conform to the provisions of section 604 of the RFA. For
purposes of section 1102(b) of the Act, we define a small rural
hospital as a hospital that is located outside of a Core-Based
Statistical Area for Medicaid payment regulations and has fewer than
100 beds. We are not preparing analysis for section 1102(b) of the Act
because the Secretary has determined that this notice will not have a
significant impact on the operations of a substantial number of small
rural hospitals.
The Medicaid statute specifies the methodology for determining the
amounts of states' DSH allotments and IMD DSH limits; and as described
previously, the application of the methodology specified in statute
results in the decreases or increases in states' DSH allotments and IMD
DSH limits for the applicable FYs. The statute applicable to these
allotments and limits does not apply to the determination of the
amounts of DSH payments made to specific DSH hospitals; rather, these
allotments and limits represent an overall limit on the total of such
DSH payments. For this reason, we do not believe that this notice will
have a significant economic impact on a substantial number of small
entities.
Section 202 of the Unfunded Mandates Reform Act of 1995 also
requires that agencies assess anticipated costs and benefits before
issuing any rule whose mandates require spending in any 1 year of $100
million in 1995 dollars, updated annually for inflation. In 2018, that
threshold is approximately $150 million. This notice will have no
consequential effect on spending by state, local, or tribal
governments, in the aggregate, or on the private sector.
Executive Order 13132 establishes certain requirements that an
agency must meet when it promulgates a proposed rule (and subsequent
final rule) that imposes substantial direct requirement costs on state
and local governments, preempts state law, or otherwise has Federalism
implications. Since this notice does not impose any costs on state or
local governments or otherwise have Federalism implications, the
requirements of E.O. 13132 are not applicable.
Executive Order 13771, titled ``Reducing Regulation and Controlling
Regulatory Costs,'' was issued on January 30, 2017. It has been
determined that this notice is a transfer rule and is not a regulatory
action for the purposes of Executive Order 13771.
A. Alternatives Considered
The methodologies for determining the states' fiscal year DSH
allotments and IMD DSH limits, as reflected in this notice, were
established in accordance with the methodologies and formula for
determining states' allotments and limits as specified in statute. This
notice does not put forward any further discretionary administrative
policies for determining such allotments and limits, or otherwise.
B. Accounting Statement
As required by OMB Circular A-4 (available at 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 2018 to FY 2019.
Table 1--Accounting Statement: Classification of Estimated Expenditures,
From the FY 2018 to FY 2019
[in Millions]
------------------------------------------------------------------------
Category Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers............ $295.
From Whom To Whom? Federal Government to
States.
------------------------------------------------------------------------
[[Page 3172]]
C. Congressional Review Act
This proposed regulation is subject to the Congressional Review Act
provisions of the Small Business Regulatory Enforcement Fairness Act of
1996 (5 U.S.C. 801 et seq.) and has been transmitted to the Congress
and the Comptroller General for review.
In accordance with the provisions of Executive Order 12866, this
notice was reviewed by the Office of Management and Budget.
Dated: January 9, 2019.
Seema Verma,
Administrator, Centers for Medicare & Medicaid Services.
Dated: January 18, 2019.
Alex M. Azar II,
Secretary, Department of Health and Human Services.
[[Page 3173]]
Key to ADDENDUM 1--Final DSH Allotments for FY 2017
[The Final FY 2017 DSH Allotments for the NON-Low DSH States are presented in the top section of this addendum, and the Final FY 2017 DSH Allotments for
the Low-DSH States are presented in the bottom section of this addendum.]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Column Description
--------------------------------------------------------------------------------------------------------------------------------------------------------
Column A................................... State.
Column B................................... FY 2017 FMAPs.
This column contains the States' FY 2017 Federal Medical Assistance Percentages.
Column C................................... Prior FY (2016) DSH Allotments.
This column contains the States' prior FY 2016 DSH Allotments.
Column D................................... Prior FY (2016) DSH Allotments (Col C) x (100 percent + Percentage Increase in CPIU): 100.9 percent.
This column contains the amount in Column C increased by 1 plus the percentage increase in the CPI-U for
the prior FY (100.9 percent).
Column E................................... FY 2017 TC MAP Exp. Including DSH.
This column contains the amount of the States' FY 2017 total computable (TC) medical assistance
expenditures including DSH expenditures.
Column F................................... FY 2017 TC DSH Expenditures.
This column contains the amount of the States' FY 2017 total computable DSH expenditures.
Column G................................... FY 2017 TC MAP Exp. Net of DSH.
This column contains the amount of the States' FY 2017 total computable medical assistance expenditures net
of DSH expenditures, calculated as the amount in Column E minus the amount in Column F.
Column H................................... 12 percent Amount.
This column contains the amount of the ``12 percent limit'' in Federal share, determined in accordance with
the provisions of section 1923(f)(3) of the Act.
Column I................................... Greater of FY 2016 Allotment or 12 percent Limit.
This column contains the greater of the State's prior FY (FY 2016) DSH allotment or the amount of the 12
percent Limit, determined as the greater of the amount in Column C or Column H.
Column J................................... FY 2017 DSH Allotment.
This column contains the States' final FY 2017 DSH allotments, determined as the lesser of the amount in
Column I or Column D.
For states with ``na'' in Columns I or D, refer to the footnotes in the addendum.
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[[Page 3175]]
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Key to ADDENDUM 2--Preliminary DSH Allotments for FY 2019
[The Preliminary FY 2019 DSH Allotments for the NON-Low DSH States are presented in the top section of this addendum, and the Preliminary FY 2019 DSH
Allotments for the Low-DSH States are presented in the bottom section of this addendum.]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Column Description
--------------------------------------------------------------------------------------------------------------------------------------------------------
Column A................................... State.
Column B................................... FY 2019 FMAPs.
This column contains the States' FY 2019 Federal Medical Assistance Percentages.
Column C................................... Prior FY (2018) DSH Allotments.
This column contains the States' prior preliminary FY 2018 DSH Allotments.
Column D................................... Prior FY (2018) DSH Allotments (Col C) x (100 percent + Percentage Increase in CPIU): 102.4 percent.
This column contains the amount in Column C increased by 1 plus the estimated percentage increase in the
CPI-U for the prior FY (102.4 percent).
Column E................................... FY 2019 TC MAP Exp. Including DSH.
This column contains the amount of the States' projected FY 2019 total computable (TC) medical assistance
expenditures including DSH expenditures.
Column F................................... FY 2019 TC DSH Expenditures.
This column contains the amount of the States' projected FY 2019 total computable DSH expenditures.
Column G................................... FY 2019 TC MAP Exp. Net of DSH.
This column contains the amount of the States' projected FY 2019 total computable medical assistance
expenditures net of DSH expenditures, calculated as the amount in Column E minus the amount in Column F.
Column H................................... 12 percent Amount.
This column contains the amount of the ``12 percent limit'' in Federal share, determined in accordance with
the provisions of section 1923(f)(3) of the Act.
Column I................................... Greater of FY 2018 Allotment or 12 percent Limit.
This column contains the greater of the State's preliminary prior FY (FY 2018) DSH allotment or the amount
of the 12 percent Limit, determined as the greater of the amount in Column C or Column H.
Column J................................... FY 2019 DSH Allotment.
This column contains the States' preliminary FY 2018 DSH allotments, determined as the lesser of the amount
in Column I or Column D.
For states with ``na'' in Columns I or D, refer to the footnotes in the addendum.
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[[Page 3179]]
Key to ADDENDUM 3--Final IMD DSH Limits for FY 2017
[The final FY 2017 IMD DSH Limits for the Non-Low DSH States are presented in the top section of this addendum and the preliminary FY 2017 IMD DSH
Limits for the Low-DSH States are presented in the bottom section of the addendum.]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Column Description
--------------------------------------------------------------------------------------------------------------------------------------------------------
Column A................................... State.
Column B................................... Inpatient Hospital Services FY 95 DSH Total Computable.
This column contains the States' total computable FY 1995 inpatient hospital DSH expenditures as reported
on the Form CMS-64 as of January 1, 1997.
Column C................................... IMD and Mental Health Services FY 95 DSH Total Computable.
This column contains the total computable FY 1995 mental health facility DSH expenditures as reported on
the Form CMS-64 as of January 1, 1997.
Column D................................... Total Inpatient Hospital & IMD & Mental Health FY 95 DSH Total Computable, Col. B + C.
This column contains the total computation of all inpatient hospital DSH expenditures and mental health
facility DSH expenditures for FY 1995 as reported on the Form CMS-64 as of January 1, 1997 (representing
the sum of Column B and Column C).
Column E................................... Applicable Percentage, Col. C/D.
This column contains the ``applicable percentage'' representing the total Computable FY 1995 mental health
facility DSH expenditures divided by total computable all inpatient hospital and mental health facility
DSH expenditures for FY 1995 (the amount in Column C divided by the amount in Column D) Per section
1923(h)(2)(A)(ii)(III) of the Act, for FYs after FY 2002, the applicable percentage can be no greater than
33 percent.
Column F................................... FY 2017 Federal Share DSH Allotment.
This column contains the states' FY 2017 DSH allotments from Addendum 1, Column J.
Column G................................... FY 2017 FMAP.
Column H................................... FY 2017 DSH Allotments in Total Computable, Col. F/G.
This column contains states' FY 2017 total computable DSH allotment (determined as Column F/Column G).
Column I................................... Applicable Percentage Applied to FY 2017 Allotments in TC, Col E x Col H.
This column contains the applicable percentage of FY 2017 total computable DSH allotment (calculated as the
percentage in Column E multiplied by the amount in Column H).
Column J................................... FY 2017 TC IMD DSH Limit. Lesser of Col. I or C.
This column contains the total computable FY 2017 TC IMD DSH Limit equal to the lesser of the amount in
Column I or Column C.
Column K................................... FY 2017 IMD DSH Limit in Federal Share, Col. G x J.
This column contains the FY 2017 Federal Share IMD DSH limit determined by converting the total computable
FY 2017 IMD DSH Limit from Column J into a federal share amount by multiplying it by the FY 2016 FMAP in
Column G.
--------------------------------------------------------------------------------------------------------------------------------------------------------
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[[Page 3181]]
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[[Page 3182]]
Key to ADDENDUM 4--Preliminary IMD DSH Limits for FY 2019
[The preliminary FY 2019 IMD DSH Limits for the Non-Low DSH States are presented in the top section of this addendum and the preliminary FY 2019 IMD DSH
Limits for the Low-DSH States are presented in the bottom section of the addendum.]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Column Description
--------------------------------------------------------------------------------------------------------------------------------------------------------
Column A................................... State.
Column B................................... Inpatient Hospital Services FY 95 DSH Total Computable.
This column contains the States' total computable FY 1995 inpatient hospital DSH expenditures as reported
on the Form CMS-64 as of January 1, 1997.
Column C................................... IMD and Mental Health Services FY 95 DSH Total Computable.
This column contains the total computable FY 1995 mental health facility DSH expenditures as reported on
the Form CMS-64 as of January 1, 1997.
Column D................................... Total Inpatient Hospital & IMD & Mental Health FY 95 DSH Total Computable, Col. B + C.
This column contains the total computation of all inpatient hospital DSH expenditures and mental health
facility DSH expenditures for FY 1995 as reported on the Form CMS-64 as of January 1, 1997 (representing
the sum of Column B and Column C).
Column E................................... Applicable Percentage, Col. C/D.
This column contains the ``applicable percentage'' representing the total Computable FY 1995 mental health
facility DSH expenditures divided by total computable all inpatient hospital and mental health facility
DSH expenditures for FY 1995 (the amount in Column C divided by the amount in Column D) Per section
1923(h)(2)(A)(ii)(III) of the Act, for FYs after FY 2002, the applicable percentage can be no greater than
33 percent.
Column F................................... FY 2019 Federal Share DSH Allotment.
This column contains the states' preliminary FY 2019 DSH allotments from Addendum 1, Column J.
Column G................................... FY 2019 FMAP.
Column H................................... FY 2019 DSH Allotments in Total Computable, Col. F/G.
This column contains states' FY 2019 total computable DSH allotment (determined as Column F/Column G).
Column I................................... Applicable Percentage Applied to FY 2019 Allotments in TC, Col E x Col H.
This column contains the applicable percentage of FY 2019 total computable DSH allotment (calculated as the
percentage in Column E multiplied by the amount in Column H).
Column J................................... FY 2019 TC IMD DSH Limit. Lesser of Col. I or C.
This column contains the total computable FY 2019 TC IMD DSH Limit equal to the lesser of the amount in
Column I or Column C.
Column K................................... FY 2019 IMD DSH Limit in Federal Share, Col. G x J.
This column contains the FY 2018 Federal Share IMD DSH limit determined by converting the total computable
FY 2019 IMD DSH Limit from Column J into a federal share amount by multiplying it by the FY 2018 FMAP in
Column G.
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[[Page 3185]]
[FR Doc. 2019-01928 Filed 2-8-19; 8:45 am]
BILLING CODE 4120-01-P
