[Federal Register Volume 81, Number 207 (Wednesday, October 26, 2016)]
[Notices]
[Pages 74432-74447]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-25813]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-2401-N]
RIN 0938-ZB30
Medicaid Program; Final FY 2014 and Preliminary FY 2016
Disproportionate Share Hospital Allotments, and Final FY 2014 and
Preliminary FY 2016 Institutions for Mental Diseases Disproportionate
Share Hospital Limits
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
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SUMMARY: This notice announces the final federal share disproportionate
share hospital (DSH) allotments for federal fiscal year (FY) 2014 and
the preliminary federal share DSH allotments for FY 2016, and
corresponding limitations on aggregate state DSH payments to
institutions for mental disease and other mental health facilities. In
addition, this notice includes background information
[[Page 74433]]
describing the methodology for determining the amounts of states' FY
DSH allotments.
DATES: Effective November 25, 2016. The final allotments and
limitations set forth in this notice are effective 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 payments to DSH hospitals in the state for the
FY. The amount of such allotment is determined in accordance with the
provisions of section 1923(f)(3) of the Social Security Act (the Act).
Under such provisions, in general a state's FY DSH allotment is
calculated by increasing the amount of its DSH allotment for the
preceding FY by the percentage change in the Consumer Price Index for
all Urban Consumers (CPI-U) for the previous FY.
The Affordable Care Act amended Medicaid DSH provisions, adding
section 1923(f)(7) of the Act which would have required reductions to
states' FY DSH allotments beginning with FY 2014, the calculation of
which was described in the Disproportionate Share Hospital Payment
Reduction final rule published in the September 18, 2013 Federal
Register (78 FR 57293). Under the DSH reduction methodology, first,
each state's unreduced FY DSH allotment would have been calculated in
accordance with the provisions of section 1923(f) of the Act, excluding
section 1923(f)(7) of the Act; then, the reduction amount for each
state would have been determined under the provisions of section
1923(f)(7) of the Act and implementing regulations at 42 CFR 447.294;
and, finally, the net FY DSH allotment for each state would have been
determined by subtracting the DSH reduction amount for the state from
its unreduced FY 2014 DSH allotment.
The reductions under section 1923(f)(7) of the Act were delayed and
modified by section 1204 of Division B (Medicare and Other Health
Provisions) of the Pathway for SGR Reform Act of 2013 (Pub. L. 113-67
enacted on December 26, 2013). The reductions of states' fiscal year
DSH allotments under section 1923(f)(7) of the Act that were applicable
to FY 2014 and 2015 were repealed, and the FY 2016 reductions were
increased. Subsequently, the reductions were delayed and modified by
the Medicare Access and CHIP Reauthorization Act of 2015 (Pub. L. 114-
10 enacted on April 16, 2015) (MACRA). The reductions of states' fiscal
year DSH allotments under section 1923(f)(7) of the Act that were
applicable to FY 2017 were repealed and are instead scheduled to begin
in FY 2018.
Because there are no reductions to DSH allotments for FY 2014 and
FY 2016 under section 1923(f)(7) of the Act, this notice contains only
the state-specific final FY 2014 DSH allotments and preliminary FY 2016
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 disease (IMD) DSH
limits, and the amounts of states' final FY 2014 IMD DSH limits and
preliminary FY 2016 IMD DSH limits.
B. Determination of Fiscal Year DSH Allotments
Generally, in accordance with the methodology specified under
section 1923(f)(3) of the Act, a state's FY DSH allotment is calculated
by increasing the amount of its DSH allotment for the preceding FY by
the percentage change in the CPI-U for the previous FY. Also in
accordance with section 1923(f)(3) of the Act, a state's DSH allotment
for a FY is subject to the limitation that an increase to a state's DSH
allotment for a FY cannot result in the DSH allotment exceeding the
greater of the state's DSH allotment for the previous FY or 12 percent
of the state's total medical assistance expenditures for the allotment
year (this is referred to as the 12 percent limit).
Furthermore, under section 1923(h) of the Act, federal financial
participation (FFP) for DSH payments to IMDs and other mental health
facilities is limited to state-specific aggregate amounts. Under this
provision, the aggregate limit for DSH payments to IMDs and other
mental health facilities is the lesser of a state's FY 1995 total
computable (state and federal share) IMD and other mental health
facility DSH expenditures applicable to the state's FY 1995 DSH
allotment (as reported on the Form CMS-64 as of January 1, 1997), or
the amount equal to the product of the state's current year total
computable DSH allotment and the applicable percentage specified in
section 1902(h) of the Act (the applicable percentage is the IMD share
of DSH total computable expenditures as of FY 1995).
In general, we determine states' DSH allotments for a FY and the
IMD DSH limits for the same FY using the most 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 2014 Federal Share State DSH Allotments,
and the Preliminary FY 2016 Federal Share State DSH Allotments
1. Final FY 2014 Federal Share State DSH Allotments
Addendum 1 to this notice provides the states' final FY 2014 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 2014 DSH allotments, the
preceding final fiscal year DSH allotments (for FY 2013) were published
in the February 2, 2016
[[Page 74434]]
Federal Register (81 FR 5448). For purposes of calculating the states'
final FY 2014 DSH allotments we are using the actual Medicaid
expenditures for FY 2014. Finally, for purposes of calculating the
states' final FY 2014 DSH allotments, the applicable historical
percentage change in the CPI-U for the previous FY (FY 2013) was 1.6
percent; we note that this is an increase from the estimated 1.5
percentage change in the CPI-U for FY 2013 that was available and used
in the calculation of the preliminary FY 2014 DSH allotments which were
published in the February 28, 2014 Federal Register (79 FR 11436).
2. Calculation of the Preliminary FY 2016 Federal Share State DSH
Allotments
Addendum 2 to this notice provides the preliminary FY 2016 DSH
allotments determined in accordance with section 1923(f)(3) of the Act.
The preliminary FY 2016 DSH allotments contained in this notice were
determined based on the most recent available estimates from states of
their FY 2016 total computable Medicaid expenditures. Also, the
preliminary FY 2016 allotments contained in this notice were determined
by increasing the preliminary FY 2015 DSH allotments as contained in
the notice published in the February 2, 2016 Federal Register (81 FR
5448) by 0.3 percent, representing the most recent available estimate
of the percentage increase in the CPI-U for FY 2015 (the previous FY to
FY 2016).
We will publish states' final FY 2016 DSH allotments in future
notices based on the states' four quarterly Medicaid expenditure
reports (Form CMS-64) for FY 2016 available following the end of FY
2016 and the actual change in the CPI-U for FY 2015.
B. Calculation of the Final FY 2014 and Preliminary FY 2016 IMD DSH
Limits
Section 1923(h) of the Act specifies the methodology to be used to
establish the limits on the amount of DSH payments that a state can
make to IMDs and other mental health facilities. FFP is not available
for IMD or DSH payments that exceed the IMD limits. In this notice, we
are publishing the final FY 2014 and the preliminary FY 2016 IMD DSH
limits determined in accordance with the provisions discussed above.
Addendums 3 and 4 to this notice detail each state's final FY 2014
and preliminary FY 2016 IMD DSH limit, respectively, determined in
accordance with section 1923(h) of the Act.
III. Collection of Information Requirements
This notice does not impose any new or revised information
collection or recordkeeping requirements or burden. While discussed in
section I.B. of this preamble and in Addendums 3 and 4, the
requirements and burden associated with Form CMS-37 (OMB control number
0938-0101) and Form CMS-64 (OMB control number 0938-0067) are
unaffected by this notice. Consequently, this notice, CMS-37, and CMS-
64 are not subject to Office of Management and Budget review under the
authority of the Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et
seq.).
IV. Regulatory Impact Analysis
We have examined the impact of this notice as required by Executive
Order 12866 on Regulatory Planning and Review (September 1993), the
Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96-354),
section 1102(b) of the Act, section 202 of the Unfunded Mandates Reform
Act of 1995 (March 22, 1995; Pub. L. 104-4), Executive Order 13132 on
Federalism (August 4, 1999) and the Congressional Review Act (5 U.S.C.
804(2)).
Executive Order 12866 directs agencies to assess all costs and
benefits of available regulatory alternatives and, if regulation is
necessary, to select regulatory approaches that maximize net benefits
(including potential economic, environmental, public health and safety
effects, distributive impacts, and equity). A regulatory impact
analysis (RIA) must be prepared for major rules with economically
significant effects ($100 million or more in any 1 year). This notice
reaches the $100 million economic threshold and thus is considered a
major rule under the Congressional Review Act.
The final FY 2014 DSH allotments being published in this notice are
approximately $11 million more than the preliminary FY 2014 DSH
allotments published in the February 28, 2014 Federal Register (79 FR
11436). The increase in the final FY 2014 DSH allotments is due to the
difference between the actual percentage change in the CPI-U for FY
2013 used in the calculation of the final FY 2014 allotments (1.6
percent) as compared to the estimated percentage change in the CPI-U
for FY 2013 used in the calculation of the preliminary FY 2014
allotments (1.5 percent). The final FY 2014 IMD DSH limits being
published in this notice are approximately $563 thousand more than the
preliminary FY 2014 IMD DSH limits published in the February 28, 2014
Federal Register (79 FR 11436). The increases in the IMD DSH limits are
because the DSH allotment for a FY is a factor in the determination of
the IMD DSH limit for the FY. Since the final FY 2014 DSH allotments
were increased as compared to the preliminary FY 2014 DSH allotments,
the associated FY 2014 IMD DSH limits for some states were also
increased.
The preliminary FY 2016 DSH allotments being published in this
notice are about $36 million more than the preliminary FY 2015 DSH
allotments published in the February 2, 2016 Federal Register (81 FR
5448). 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 2016 IMD DSH
limits being published in this notice are about $260 thousand less than
the final FY 2014 IMD DSH limits published in the February 28, 2014
Federal Register (79 FR 11436). Although the DSH allotment for a FY is
a factor in the determination of the IMD DSH limit for the FY and the
preliminary FY 2016 DSH allotments are greater than the preliminary FY
2015 DSH allotments, the associated preliminary FY 2016 IMD DSH limits
for some states decreased. This is attributable to a decrease in the
FMAP rates for certain states.
The RFA requires agencies to analyze options for regulatory relief
of small businesses, if a rule has a significant impact on a
substantial number of small entities. For purposes of the RFA, small
entities include small businesses, nonprofit organizations, and small
governmental jurisdictions. Most hospitals and most other providers and
suppliers are small entities, either by nonprofit status or by having
revenues of less than $7.0 million to $34.5 million in any one year.
Individuals and states are not included in the definition of a small
entity. We are not preparing an analysis for the RFA because the
Secretary has determined that this notice will not have significant
economic impact on a substantial number of small entities.
Specifically, any impact on providers is due to the effect of the
various controlling statutes; providers are not impacted as a result of
the independent regulatory action in publishing this notice. The
purpose of the notice is to announce the latest distributions as
required by the statute.
In addition, section 1102(b) of the Act requires us to prepare a
regulatory impact analysis if a rule may have a significant impact on
the operations of
[[Page 74435]]
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. In this regard, we do not believe that this notice will
have a significant economic impact on a substantial number of small
entities.
Section 202 of the Unfunded Mandates Reform Act of 1995 also
requires that agencies assess anticipated costs and benefits before
issuing any rule whose mandates require spending in any 1 year of $100
million in 1995 dollars, updated annually for inflation. In 2016, that
threshold is approximately $146 million. This notice will have no
consequential effect on state, local, or tribal governments, in the
aggregate, or on the private sector.
Executive Order 13132 establishes certain requirements that an
agency must meet when it promulgates a proposed rule (and subsequent
final rule) that imposes substantial direct requirement costs on state
and local governments, preempts state law, or otherwise has Federalism
implications. Since this notice does not impose any costs on state or
local governments, the requirements of E.O. 13132 are not applicable.
A. Alternatives Considered
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 as specified in statute. This notice
does not put forward any further discretionary administrative policies
for determining such allotments.
B. Accounting Statement
As required by OMB Circular A-4 (available at http://www.whitehouse.gov/omb/circulars/a004/a-4.pdf), in the Table 1, we have
prepared an accounting statement showing the classification of the
estimated expenditures associated with the provisions of this notice.
Table 1 provides our best estimate of the change (decrease) in the
federal share of states' Medicaid DSH payments resulting from the
application of the provisions of the Medicaid statute relating to the
calculation of states' FY DSH allotments and the increase in the FY DSH
allotments from FY 2015 to FY 2016.
Table 1--Accounting Statement: Classification of Estimated Expenditures,
From the FY 2015 to FY 2016
[In millions]
------------------------------------------------------------------------
Category Transfers
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Annualized Monetized Transfers $36.
From Whom To Whom?............ Federal Government to States.
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C. Congressional Review Act
This proposed regulation is subject to the Congressional Review Act
provisions of the Small Business Regulatory Enforcement Fairness Act of
1996 (5 U.S.C. 801 et seq.) and has been transmitted to the Congress
and the Comptroller General for review.
In accordance with the provisions of Executive Order 12866, this
notice was reviewed by the Office of Management and Budget.
Dated: September 8, 2016.
Andrew M. Slavitt,
Acting Administrator, Centers for Medicare & Medicaid Services.
Dated: October 13, 2016.
Sylvia Burwell,
Secretary, Department of Health and Human Services.
Key to Addendum 1--Final DSH Allotments for FY 2014
[The Final FY 2014 DSH Allotments for the NON-Low DSH States are
presented in the top section of this addendum, and the Final FY 2014 DSH
Allotments for the Low-DSH States are presented in the bottom section of
this addendum]
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Column Description
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Column A................. State.
Column B................. FY 2014 FMAPs. This column contains the
States' FY 2014 Federal Medical Assistance
Percentages.
Column C................. Prior FY (2013) DSH Allotments. This column
contains the States' prior FY 2013 DSH
Allotments.
Column D................. Prior FY (2013) DSH Allotments (Col C) x (100
percent + Percentage Increase in CPIU):
101.6 percent. This column contains the
amount in Column C increased by 1 plus the
percentage increase in the CPI-U for the
prior FY (101.6 percent).
Column E................. FY 2014 TC MAP Exp. Including DSH. This
column contains the amount of the States' FY
2014 total computable (TC) medical
assistance expenditures including DSH
expenditures.
Column F................. FY 2014 TC DSH Expenditures. This column
contains the amount of the States' FY 2014
total computable DSH expenditures.
Column G................. FY 2014 TC MAP Exp. Net of DSH. This column
contains the amount of the States' FY 2014
total computable medical assistance
expenditures net of DSH expenditures,
calculated as the amount in Column E minus
the amount in Column F.
Column H................. 12 percent Amount. This column contains the
amount of the ``12 percent limit'' in
Federal share, determined in accordance with
the provisions of section 1923(f)(3) of the
Act.
Column I................. Greater of FY 2013 Allotment or 12 percent
Limit. This column contains the greater of
the State's prior FY (FY 2013) DSH allotment
or the amount of the 12 percent Limit,
determined as the maximum of the amount in
Column C or Column H.
Column J................. FY 2014 DSH Allotment. This column contains
the States' final FY 2014 DSH allotments,
determined as the minimum of the amount in
Column I or Column D. For states with ``na''
in Columns I or D, refer to the footnotes in
the addendum.
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[[Page 74436]]
Addendum 1--Final DSH Allotments for Fiscal Year: 2014
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Prior FY (2013)
DSH allotment FY 2014 TC MAP FY 2014 TC MAP ``12% Amount'' = Greater of Col FY 2014 DSH
State FY 2014 Prior FY (2013) (Col C) x 100% Exp. including FY 2014 TC DSH EXP. net of DSH Col G x .12/(1- H. Or Col C allotment MIN
FMAPs (%) DSH Allotments + pct increase DSH expenditures Col E-F .12/Col B)* (in (12% Limit, FY Col I, Col D
in CPIU: 101.6% FS) 2012 allotment)
A B C D E F G H I J
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ALABAMA............................... 68.12 $323,093,267 $328,262,759 $5,211,164,487 $481,382,790 $4,729,781,697 $688,936,698 $688,936,698 $328,262,759
ARIZONA............................... 67.23 106,384,369 108,086,519 9,184,808,597 143,402,254 9,041,406,343 1,320,703,419 1,320,703,419 108,086,519
CALIFORNIA............................ 50.00 1,151,840,630 1,170,270,080 63,473,249,870 2,483,466,487 60,989,783,383 9,629,965,797 9,629,965,797 1,170,270,080
COLORADO.............................. 50.00 97,190,657 98,745,708 5,919,783,385 197,297,029 5,722,486,356 903,550,477 903,550,477 98,745,708
CONNECTICUT........................... 50.00 210,141,962 213,504,233 6,820,658,024 149,024,544 6,671,633,480 1,053,415,813 1,053,415,813 213,504,233
DISTRICT OF COLUMBIA.................. 70.00 64,355,975 65,385,671 2,367,792,161 54,250,889 2,313,541,272 335,064,598 335,064,598 65,385,671
FLORIDA............................... 58.79 210,141,962 213,504,233 20,303,199,078 336,086,757 19,967,112,321 3,010,557,470 3,010,557,470 213,504,233
GEORGIA............................... 65.93 282,378,262 286,896,314 9,396,958,654 435,057,563 8,961,901,091 1,314,722,356 1,314,722,356 286,896,314
ILLINOIS.............................. 50.00 225,902,609 229,517,051 16,616,392,364 457,503,046 16,158,889,318 2,551,403,577 2,551,403,577 229,517,051
INDIANA............................... 66.92 224,589,223 228,182,651 9,094,042,848 260,455,931 8,833,586,917 1,291,646,693 1,291,646,693 228,182,651
KANSAS................................ 56.91 43,341,780 44,035,248 2,727,710,336 77,294,578 2,650,415,758 403,033,162 403,033,162 44,035,248
KENTUCKY.............................. 69.83 152,352,923 154,790,570 7,792,776,771 211,149,028 7,581,627,743 1,098,582,186 1,098,582,186 154,790,570
LOUISIANA \1\......................... na na na na na na na na 731,960,000
MAINE................................. 61.55 110,324,530 112,089,722 2,365,417,230 39,328,950 2,326,088,280 346,730,334 346,730,334 112,089,722
MARYLAND.............................. 50.00 80,116,623 81,398,489 9,210,329,395 100,897,485 9,109,431,910 1,438,331,354 1,438,331,354 81,398,489
MASSACHUSETTS......................... 50.00 320,466,492 325,593,956 14,250,839,665 0 14,250,839,665 2,250,132,579 2,250,132,579 325,593,956
MICHIGAN.............................. 66.32 278,438,100 282,893,110 13,502,617,518 562,486,296 12,940,131,222 1,895,853,099 1,895,853,099 282,893,110
MISSISSIPPI........................... 73.05 160,233,246 162,796,978 4,865,309,235 222,637,569 4,642,671,666 666,628,335 666,628,335 162,796,978
MISSOURI.............................. 62.03 497,773,773 505,738,153 8,828,757,766 728,957,576 8,099,800,190 1,205,110,388 1,205,110,388 505,738,153
NEVADA................................ 63.10 48,595,328 49,372,853 2,281,105,301 78,243,748 2,202,861,553 326,420,111 326,420,111 49,372,853
NEW HAMPSHIRE......................... 50.00 168,217,088 170,908,561 1,322,700,772 109,314,773 1,213,385,999 191,587,263 191,587,263 170,908,561
NEW JERSEY............................ 50.00 676,394,441 687,216,752 12,470,313,962 1,213,920,187 11,256,393,775 1,777,325,333 1,777,325,333 687,216,752
NEW YORK.............................. 50.00 1,687,702,633 1,714,705,875 51,806,022,238 3,366,485,105 48,439,537,133 7,648,347,968 7,648,347,968 1,714,705,875
NORTH CAROLINA........................ 65.78 309,959,394 314,918,744 11,992,545,816 406,901,519 11,585,644,297 1,700,491,666 1,700,491,666 314,918,744
OHIO.................................. 63.02 426,850,861 433,680,475 19,439,277,855 672,625,070 18,766,652,785 2,781,672,580 2,781,672,580 433,680,475
PENNSYLVANIA.......................... 53.52 589,710,881 599,146,255 23,461,728,946 956,292,192 22,505,436,754 3,481,187,789 3,481,187,789 599,146,255
RHODE ISLAND.......................... 50.11 68,296,138 69,388,876 2,434,239,452 138,322,435 2,295,917,017 362,262,089 362,262,089 69,388,876
SOUTH CAROLINA........................ 70.57 344,107,463 349,613,182 5,321,038,897 495,387,414 4,825,651,483 697,721,479 697,721,479 349,613,182
TENNESSEE \2\......................... na na na na na na na na 0
TEXAS................................. 58.69 1,004,741,257 1,020,817,117 31,385,332,042 1,526,236,093 29,859,095,949 4,503,997,450 4,503,997,450 1,020,817,117
VERMONT \3\........................... 56.76 23,640,971 24,019,227 1,526,126,311 37,448,781 1,488,677,530 226,534,414 226,534,414 24,019,227
VIRGINIA.............................. 50.00 92,050,138 93,522,940 7,547,405,238 178,694,576 7,368,710,662 1,163,480,631 1,163,480,631 93,522,940
WASHINGTON............................ 50.00 194,381,315 197,491,416 10,233,713,069 365,034,687 9,868,678,382 1,558,212,376 1,558,212,376 197,491,416
WEST VIRGINIA......................... 71.09 70,922,912 72,057,679 3,331,020,307 74,411,705 3,256,608,602 470,155,300 470,155,300 72,057,679
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TOTAL............................. 0.00 10,244,637,203 10,408,551,398 396,484,377,590 16,559,997,057 379,924,380,533 58,293,764,783 58,293,764,783 11,140,511,397
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LOW DSH STATES
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ALASKA................................ 50.00 21,402,636 21,745,078 1,412,407,094 23,114,859 1,389,292,235 219,361,931.84 219,361,932 21,745,078
ARKANSAS.............................. 70.10 45,325,292 46,050,497 4,840,075,746 37,579,991 4,802,495,755 695,328,645 695,328,645 46,050,497
DELAWARE.............................. 55.31 9,512,282 9,664,479 1,691,771,386 14,203,340 1,677,568,046 257,085,076 257,085,076 9,664,479
HAWAII................................ 51.85 10,240,000 10,403,840 1,949,895,249 0 1,949,895,249 304,447,885.55 304,447,886 10,403,840
IDAHO................................. 71.64 17,271,044 17,547,381 1,585,631,105 24,108,102 1,561,523,003 225,085,529.04 225,085,529 17,547,381
IOWA.................................. 57.93 41,378,149 42,040,199 3,921,556,276 43,692,924 3,877,863,352 586,922,597 586,922,597 42,040,199
MINNESOTA............................. 50.00 78,476,334 79,731,955 9,917,891,767 43,384,841 9,874,506,926 1,559,132,673 1,559,132,673 79,731,955
MONTANA............................... 66.33 11,926,371 12,117,193 1,072,160,721 18,113,453 1,054,047,268 154,422,872 154,422,872 12,117,193
NEBRASKA.............................. 54.74 29,733,219 30,208,951 1,771,909,070 41,226,990 1,730,682,080 265,992,149 265,992,149 30,208,951
NEW MEXICO............................ 69.20 21,402,636 21,745,078 4,168,980,357 2,385,192 4,166,595,165 604,884,725 604,884,725 21,745,078
NORTH DAKOTA.......................... 50.00 10,036,360 10,196,942 911,750,976 2,102,554 909,648,422 143,628,698 143,628,698 10,196,942
OKLAHOMA.............................. 64.02 38,049,129 38,657,915 4,666,284,967 43,523,823 4,622,761,144 682,697,044 682,697,044 38,657,915
OREGON................................ 63.14 47,561,414 48,322,397 6,784,093,341 32,160,564 6,751,932,777 1,000,352,841 1,000,352,841 48,322,397
SOUTH DAKOTA.......................... 53.54 11,604,719 11,790,395 778,125,953 1,642,404 776,483,549 120,095,125 120,095,125 11,790,395
UTAH.................................. 70.34 20,612,808 20,942,613 2,064,362,848 31,747,312 2,032,615,536 294,084,697 294,084,697 20,942,613
WISCONSIN............................. 59.06 99,326,563 100,915,788 7,396,295,700 50,838,381 7,345,457,319 1,106,220,253 1,106,220,253 100,915,788
[[Page 74437]]
WYOMING............................... 50.00 237,807 241,612 539,403,281 466,255 538,937,026 85,095,320 85,095,320 241,612
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
TOTAL LOW DSH STATES.............. 0.00 514,096,763 522,322,311 55,472,595,837 410,290,985 55,062,304,852 8,304,838,060 8,304,838,060 522,322,313
---------------------------------------------------------------------------------------------------------------------------------------------------------
TOTAL......................... 0.00 10,758,733,966 10,930,873,709 451,956,973,427 16,970,288,042 434,986,685,385 66,598,602,843 66,598,602,843 11,662,833,710
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ FY 2014 DSH allotment for Louisiana determined under the provisions of section 1903(f)(3)(C) and (D) of the Act.
\2\ Tennessee's DSH allotment for FY 2014, determined under section 1923(f)(6)(A) of the Social Security Act, is 0.
\3\ Per 1905(z)(1)(A) of Act, Vermont's regular FMAP is increased by 2.2 percentage points for the period 1/1/2014--12/31/2015.
[[Page 74438]]
Key to Addendum 2--Preliminary DSH Allotments for FY 2016
[The Preliminary FY 2016 DSH Allotments for the NON-Low DSH States are
presented in the top section of this addendum, and the Preliminary FY
2016 DSH Allotments for the Low-DSH States are presented in the bottom
section of this addendum]
------------------------------------------------------------------------
Column Description
------------------------------------------------------------------------
Column A................. State.
Column B................. FY 2016 FMAPs. This column contains the
States' FY 2016 Federal Medical Assistance
Percentages.
Column C................. Prior FY (2015) DSH Allotments. This column
contains the States' prior FY 2015 DSH
Allotments.
Column D................. Prior FY (2015) DSH Allotments (Col C) x
(100percent + Percentage Increase in CPIU):
100.3percent. This column contains the
amount in Column C increased by 1 plus the
estimated percentage increase in the CPI-U
for the prior FY (100.3 percent).
Column E................. FY 2016 TC MAP Exp. Including DSH. This
column contains the amount of the States'
projected FY 2016 total computable (TC)
medical assistance expenditures including
DSH expenditures.
Column F................. FY 2016 TC DSH Expenditures. This column
contains the amount of the States' projected
FY 2016 total computable DSH expenditures.
Column G................. FY 2016 TC MAP Exp. Net of DSH. This column
contains the amount of the States' projected
FY 2016 total computable medical assistance
expenditures net of DSH expenditures,
calculated as the amount in Column E minus
the amount in Column F.
Column H................. 12 percent Amount. This column contains the
amount of the ``12 percent limit'' in
Federal share, determined in accordance with
the provisions of section 1923(f)(3) of the
Act.
Column I................. Greater of FY 2015 Allotment or 12 percent
Limit. This column contains the greater of
the State's prior FY (FY 2015) DSH allotment
or the amount of the 12 percent Limit,
determined as the maximum of the amount in
Column C or Column H.
Column J................. FY 2016 DSH Allotment. This column contains
the States' preliminary FY 2016 DSH
allotments, determined as the minimum of the
amount in Column I or Column D. For states
with ``na'' in Columns I or D, refer to the
footnotes in the addendum.
------------------------------------------------------------------------
[[Page 74439]]
Addendum 2--Preliminary DSH Allotments for Fiscal Year: 2016
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Prior FY (2015)
DSH allotment ``12% Amount'' = Greater of Col
FY 2016 Prior FY (2015) (Col C) x 100% FY 2016 TC MAP FY 2016 TC DSH FY 2016 TC MAP Col G x .12/(1- H or Col C (12% FY 2016 DSH
State FMAPs (%) DSH Allotments + pct increase Exp. including expenditures EXP. net of DSH .12/Col B) * (in Limit, FY 2015 Allotment MIN
in CPIU: DSH Col E-F FS) Allotment) Col I, Col D
100.3%
A B C D E F G H I J
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
ALABAMA............................... 69.87 $333,186,701 $334,186,261 $5,930,834,000 $479,878,000 $5,450,956,000 $789,752,816 $789,752,816 $334,186,261
ARIZONA............................... 68.92 109,707,817 110,036,940 12,053,707,000 170,695,000 11,883,012,000 1,726,585,777 1,726,585,777 110,036,940
CALIFORNIA............................ 50.00 1,187,824,131 1,191,387,603 111,044,623,000 615,463,000 110,429,160,000 17,436,183,158 17,436,183,158 1,191,387,603
COLORADO.............................. 50.72 100,226,893 100,527,574 8,094,087,000 221,186,000 7,872,901,000 1,237,541,959 1,237,541,959 100,527,574
CONNECTICUT........................... 50.00 216,706,796 217,356,916 7,523,550,000 121,554,000 7,401,996,000 1,168,736,211 1,168,736,211 217,356,916
DISTRICT OF COLUMBIA.................. 70.00 66,366,456 66,565,555 2,768,440,000 36,674,000 2,731,766,000 395,635,076 395,635,076 66,565,555
FLORIDA............................... 60.67 216,706,796 217,356,916 21,269,943,000 360,904,000 20,909,039,000 3,127,720,722 3,127,720,722 217,356,916
GEORGIA............................... 67.55 291,199,759 292,073,358 9,111,625,000 435,016,000 8,676,609,000 1,266,113,277 1,266,113,277 292,073,358
ILLINOIS.............................. 50.89 232,959,806 233,658,685 16,127,216,000 394,376,000 15,732,840,000 2,470,488,745 2,470,488,745 233,658,685
INDIANA............................... 66.60 231,605,390 232,300,206 12,434,804,000 128,475,000 12,306,329,000 1,801,322,003 1,801,322,003 232,300,206
KANSAS................................ 55.96 44,695,778 44,829,865 3,237,360,000 78,926,000 3,158,434,000 482,473,066 482,473,066 44,829,865
KENTUCKY.............................. 70.32 157,112,428 157,583,765 10,502,654,000 498,275,000 10,004,379,000 1,447,547,184 1,447,547,184 157,583,765
LOUISIANA............................. 62.21 743,671,360 745,902,374 8,188,536,000 881,390,000 7,307,146,000 1,086,423,149 1,086,423,149 745,902,374
MAINE................................. 62.67 113,771,068 114,112,381 2,595,932,000 42,279,000 2,553,653,000 379,011,092 379,011,092 114,112,381
MARYLAND.............................. 50.00 82,619,466 82,867,324 10,300,033,000 102,916,000 10,197,117,000 1,610,071,105 1,610,071,105 82,867,324
MASSACHUSETTS......................... 50.00 330,477,865 331,469,299 17,688,569,000 0 17,688,569,000 2,792,931,947 2,792,931,947 331,469,299
MICHIGAN.............................. 65.60 287,136,507 287,997,917 18,245,307,000 399,957,000 17,845,350,000 2,620,869,313 2,620,869,313 287,997,917
MISSISSIPPI........................... 74.17 165,238,933 165,734,650 5,593,780,000 225,000,000 5,368,780,000 768,606,876 768,606,876 165,734,650
MISSOURI.............................. 63.28 513,324,226 514,864,199 9,977,517,000 741,320,000 9,236,197,000 1,367,706,426 1,367,706,426 514,864,199
NEVADA................................ 64.93 50,113,446 50,263,786 3,487,301,000 79,052,000 3,408,249,000 501,713,828 501,713,828 50,263,786
NEW HAMPSHIRE......................... 50.00 173,472,190 173,992,607 1,982,620,000 215,300,000 1,767,320,000 279,050,526 279,050,526 173,992,607
NEW JERSEY............................ 50.00 697,525,004 699,617,579 15,818,782,000 1,055,083,000 14,763,699,000 2,331,110,368 2,331,110,368 699,617,579
NEW YORK.............................. 50.00 1,740,426,463 1,745,647,742 67,708,685,000 5,212,860,000 62,495,825,000 9,867,761,842 9,867,761,842 1,745,647,742
NORTH CAROLINA........................ 66.24 319,642,526 320,601,454 14,344,107,000 584,963,000 13,759,144,000 2,016,384,289 2,016,384,289 320,601,454
OHIO.................................. 62.47 440,185,682 441,506,239 23,409,769,000 0 23,409,769,000 3,477,095,152 3,477,095,152 441,506,239
PENNSYLVANIA.......................... 52.01 608,133,449 609,957,849 25,118,027,000 970,040,000 24,147,987,000 3,766,868,694 3,766,868,694 609,957,849
RHODE ISLAND.......................... 50.42 70,429,709 70,640,998 2,798,911,000 140,859,000 2,658,052,000 418,591,302 418,591,302 70,640,998
SOUTH CAROLINA........................ 71.08 354,857,380 355,921,952 6,627,245,000 514,209,000 6,113,036,000 882,561,812 882,561,812 355,921,952
TENNESSEE \1\......................... 65.05 na na na na na na na 53,100,000
TEXAS................................. 57.13 1,036,129,374 1,039,237,762 40,938,942,000 2,913,588,000 38,025,354,000 5,776,348,701 5,776,348,701 1,039,237,762
VERMONT \2\........................... 54.45 24,379,515 24,452,654 1,950,326,000 37,449,000 1,912,877,000 294,434,354 294,434,354 24,452,654
VIRGINIA.............................. 50.00 94,925,784 95,210,561 8,682,506,000 202,125,000 8,480,381,000 1,339,007,526 1,339,007,526 95,210,561
WASHINGTON............................ 50.00 200,453,788 201,055,149 13,268,547,000 412,552,000 12,855,995,000 2,029,893,947 2,029,893,947 201,055,149
WEST VIRGINIA......................... 71.42 73,138,544 73,357,960 4,023,484,000 73,139,000 3,950,345,000 569,775,106 569,775,106 73,357,960
---------------------------------------------------------------------------------------------------------------------------------------------------------
TOTAL............................. .......... 11,308,351,030 11,342,276,083 522,847,769,000 18,345,503,000 504,502,266,000 77,526,317,353 77,526,317,353 11,395,376,080
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
LOW DSH STATES
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
ALASKA................................ 50.00 22,071,255 22,137,469 1,845,425,000 28,763,000 1,816,662,000 286,841,368.42 286,841,368 22,137,469
ARKANSAS.............................. 70.00 46,741,254 46,881,478 6,474,078,000 50,820,000 6,423,258,000 930,264,952 930,264,952 46,881,478
DELAWARE.............................. 54.83 9,809,445 9,838,873 2,024,107,000 23,869,000 2,000,238,000 307,279,149 307,279,149 9,838,873
HAWAII \3\............................ 53.98 10,559,898 10,591,578 2,280,099,000 0 2,280,099,000 351,823,946.70 351,823,947 10,591,578
IDAHO................................. 71.24 17,810,592 17,864,024 1,954,296,000 25,668,000 1,928,628,000 278,316,256.69 278,316,257 17,864,024
IOWA.................................. 54.91 42,670,802 42,798,814 4,977,980,000 46,668,000 4,931,312,000 757,245,421 757,245,421 42,798,814
MINNESOTA............................. 50.00 80,927,935 81,170,719 12,331,901,000 154,640,000 12,177,261,000 1,922,725,421 1,922,725,421 81,170,719
MONTANA............................... 65.24 12,298,951 12,335,848 1,114,619,000 1,656,000 1,112,963,000 163,658,241 163,658,241 12,335,848
NEBRASKA.............................. 51.16 30,662,084 30,754,070 2,123,413,000 45,557,000 2,077,856,000 325,750,091 325,750,091 30,754,070
NEW MEXICO............................ 70.37 22,071,255 22,137,469 6,102,795,000 32,020,000 6,070,775,000 878,260,278 878,260,278 22,137,469
NORTH DAKOTA.......................... 50.00 10,349,895 10,380,945 1,291,738,000 1,765,000 1,289,973,000 203,679,947 203,679,947 10,380,945
OKLAHOMA.............................. 60.99 39,237,784 39,355,497 5,461,374,000 52,314,000 5,409,060,000 808,079,778 808,079,778 39,355,497
OREGON................................ 64.38 49,047,232 49,194,374 9,507,193,000 82,564,000 9,424,629,000 1,390,051,810 1,390,051,810 49,194,374
SOUTH DAKOTA.......................... 51.61 11,967,251 12,003,153 901,031,000 1,617,000 899,414,000 140,627,387 140,627,387 12,003,153
UTAH.................................. 70.24 21,256,752 21,320,522 2,546,400,000 30,842,000 2,515,558,000 364,064,823 364,064,823 21,320,522
WISCONSIN............................. 58.23 102,429,524 102,736,813 8,533,715,000 170,702,000 8,363,013,000 1,264,057,747 1,264,057,747 102,736,813
[[Page 74440]]
WYOMING............................... 50.00 245,236 245,972 608,180,000 482,000 607,698,000 95,952,316 95,952,316 245,972
---------------------------------------------------------------------------------------------------------------------------------------------------------
TOTAL LOW DSH STATES.............. .......... 530,157,145 531,747,616 70,078,344,000 749,947,000 69,328,397,000 10,468,678,931 10,468,678,931 531,747,618
---------------------------------------------------------------------------------------------------------------------------------------------------------
TOTAL......................... .......... 11,838,508,175 11,874,023,700 592,926,113,000 19,095,450,000 573,830,663,000 87,994,996,285 87,994,996,285 11,927,123,698
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Tennessee's DSH allotment for FY 2016 determined under section 1923(f)(6)(A) of the Act
\2\ FMAP for Vermont for FY 2016 determined in accordance with section 1905(z)(1)(A) of the Act.
[[Page 74441]]
Key to Addendum 3--Final IMD DSH Limits for FY 2014
[The final FY 2014 IMD DSH Limits for the Non-Low DSH States are
presented in the top section of this addendum and the preliminary FY
2014 IMD DSH Limits for the Low-DSH States are presented in the bottom
section of the addendum]
------------------------------------------------------------------------
Column 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.
Column C................. IMD and Mental Health Services FY 95 DSH
Total Computable. This column contains the
total computable FY 1995 mental health
facility DSH expenditures as reported on the
Form CMS-64 as of January 1, 1997.
Column D................. Total Inpatient Hospital & IMD & Mental
Health FY 95 DSH Total Computable, Col. B +
C. This column contains the total
computation of all inpatient hospital DSH
expenditures and mental health facility DSH
expenditures for FY 1995 as reported on the
Form CMS-64 as of January 1, 1997
(representing the sum of Column B and Column
C).
Column E................. Applicable Percentage, Col. C/D. This column
contains the ``applicable percentage''
representing the total Computable FY 1995
mental health facility DSH expenditures
divided by total computable all inpatient
hospital and mental health facility DSH
expenditures for FY 1995 (the amount in
Column C divided by the amount in Column D)
Per section 1923(h)(2)(A)(ii)(III) of the
Act, for FYs after FY 2002, the applicable
percentage can be no greater than 33
percent.
Column F................. FY 2014 Federal Share DSH Allotment. This
column contains the states' FY 2014 DSH
allotments from Column J Addendum 1.
Column G................. FY 2014 FMAP.
Column H................. FY 2014 DSH Allotments in Total Computable,
Col. F/G. This column contains states' FY
2013 total computable DSH allotment
(determined as Column F/Column G).
Column I................. Applicable Percentage Applied to FY 2014
Allotments in TC, Col E x Col H. This column
contains the applicable percentage of FY
2013 total computable DSH allotment
(calculated as the percentage in Column E
multiplied by the amount in Column H).
Column J................. FY 2014 TC IMD DSH Limit. Lesser of Col. I or
C. This column contains the total computable
FY 2014 TC IMD DSH Limit equal to the lesser
of the amount in Column I or Column C.
Column K................. FY 2014 IMD DSH Limit in Federal Share, Col.
G x J. This column contains the FY 2014
Federal Share IMD DSH limit determined by
converting the total computable FY 2014 IMD
DSH Limit from Column J into a federal share
amount by multiplying it by the FY 2014 FMAP
in Column G.
------------------------------------------------------------------------
[[Page 74442]]
Addendum 3--Final IMD DSH Limit for FY: 2014
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Applicable
Inpatient Total inpatient percentage
hospital IMD and mental & IMD & mental Applicable FY 2014 FY 2014 applied to FY FY 2014 TC IMD FY 2014 IMD MMA low
STATE services FY 95 health services health FY 95 percent Col C/ FY 2014 FMA Ps allotments in 2013 limit (lesser limit in FS DSH
DSH total FY 95 DSH total DSH total D allotment in FS (%) TC col F/G allotments in of Col I or Col Col G x J Status
computable computable computable Col TC Col E x Col C)
B + C H
A B C D E F G H I J K L
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
ALABAMA................................................. $413,006,229 $4,451,770 $417,457,999 1.07 $328,262,759 68.12 $481,888,959 $5,138,861 $4,451,770 $3,032,546 N/A
ARIZONA................................................. 93,916,100 28,474,900 122,391,000 23.27 108,086,519 67.23 160,771,261 37,404,267 28,474,900 19,143,675 N/A
CALIFORNIA.............................................. 2,189,879,543 1,555,919 2,191,435,462 0.07 1,170,270,080 50.00 2,340,540,160 1,661,783 1,555,919 777,960 N/A
COLORADO................................................ 173,900,441 594,776 174,495,217 0.34 98,745,708 50.00 197,491,416 673,160 594,776 297,388 N/A
CONNECTICUT............................................. 303,359,275 105,573,725 408,933,000 25.82 213,504,233 50.00 427,008,466 110,240,246 105,573,725 52,786,863 N/A
DISTRICT OF COLUMBIA.................................... 39,532,234 6,545,136 46,077,370 14.20 65,385,671 70.00 93,408,101 13,268,308 6,545,136 4,581,595 N/A
FLORIDA................................................. 184,468,014 149,714,986 334,183,000 33.00 213,504,233 58.79 363,164,200 119,844,186 119,844,186 70,456,397 N/A
GEORGIA................................................. 407,343,557 0 407,343,557 0.00 286,896,314 65.93 435,152,911 0 0 0 N/A
ILLINOIS................................................ 315,868,508 89,408,276 405,276,784 22.06 229,517,051 50.00 459,034,102 101,267,700 89,408,276 44,704,138 N/A
INDIANA................................................. 79,960,783 153,566,302 233,527,085 33.00 228,182,651 66.92 340,978,259 112,522,826 112,522,826 75,300,275 N/A
KANSAS.................................................. 11,587,208 76,663,508 88,250,716 33.00 44,035,248 56.91 77,376,995 25,534,408 25,534,408 14,531,632 N/A
KENTUCKY................................................ 158,804,908 37,443,073 196,247,981 19.08 154,790,570 69.83 221,667,722 42,293,025 37,443,073 26,146,498 N/A
LOUISIANA............................................... 1,078,512,169 132,917,149 1,211,429,318 10.97 731,960,000 62.11 1,178,489,776 129,303,046 129,303,046 80,310,122 N/A
MAINE................................................... 99,957,958 60,958,342 160,916,300 33.00 112,089,722 61.55 182,111,652 60,096,845 60,096,845 36,989,608 N/A
MARYLAND................................................ 22,226,467 120,873,531 143,099,998 33.00 81,398,489 50.00 162,796,978 53,723,003 53,723,003 26,861,501 N/A
MASSACHUSETTS........................................... 469,653,946 105,635,054 575,289,000 18.36 325,593,956 50.00 651,187,912 119,571,677 105,635,054 52,817,527 N/A
MICHIGAN................................................ 133,258,800 304,765,552 438,024,352 33.00 282,893,110 66.32 426,557,765 140,764,063 140,764,063 93,354,726 N/A
MISSISSIPPI............................................. 182,608,033 0 182,608,033 0.00 162,796,978 73.05 222,856,917 0 0 0 N/A
MISSOURI................................................ 521,946,524 207,234,618 729,181,142 28.42 505,738,153 62.03 815,312,192 231,713,221 207,234,618 128,547,634 N/A
NEVADA.................................................. 73,560,000 0 73,560,000 0.00 49,372,853 63.10 78,245,409 0 0 0 N/A
NEW HAMPSHIRE........................................... 92,675,916 94,753,948 187,429,864 33.00 170,908,561 50.00 341,817,122 112,799,650 94,753,948 47,376,974 N/A
NEW JERSEY.............................................. 736,742,539 357,370,461 1,094,113,000 32.66 687,216,752 50.00 1,374,433,504 448,931,632 357,370,461 178,685,231 N/A
NEW YORK................................................ 2,418,869,368 605,000,000 3,023,869,368 20.01 1,714,705,875 50.00 3,429,411,750 686,138,803 605,000,000 302,500,000 N/A
NORTH CAROLINA.......................................... 193,201,966 236,072,627 429,274,593 33.00 314,918,744 65.78 478,745,430 157,985,992 157,985,992 103,923,186 N/A
OHIO.................................................... 535,731,956 93,432,758 629,164,714 14.85 433,680,475 63.02 688,163,242 102,194,208 93,432,758 58,881,324 N/A
PENNSYLVANIA............................................ 388,207,319 579,199,682 967,407,001 33.00 599,146,255 53.52 1,119,481,044 369,428,745 369,428,745 197,718,264 N/A
RHODE ISLAND............................................ 108,503,167 2,397,833 110,901,000 2.16 69,388,876 50.11 138,473,111 2,993,980 2,397,833 1,201,554 N/A
SOUTH CAROLINA.......................................... 366,681,364 72,076,341 438,757,705 16.43 349,613,182 70.57 495,413,323 81,383,368 72,076,341 50,864,274 N/A
TENNESSEE............................................... 0 0 0 0.00 0 65.29 0 0 0 0 N/A
TEXAS................................................... 1,220,515,401 292,513,592 1,513,028,993 19.33 1,020,817,117 58.69 1,739,337,395 336,265,750 292,513,592 171,676,227 N/A
VERMONT................................................. 19,979,252 9,071,297 29,050,549 31.23 24,019,227 56.76 42,317,172 13,213,920 9,071,297 5,148,868 N/A
VIRGINIA................................................ 129,313,480 7,770,268 137,083,748 5.67 93,522,940 50.00 187,045,880 10,602,253 7,770,268 3,885,134 N/A
WASHINGTON.............................................. 171,725,815 163,836,435 335,562,250 33.00 197,491,416 50.00 394,982,832 130,344,335 130,344,335 65,172,167 N/A
WEST VIRGINIA........................................... 66,962,606 18,887,045 85,849,651 22.00 72,057,679 71.09 101,361,203 22,299,608 18,887,045 13,426,800 N/A
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
TOTAL............................................... 13,402,460,846 4,118,758,904 17,521,219,750 .............. 11,140,511,397 .......... 19,847,024,163 3,779,602,867 3,439,738,238 1,931,100,088 ..........
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
LOW DSH STATES
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
ALASKA.................................................. 2,506,827 17,611,765 20,118,592 33.00 21,745,078 50.00 43,490,156 14,351,751 14,351,751 7,175,876 LOW DSH
ARKANSAS................................................ 2,422,649 819,351 3,242,000 25.27 46,050,497 70.10 65,692,578 16,602,492 819,351 574,365 LOW DSH
DELAWARE................................................ 0 7,069,000 7,069,000 33.00 9,664,479 55.31 17,473,294 5,766,187 5,766,187 3,189,278 LOW DSH
HAWAII.................................................. 0 0 0 0.00 10,403,840 51.85 20,065,265 0 0 0 LOW DSH
IDAHO................................................... 2,081,429 0 2,081,429 0.00 17,547,381 71.64 24,493,832 0 0 0 LOW DSH
IOWA.................................................... 12,011,250 0 12,011,250 0.00 42,040,199 57.93 72,570,687 0 0 0 LOW DSH
MINNESOTA............................................... 24,240,000 5,257,214 29,497,214 17.82 79,731,955 50.00 159,463,910 28,420,850 5,257,214 2,628,607 LOW DSH
MONTANA................................................. 237,048 0 237,048 0.00 12,117,193 66.33 18,268,043 0 0 0 LOW DSH
NEBRASKA................................................ 6,449,102 1,811,337 8,260,439 21.93 30,208,951 54.74 55,186,246 12,101,159 1,811,337 991,526 LOW DSH
NEW MEXICO.............................................. 6,490,015 254,786 6,744,801 3.78 21,745,078 69.20 31,423,523 1,187,029 254,786 176,312 LOW DSH
NORTH DAKOTA............................................ 214,523 988,478 1,203,001 33.00 10,196,942 50.00 20,393,884 6,729,982 988,478 494,239 LOW DSH
OKLAHOMA................................................ 20,019,969 3,273,248 23,293,217 14.05 38,657,915 64.02 60,384,122 8,485,398 3,273,248 2,095,533 LOW DSH
OREGON.................................................. 11,437,908 19,975,092 31,413,000 33.00 48,322,397 63.14 76,532,146 25,255,608 19,975,092 12,612,273 LOW DSH
SOUTH DAKOTA............................................ 321,120 751,299 1,072,419 33.00 11,790,395 53.54 22,021,657 7,267,147 751,299 402,245 LOW DSH
UTAH.................................................... 3,621,116 934,586 4,555,702 20.51 20,942,613 70.34 29,773,405 6,107,908 934,586 657,388 LOW DSH
[[Page 74443]]
WISCONSIN............................................... 6,609,524 4,492,011 11,101,535 33.00 100,915,788 59.06 170,869,942 56,387,081 4,492,011 2,652,982 LOW DSH
WYOMING................................................. 0 0 0 0.00 241,612 50.00 483,224 0 0 0 LOW DSH
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
TOTAL LOW DSH STATES................................ 98,662,480 63,238,167 161,900,647 .............. 522,322,313 .......... 888,585,914 188,662,592 58,675,341 33,650,624 ..........
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
TOTAL........................................... 13,501,123,326 4,181,997,071 17,683,120,397 .............. 11,662,833,710 .......... 20,735,610,077 3,968,265,459 3,498,413,578 1,964,750,712 ..........
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
[[Page 74444]]
Key to Addendum 4--Preliminary IMD DSH Limits for FY 2016
[The preliminary FY 2016 IMD DSH Limits for the Non-Low DSH States are
presented in the top section of this addendum and the preliminary FY
2016 IMD DSH Limits for the Low-DSH States are presented in the bottom
section of the addendum]
------------------------------------------------------------------------
Column Description
------------------------------------------------------------------------
Column A................. State.
Column B................. Inpatient Hospital Services FY 95 DSH Total
Computable. This column contains the States'
total computable FY 1995 inpatient hospital
DSH expenditures as reported on the Form CMS-
64.
Column C................. IMD and Mental Health Services FY 95 DSH
Total. Computable. This column contains the
total computable FY 1995 mental health
facility DSH expenditures as reported on the
Form CMS-64 as of January 1, 1997.
Column D................. Total Inpatient Hospital & IMD & Mental
Health FY 95 DSH Total. Computable, Col. B +
C. This column contains the total
computation of all inpatient hospital DSH
expenditures and mental health facility DSH
expenditures for FY 1995 as reported on the
Form CMS-64 as of January 1, 1997
(representing the sum of Column B and Column
C).
Column E................. Applicable Percentage, Col. C/D. This column
contains the ``applicable percentage''
representing the total Computable FY 1995
mental health facility DSH expenditures
divided by total computable all inpatient
hospital and mental health facility DSH
expenditures for FY 1995 (the amount in
Column C divided by the amount in Column D)
Per section 1923(h)(2)(A)(ii)(III) of the
Act, for FYs after FY 2002, the applicable
percentage can be no greater than 33
percent.
Column F................. FY 2016 Federal Share DSH Allotment. This
column contains the states' preliminary FY
2016 DSH allotments from Column J Addendum
1.
Column G................. FY 2016 FMAP.
Column H................. FY 2016 DSH Allotments in Total Computable,
Col. F/G. This column contains states' FY
2016 total computable DSH allotment
(determined as Column F/Column G).
Column I................. Applicable Percentage Applied to FY 2016
Allotments in TC, Col E x Col H. This column
contains the applicable percentage of FY
2015 total computable DSH allotment
(calculated as the percentage in Column E
multiplied by the amount in Column H).
Column J................. FY 2016 TC IMD DSH Limit. Lesser of Col. I or
C. This column contains the total computable
FY 2016 TC IMD DSH Limit equal to the lesser
of the amount in Column I or Column C.
Column K................. FY 2016 IMD DSH Limit in Federal Share, Col.
G x J. This column contains the FY 2016
Federal Share IMD DSH limit determined by
converting the total computable FY 2016 IMD
DSH Limit from Column J into a federal share
amount by multiplying it by the FY 2016 FMAP
in Column G.
------------------------------------------------------------------------
[[Page 74445]]
Addendum 4--Preliminary IMD DSH Limit for Fiscal Year: 2016
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Applicable
Inpatient Total inpatient percentage
hospital IMD and mental & IMD & mental Applicable FY 2016 applied to FY FY 2016 TC IMD FY 2016 IMD MMA low
State services FY 95 health services health FY 95 percent Col C/ FY 2016 FY 2016 allotments in 2016 limit (lesser limit in FS Col DSH
DSH total FY 95 DSH total DSH total D allotment in FS FMAPs (%) TC Col F/G allotments in of Col I or Col G x J status
computable computable computable Col TC Col E x Col C)
B + C H
A B C D E F G H I J K L
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
ALABAMA................................................. $413,006,229 $4,451,770 $417,457,999 1.07 $334,186,261 69.87 $478,297,211 $5,100,559 $4,451,770 $3,110,452 N/A
ARIZONA................................................. 93,916,100 28,474,900 122,391,000 23.27 110,036,940 68.92 159,658,938 37,145,479 28,474,900 19,624,901 N/A
CALIFORNIA.............................................. 2,189,879,543 1,555,919 2,191,435,462 0.07 1,191,387,603 50.00 2,382,775,206 1,691,770 1,555,919 777,960 N/A
COLORADO................................................ 173,900,441 594,776 174,495,217 0.34 100,527,574 50.72 198,201,053 675,579 594,776 301,670 N/A
CONNECTICUT............................................. 303,359,275 105,573,725 408,933,000 25.82 217,356,916 50.00 434,713,832 112,229,530 105,573,725 52,786,863 N/A
DISTRICT OF COLUMBIA.................................... 39,532,234 6,545,136 46,077,370 14.20 66,565,555 70.00 95,093,650 13,507,734 6,545,136 4,581,595 N/A
FLORIDA................................................. 184,468,014 149,714,986 334,183,000 33.00 217,356,916 60.67 358,260,946 118,226,112 118,226,112 71,727,782 N/A
GEORGIA................................................. 407,343,557 0 407,343,557 0.00 292,073,358 67.55 432,380,989 0 0 0 N/A
ILLINOIS................................................ 315,868,508 89,408,276 405,276,784 22.06 233,658,685 50.89 459,144,596 101,292,076 89,408,276 45,499,872 N/A
INDIANA................................................. 79,960,783 153,566,302 233,527,085 33.00 232,300,206 66.60 348,799,108 115,103,706 115,103,706 76,659,068 N/A
KANSAS.................................................. 11,587,208 76,663,508 88,250,716 33.00 44,829,865 55.96 80,110,552 26,436,482 26,436,482 14,793,855 N/A
KENTUCKY................................................ 158,804,908 37,443,073 196,247,981 19.08 157,583,765 70.32 224,095,229 42,756,180 37,443,073 26,329,969 N/A
LOUISIANA............................................... 1,078,512,169 132,917,149 1,211,429,318 10.97 745,902,374 62.21 1,199,007,192 131,554,202 131,554,202 81,839,869 N/A
MAINE................................................... 99,957,958 60,958,342 160,916,300 33.00 114,112,381 62.67 182,084,540 60,087,898 60,087,898 37,657,086 N/A
MARYLAND................................................ 22,226,467 120,873,531 143,099,998 33.00 82,867,324 50.00 165,734,648 54,692,434 54,692,434 27,346,217 N/A
MASSACHUSETTS........................................... 469,653,946 105,635,054 575,289,000 18.36 331,469,299 50.00 662,938,598 121,729,348 105,635,054 52,817,527 N/A
MICHIGAN................................................ 133,258,800 304,765,552 438,024,352 33.00 287,997,917 65.60 439,021,215 144,877,001 144,877,001 95,039,313 N/A
MISSISSIPPI............................................. 182,608,033 0 182,608,033 0.00 165,734,650 74.17 223,452,407 0 0 0 N/A
MISSOURI................................................ 521,946,524 207,234,618 729,181,142 28.42 514,864,199 63.28 813,628,633 231,234,750 207,234,618 131,138,066 N/A
NEVADA.................................................. 73,560,000 0 73,560,000 0.00 50,263,786 64.93 77,412,269 0 0 0 N/A
NEW HAMPSHIRE........................................... 92,675,916 94,753,948 187,429,864 33.00 173,992,607 50.00 347,985,214 114,835,121 94,753,948 47,376,974 N/A
NEW JERSEY.............................................. 736,742,539 357,370,461 1,094,113,000 32.66 699,617,579 50.00 1,399,235,158 457,032,604 357,370,461 178,685,231 N/A
NEW YORK................................................ 2,418,869,368 605,000,000 3,023,869,368 20.01 1,745,647,742 50.00 3,491,295,484 698,520,178 605,000,000 302,500,000 N/A
NORTH CAROLINA.......................................... 193,201,966 236,072,627 429,274,593 33.00 320,601,454 66.24 483,999,780 159,719,927 159,719,927 105,798,480 N/A
OHIO.................................................... 535,731,956 93,432,758 629,164,714 14.85 441,506,239 62.47 706,749,222 104,954,279 93,432,758 58,367,444 N/A
PENNSYLVANIA............................................ 388,207,319 579,199,682 967,407,001 33.00 609,957,849 52.01 1,172,770,331 387,014,209 387,014,209 201,286,090 N/A
RHODE ISLAND............................................ 108,503,167 2,397,833 110,901,000 2.16 70,640,998 50.42 140,105,113 3,029,266 2,397,833 1,208,987 N/A
SOUTH CAROLINA.......................................... 366,681,364 72,076,341 438,757,705 16.43 355,921,952 71.08 500,734,316 82,257,467 72,076,341 51,231,863 N/A
TENNESSEE............................................... 0 0 0 0.00 53,100,000 65.05 81,629,516 0 0 0 N/A
TEXAS................................................... 1,220,515,401 292,513,592 1,513,028,993 19.33 1,039,237,762 57.13 1,819,075,375 351,681,478 292,513,592 167,113,015 N/A
VERMONT................................................. 19,979,252 9,071,297 29,050,549 31.23 24,452,654 54.45 44,908,455 14,023,072 9,071,297 4,939,321 N/A
VIRGINIA................................................ 129,313,480 7,770,268 137,083,748 5.67 95,210,561 50.00 190,421,122 10,793,571 7,770,268 3,885,134 N/A
WASHINGTON.............................................. 171,725,815 163,836,435 335,562,250 33.00 201,055,149 50.00 402,110,298 132,696,398 132,696,398 66,348,199 N/A
WEST VIRGINIA........................................... 66,962,606 18,887,045 85,849,651 22.00 73,357,960 71.42 102,713,470 22,597,109 18,887,045 13,489,128 N/A
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
TOTAL............................................... 13,402,460,846 4,118,758,904 17,521,219,750 .............. 11,395,376,080 .......... 20,298,543,664 3,857,495,519 3,470,599,160 1,944,261,931 ..........
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
LOW DSH STATES
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
ALASKA.................................................. 2,506,827 17,611,765 20,118,592 33.00 22,137,469 50.00 44,274,938 14,610,730 14,610,730 7,305,365 LOW DSH
ARKANSAS................................................ 2,422,649 819,351 3,242,000 25.27 46,881,478 70.00 66,973,540 16,926,230 819,351 573,546 LOW DSH
DELAWARE................................................ 0 7,069,000 7,069,000 33.00 9,838,873 54.83 17,944,324 5,921,627 5,921,627 3,246,828 LOW DSH
HAWAII.................................................. 0 0 0 0.00 10,591,578 53.98 19,621,300 0 0 0 LOW DSH
IDAHO................................................... 2,081,429 0 2,081,429 0.00 17,864,024 71.24 25,075,834 0 0 0 LOW DSH
IOWA.................................................... 12,011,250 0 12,011,250 0.00 42,798,814 54.91 77,943,569 0 0 0 LOW DSH
MINNESOTA............................................... 24,240,000 5,257,214 29,497,214 17.82 81,170,719 50.00 162,341,438 28,933,705 5,257,214 2,628,607 LOW DSH
MONTANA................................................. 237,048 0 237,048 0.00 12,335,848 65.24 18,908,412 0 0 0 LOW DSH
NEBRASKA................................................ 6,449,102 1,811,337 8,260,439 21.93 30,754,070 51.16 60,113,507 13,181,602 1,811,337 926,680 LOW DSH
NEW MEXICO.............................................. 6,490,015 254,786 6,744,801 3.78 22,137,469 70.37 31,458,674 1,188,357 254,786 179,293 LOW DSH
NORTH DAKOTA............................................ 214,523 988,478 1,203,001 33.00 10,380,945 50.00 20,761,890 6,851,424 988,478 494,239 LOW DSH
OKLAHOMA................................................ 20,019,969 3,273,248 23,293,217 14.05 39,355,497 60.99 64,527,787 9,067,680 3,273,248 1,996,354 LOW DSH
OREGON.................................................. 11,437,908 19,975,092 31,413,000 33.00 49,194,374 64.38 76,412,510 25,216,128 19,975,092 12,859,964 LOW DSH
SOUTH DAKOTA............................................ 321,120 751,299 1,072,419 33.00 12,003,153 51.61 23,257,417 7,674,948 751,299 387,745 LOW DSH
UTAH.................................................... 3,621,116 934,586 4,555,702 20.51 21,320,522 70.24 30,353,818 6,226,977 934,586 656,453 LOW DSH
[[Page 74446]]
WISCONSIN............................................... 6,609,524 4,492,011 11,101,535 33.00 102,736,813 58.23 176,432,789 58,222,820 4,492,011 2,615,698 LOW DSH
WYOMING................................................. 0 0 0 0.00 245,972 50.00 491,944 0 0 0 LOW DSH
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
TOTAL LOW DSH STATES................................ 98,662,480 63,238,167 161,900,647 .............. 531,747,618 .......... 916,893,692 194,022,228 59,089,759 33,870,772 ..........
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
TOTAL........................................... 13,501,123,326 4,181,997,071 17,683,120,397 .............. 11,927,123,698 .......... 21,215,437,356 4,051,517,746 3,529,688,919 1,978,132,703 ..........
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
[[Page 74447]]
[FR Doc. 2016-25813 Filed 10-25-16; 8:45 am]
BILLING CODE 4120-01-P