148 Federal Register / Vol. 76, No. 1 / Monday, January 3, 2011 / Notices 

ESTIMATED ANNUALIZED BURDEN HOURS—Continued 

Respondent category Number of 

respondents 

Number of responses per 

respondent 

Average burden response 

(in hours) 

Total burden 

(in hours) 

Total .......................................................................................................... ........................ ........................ ........................ 63 

Dated: December 27, 2010. 

Carol E. Walker, 

Acting Reports Clearance Officer, Centers for 

Disease Control and Prevention. 

[FR Doc. 2010–33128 Filed 12–30–10; 8:45 am] 

BILLING CODE P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–2321–N] 

RIN 0938–AQ44 

Medicaid Program; Final FY 2009 and 

Preliminary FY 2011 Disproportionate 

Share Hospital Allotments, and Final 

FY 2009 and Preliminary FY 2011 

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 FY (FY) 2009 and the 

preliminary Federal share DSH 

allotments for FY 2011. This notice also 

announces the final FY 2009 and the 

preliminary FY 2011 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: Effective Date: This notice is 

effective March 4, 2011. The final 

allotments and limitations set forth in 

this notice are effective for the fiscal 

years specified. 

FOR FURTHER INFORMATION CONTACT: 

Richard Strauss, (410) 786–2019. 

SUPPLEMENTARY INFORMATION: 

I. Background 

A. Disproportionate Share Hospital 

Allotments for Federal FY 2003 

Under section 1923(f)(3) of the Social 

Security Act (the Act), States’ Federal 

fiscal year (FY) 2003 disproportionate 

share hospital (DSH) allotments were 

calculated by increasing the amounts of 

the FY 2002 allotments for each State 

(as specified in the chart, entitled ‘‘DSH 

Allotment (in millions of dollars)’’, 

contained in section 1923(f)(2) of the 

Act) by the percentage change in the 

Consumer Price Index for all Urban 

Consumers (CPI–U) for the prior fiscal 

year. The allotment, determined in this 

way, 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). 

Most States’ actual FY 2002 

allotments were determined in 

accordance with the provisions of 

section 1923(f)(4) of the Act which 

allowed for a special DSH calculation 

rule for FY 2001 and FY 2002. However, 

as indicated previously, the calculation 

of States’ FY 2003 allotments was not 

based on the actual FY 2002 DSH 

allotments; rather, section 1923(f)(3) of 

the Act requires that the States’ FY 2003 

allotments be determined using the 

amount of the States’ FY 2002 

allotments specified in the chart in 

section 1923(f)(2) of the Act. The 

exception to this is the calculation of 

the FY 2003 DSH allotments for certain 

‘‘Low-DSH States’’ (defined in section 

1923(f)(5) of the Act). Under the LowDSH State provision, there is a special 

calculation methodology for the LowDSH States only. Under this 

methodology, the FY 2003 allotments 

were determined by increasing States’ 

actual FY 2002 DSH allotments, rather 

than their FY 2002 allotments specified 

in the chart in section 1923(f)(2) of the 

Act, by the percentage change in the 

CPI–U for the previous fiscal year. 

B. DSH Allotments for FY 2004 

Section 1001(a) of the Medicare 

Prescription Drug, Improvement, and 

Modernization Act of 2003 (MMA) (Pub. 

L. 108–173, enacted on December 8, 

2003) amended section 1923(f)(3) of the 

Act to provide for a ‘‘Special, Temporary 

Increase In Allotments On A One-Time, 

Non-Cumulative Basis.’’ Under this 

provision, States’ FY 2004 DSH 

allotments were determined by 

increasing their FY 2003 allotments by 

16 percent, and the FY DSH allotment 

amounts so determined were not subject 

to the 12 percent limit. 

C. DSH Allotments for Non-Low DSH 

States for FY 2005, and FYs Thereafter 

Under the methodology contained in 

section 1923(f)(3)(C) of the Act, as 

amended by section 1001(a)(2) of the 

MMA, the non-Low-DSH States’ DSH 

allotments for FY 2005 and subsequent 

FYs continue at the same level as the 

States’ DSH allotments for FY 2004 until 

a ‘‘fiscal year specified’’ occurs. The 

fiscal year specified is the first FY for 

which the Secretary estimates that a 

State’s DSH allotment equals (or no 

longer exceeds) the DSH allotment as 

would have been determined under the 

statute in effect before the enactment of 

the MMA. We determine whether the 

fiscal year specified has occurred under 

a special parallel process. Specifically, 

under this parallel process, a ‘‘parallel’’ 

DSH allotment is determined for FYs 

after 2003 by increasing the State’s DSH 

allotment for the previous FY by the 

percentage change in the CPI–U for the 

prior FY, subject to the 12 percent limit. 

This is the methodology as would 

otherwise have been applied under 

section 1923(f)(3)(A) of the Act, 

notwithstanding the application of the 

provisions of MMA. The fiscal year 

specified, is the FY in which the 

parallel DSH allotment calculated under 

this special parallel process equals or 

exceeds the FY 2004 DSH allotment, as 

determined under the MMA provisions. 

Once the fiscal year specified occurs for 

a State, that State’s FY DSH allotment 

will be calculated by increasing the 

State’s previous actual FY DSH 

allotment (which would be equal to the 

FY 2004 DSH allotment) by the 

percentage change in the CPI–U for the 

previous FY, subject to the 12 percent 

limit. The following example illustrates 

how the FY DSH allotment would be 

calculated for FYs after FY 2004. 

Example—In this example, we are 

determining the parallel FY 2009 DSH 

allotment. A State’s actual FY 2003 DSH 

allotment is $100 million. Under the MMA, 

this State’s actual FY 2004 DSH allotment 

would be $116 million ($100 million 

increased by 16 percent). The State’s DSH 

allotment for FY 2005 and subsequent FYs 

would continue at the $116 million FY 2004 

DSH allotment for FYs following FY 2004 

until the fiscal year specified occurs. Under 

the separate parallel process, we determine 


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Federal Register / Vol. 76, No. 1 / Monday, January 3, 2011 / Notices 149 

whether the fiscal year specified has 

occurred by calculating the State’s DSH 

allotments in accordance with the statute in 

effect before the enactment of the MMA. 

Under this special process, we continue to 

determine the State’s parallel DSH allotment 

for each FY by increasing the State’s parallel 

DSH allotment for the previous FY (as also 

determined under the special parallel 

process) by the percentage change in the CPI– 

U for the previous FY, and subject to the 12 

percent limit. Assume for purposes of this 

example that, in accordance with this special 

parallel process, the State’s parallel FY 2008 

DSH allotment was determined to be $115 

million and the percentage change in the 

CPI–U for FY 2008 (the previous FY) relevant 

for the calculation of the FY 2009 DSH 

allotment was 4.4 percent. That is, the 

percentage change for the CPI–U for FY 2008, 

the year before FY 2009, was 4.4 percent. 

Therefore, the State’s special parallel process 

FY 2009 DSH allotment amount would be 

calculated by increasing the special parallel 

process FY 2008 DSH allotment amount of 

$115 million by 4.4 percent; this results in 

a parallel process DSH allotment process 

amount for FY 2009 of $120.06 million. Since 

$120.06 million is greater than $116 million 

(the actual FY 2004 DSH allotment calculated 

under the MMA), we would determine that 

FY 2009 is the fiscal year specified (the first 

year that the FY 2004 allotment equals or no 

longer exceeds the parallel process 

allotment). Since FY 2009 is the fiscal year 

specified, we would then determine the 

State’s FY 2009 allotment by increasing the 

State’s actual FY 2008 DSH allotment ($116 

million) by the percentage change in the CPI– 

U for FY 2008 (4.4 percent). Therefore, the 

State’s FY 2009 DSH allotment would be 

$121.104 million ($116 million increased by 

4.4 percent); for purposes of the calculation 

in this example, the application of the 12 

percent limit has no effect. Furthermore, for 

FY 2009 and thereafter, the State’s DSH 

allotment would be calculated under the 

provisions of section 1923(f)(3)(A) of the Act 

by increasing the State’s previous FY’s DSH 

allotment by the percentage change in the 

CPI–U for the previous FY, subject to the 12 

percent limit. 

However, as amended by section 1001(b)(4) 

of the MMA, section 1923(f)(5)(B) of the Act 

also contains criteria for determining 

whether a State is a Low-DSH State, 

beginning with FY 2004. This provision is 

described in section I.D. 

D. DSH Allotments for Low-DSH States 

for FY 2004 and FYs Thereafter 

Section 1001(b)(1) of the MMA 

amended section 1923(f)(5) of the Act 

regarding the calculation of the FY DSH 

allotments for ‘‘Low-DSH’’ States for FY 

2004 and subsequent fiscal years. 

Specifically, under section 1923(f)(5)(B) 

of the Act, as amended by section 

1001(b)(4) of the MMA, a State is 

considered a Low-DSH State for FY 

2004 if its total DSH payments under its 

State plan for FY 2000 (including 

Federal and State shares) as reported to 

CMS as of August 31, 2003, are greater 

than 0 percent and less than 3 percent 

of the State’s total FY 2000 expenditures 

under its State plan for medical 

assistance. For States that meet the LowDSH criteria, their FY 2004 DSH 

allotments are calculated by increasing 

their FY 2003 DSH allotments by 16 

percent. Therefore, for FY 2004, LowDSH States’ FY DSH allotments are 

calculated in the same way as the DSH 

allotments for regular States, which 

under section 1923(f)(3) of the Act, get 

the special temporary increase for FY 

2004. 

Furthermore, for States meeting the 

MMA’s Low-DSH definition, the DSH 

allotments for FYs 2005 through 2008 

will continue to be determined by 

increasing the previous FY’s DSH 

allotment by 16 percent. The Low-DSH 

States’ DSH allotments for FYs 2004 

through 2008 are not subject to the 12 

percent limit. The Low-DSH States’ DSH 

allotments for FYs 2009 and subsequent 

FYs are calculated by increasing those 

States’ DSH allotments for the prior FY 

by the percentage change in the CPI–U 

for that prior fiscal year. For FYs 2009 

and thereafter, the DSH allotments so 

determined would be subject to the 12 

percent limit. 

E. Institutions for Mental Diseases DSH 

Limits for FYs 1998 and Thereafter 

Under section 1923(h) of the Act, 

Federal financial participation (FFP) is 

not available for DSH payments to 

institutions for mental diseases (IMDs) 

and other mental health facilities that 

are in excess of State-specific aggregate 

limits. Under this provision, this 

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. 

Each State’s IMD limit on DSH 

payments to IMDs and other mental 

health facilities was calculated by first 

determining the State’s total computable 

DSH expenditures attributable to the FY 

1995 DSH allotment for mental health 

facilities and inpatient hospitals. This 

calculation was based on the total 

computable DSH expenditures reported 

by the State on the Form CMS–64 as 

mental health DSH and inpatient 

hospital DSH as of January 1, 1997. We 

then calculate an ‘‘applicable 

percentage.’’ The applicable percentage 

for FY 1998 through FY 2000 (1995 IMD 

DSH percentage) is calculated by 

dividing the total computable amount of 

IMD and mental health DSH 

expenditures applicable to the State’s 

FY 1995 DSH allotment by the total 

computable amount of all DSH 

expenditures (mental health facility 

plus inpatient hospital) applicable to 

the FY 1995 DSH allotment. For FY 

2001 and thereafter, the applicable 

percentage is defined as the lesser of the 

applicable percentage as calculated 

above (for FYs 1998 through 2001) or 50 

percent for FY 2001; 40 percent for FY 

2002; and 33 percent for each 

subsequent fiscal year. 

The applicable percentage is then 

applied to each State’s total computable 

FY DSH allotment for the current fiscal 

year. The State’s total computable FY 

DSH allotment is calculated by dividing 

the State’s Federal share DSH allotment 

for the FY by the State’s Federal medical 

assistance percentage (FMAP) for that 

fiscal year. 

In the final step of the calculation of 

the IMD DSH Limit, the State’s total 

computable IMD DSH limit for the FY 

is set at the lesser of the product of a 

State’s current FY total computable DSH 

allotment and the applicable percentage 

for that FY, or the State’s FY 1995 total 

computable IMD and other mental 

health facility DSH expenditures 

applicable to the State’s FY 1995 DSH 

allotment as reported on the Form 

CMS–64. 

The MMA legislation did not amend 

the Medicaid statute with respect to the 

calculation of the IMD DSH limit. 

F. Publication in the Federal Register 

of Preliminary and Final Notice for DSH 

Allotments and IMD DSH Limits 

In general, we initially determine 

States’ DSH allotments and IMD DSH 

limits for a FY using estimates of 

medical assistance expenditures, 

including DSH expenditures in their 

Medicaid programs. These estimates are 

provided by States each year on the 

August quarterly Medicaid budget 

reports (Form CMS–37) before the FY 

for which the DSH allotments and IMD 

DSH limits are being determined. Also, 

as part of the basic determination of 

preliminary DSH allotments for a FY, 

we use the available CPI–U percentage 

increase that is available before the 

beginning of the FY for which the 

allotment is being determined to 

determine the preliminary FY DSH 

allotment. For example, in determining 

the preliminary FY 2011 DSH allotment, 

we would apply the CPI–U percentage 

increase for FY 2010 that was available 

just before the beginning of FY 2011 on 

October 1, 2010. 

The DSH allotments and IMD DSH 

limits determined using these estimates 

and CPI–U percentage increases 


jlentini on DSKJ8SOYB1PROD with NOTICES
150 Federal Register / Vol. 76, No. 1 / Monday, January 3, 2011 / Notices 

available before the beginning of the FY 

are referred to as ‘‘preliminary.’’ Only 

after we receive States’ reports of the 

actual related medical assistance 

expenditures through the quarterly 

expenditure report (Form CMS–64), and 

the final historic CPI–U percentage 

increases for the prior FY, which occurs 

after the end of the FY, are the ‘‘final’’ 

DSH Allotments and IMD DSH limits 

determined. 

The notice published in the Federal 

Register on December 19, 2008 (73 FR 

77704), included the announcement of 

the preliminary FY 2009 DSH 

allotments (based on estimates), and the 

preliminary FY 2009 IMD DSH limits 

(since they were based on the 

preliminary DSH allotments for FY 

2009). A correction notice published in 

the Federal Register on January 26, 

2009 (74 FR 4439) provided a correction 

to the chart of preliminary FY 2009 DSH 

allotments published in the December 

19, 2008 Federal Register. Finally, the 

notice published in the Federal Register 

on April 23, 2010 (75 FR 21314), 

included the announcement of the 

revised preliminary FY 2009 DSH 

allotments to reflect increases in the 

amount of the States’ DSH allotments 

for FY 2009 and FY 2010 pursuant to 

the enactment on February 17, 2009 of 

the American Recovery and 

Reinvestment Act of 2009 (section 5002 

of Pub. L. 111–5) and revisions to the 

CPI–U percentage increase for FY 2008, 

and the revised preliminary FY 2009 

IMD DSH limits (since they were based 

on the revised preliminary DSH 

allotments for FY 2009). 

This notice announces the final FY 

2009 DSH allotments and the final FY 

2009 IMD DSH limits (since these are 

now based on the actual expenditures 

for that fiscal year), the preliminary FY 

2011 DSH allotments (based on 

expenditure estimates), and the 

preliminary IMD DSH limits for FY 2011 

(since they are based on the preliminary 

DSH allotments for FY 2011). This 

notice does not include the final FY 

2010 DSH allotments or the final FY 

2010 IMD DSH limits, since the 

associated actual expenditures for FY 

2010 are not available at this time. 

G. DSH Allotment Provisions for Certain 

States 

1. DSH Allotments for the State of 

Tennessee 

Section 1923(f)(6)(A) of the Act, as 

amended by section 404 of Public Law 

109–432 (enacted on December 20, 

2006), section 204 of Public Law 110– 

173 (enacted on December 29, 2007), 

section 202 of Public Law 110–275 

(enacted on July 15, 2008), section 616 

of Public Law 111–3 (enacted on 

February 4, 2009), and most recently as 

amended by Section 1054 of Public Law 

111–152 (enacted on March 30, 2010) 

provides for the determination of a DSH 

allotment for the State of Tennessee for 

each of FYs 2007 through FY 2011, for 

2 periods encompassing FY 2012, and 

for FY 2013. In accordance with this 

provision, Tennessee’s DSH allotment 

for each of FYs 2007 through 2011 is the 

greater of $280 million and the FY 2007 

Federal medical assistance percentage of 

the DSH payment adjustments reflected 

in the State’s TennCare Demonstration 

Project for the demonstration year 

ending in 2006. In accordance with this 

provision, the State’s Federal share DSH 

allotment for each of FYs 2007 through 

2011 is $305,451,928. Furthermore, 

Tennessee’s DSH allotment for the 

period October 1, 2011 through 

December 31, 2011 (the first quarter of 

FY 2012) is one-fourth of this amount; 

that is, $76,362,982. Section 

1923(f)(6)(A)(ii) of the Act further limits 

the amount of Federal funds that are 

available for DSH payments that 

Tennessee may make in each of the FYs 

2007 through 2011, and for the first 

quarter of FY 2012 to 30 percent of the 

DSH allotment. In this regard, the limit 

on the DSH payments that the State of 

Tennessee may make is effectively 

$91,635,578 (30 percent of 

$305,451,928) for each FY 2007 through 

FY 2011, and $22,908,895 (30 percent of 

$76,362,982) for the period October 1, 

2011 through December 31, 2011 (the 

first quarter of FY 2012. The statute also 

provides for additional allotments for 

Tennessee for the period January 1, 

2011 through September 30, 2012 

(quarters 2 through 4 of FY 2012) and 

for all of FY 2013; future Federal 

Register notices will describe the 

determination of the amounts of DSH 

allotments for Tennessee for FY 2012 

and FY 2013. 

2. DSH Allotments for the State of 

Hawaii 

Section 1923(f)(6)(B) of the Act, as 

amended by section 404 of Public Law 

109–432, section 204 of Public Law 

110–173, section 202 of Public Law 

110–275, section 616 of Public Law 

111–3 (enacted on February 4, 2009) 

most recently as amended by Section 

10201(e)(1) of Public Law 111–148 

(enacted on March 23, 2010) provides 

for a DSH allotment for the State of 

Hawaii for each of FYs 2007 through 

2011, for 2 periods encompassing FY 

2012, and certain other provisions 

providing for a DSH allotment for FY 

2013. In accordance with the statute, 

Hawaii’s DSH allotment each year for 

FY 2007 through FY 2011 is $10 

million. Furthermore, for the period 

October 1, 2011 through December 31, 

2011 (the first quarter of FY 2012) 

Hawaii’s DSH allotment is $2.5 million, 

and for the period January 1, 2012 

through September 30, 2012 Hawaii’s 

DSH allotment is $7.5 million. Future 

Federal Register notices will describe 

the determination of the amounts of 

DSH allotments for Hawaii for FY 2012 

and FY 2013. 

H. DSH Allotments for FY 2009 and FY 

2010 Under the Recovery Act 

Section 5002 of the Recovery Act 

added a new section 1923(f)(3)(E) of the 

Act; this new section provides for a 

temporary increase in States’ DSH 

allotments only for FY 2009 and FY 

2010. 

1. Revised Preliminary DSH Allotments 

for FY 2009 

States’ preliminary FY 2009 DSH 

allotments were previously published in 

the Federal Register on January 26, 

2009. However, section 5002 of the 

Recovery Act enacted after the 

publication of the preliminary FY 2009 

DSH allotments provided for an increase 

in States’ DSH allotments from what 

were previously determined and 

published in the Federal Register on 

January 26, 2009. The Recovery Act 

provided fiscal relief to States during 

the recent national economic downturn. 

In that regard, section 1923(f)(3)(E)(i)(I) 

of the Act, as created by section 5002 of 

the Recovery Act, requires that, in 

general, States’ DSH allotments for FY 

2009 be equal to 102.5 percent of the FY 

2009 allotments that would otherwise 

have been determined; this provision 

does not apply to certain States as 

discussed in section G. above. 

As described in section F. above, we 

typically publish States’ preliminary 

DSH allotments based on expenditure 

estimates and CPI–U percentage 

increases available before the FY for 

which the preliminary DSH allotment is 

being determined. The preliminary DSH 

allotments are subsequently finalized 

after the FY is over and when the 

applicable inputs for determining the 

DSH allotments (that is, the applicable 

expenditures and the CPI–U percentage 

increase for the previous FY) are final. 

Due to the Recovery Act temporary 

increase for FY 2009, in this notice we 

revised the preliminary FY 2009 DSH 

allotments previously published to 

reflect updated States’ expenditures, 

and more significantly, to reflect an 

updated and increased CPI–U 

percentage increase. As described 

above, States’ DSH allotments are 

determined by increasing the previous 

FY allotment by the applicable CPI–U 


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Federal Register / Vol. 76, No. 1 / Monday, January 3, 2011 / Notices 151 

percentage increase. In particular, when 

we previously calculated the 

preliminary FY 2009 allotments, the 

applicable CPI–U percentage increase 

for FY 2008 (used for determining the 

FY 2009 DSH allotment), which was 

available before the beginning of FY 

2009, was 4.0 percent. However, 

subsequent to our initial determination 

of the preliminary FY 2009 DSH 

allotments, the historical applicable 

CPI–U percentage increase for FY 2008 

became available; that actual CPI–U 

increase for FY 2008 is 4.4 percent. In 

order to ensure that the full increase in 

DSH allotments for FY 2009 is available 

to States during FY 2009, we revised the 

preliminary FY 2009 DSH allotments 

prior to the end of FY 2009 to reflect 

both the updated increase in the 

applicable CPI–U percentage increase 

for FY 2008 and the 2.5 percent increase 

in States’ FY 2009 DSH allotments as 

required under the Recovery Act. 

The final FY 2009 allotments 

contained in this Federal Register 

notice reflect the final CPI–U percentage 

increase for FY 2008 and the actual 

expenditures in Medicaid for FY 2009. 

2. Preliminary DSH Allotments for FY 

2011 

Sections 1923(f)(3)(E) of the Act, as 

amended by Section 5002 of the 

Recovery Act, in general (with the 

exceptions for certain States described 

above) provided for a 2.5 percent 

increase in States’ FY 2009 DSH 

allotments and for States’ FY 2010 DSH 

allotments to be determined as the 

higher of: 

• 102.5 percent of the DSH allotment 

for FY 2009, as determined under the 

Recovery Act provision, or 

• The FY 2010 DSH allotment as 

would otherwise be calculated without 

the application of the Recovery Act 

provision. 

The final FY 2009 DSH allotments 

contained in this Federal Register 

notice and the preliminary FY 2010 

DSH allotment for States (as published 

in the Federal Register on April 23, 

2010, 75 FR 21314) were determined in 

accordance with the law, as amended by 

the Recovery Act. 

As indicated, the Recovery Act DSH 

allotment provisions apply only for FY 

2009 and FY 2010; that is, States’ DSH 

allotments for FY 2011 are determined 

as DSH allotments were determined 

prior to the enactment of the Recovery 

Act. 

3. Effect of the Recovery Act DSH 

Provision on Calculation of the States’ 

IMD DSH Limits for FY 2009 and FY 

2010, and Determination of Such Limits 

for FY 2011 

Section E above described the 

determination of States’ IMD DSH limits 

for FYs beginning FY 1998 and after, as 

determined under section 1923(h) of the 

Act. Section 5002 of the Recovery Act 

did not amend section 1923(h) of the 

Act. Accordingly, States’ preliminary 

IMD DSH limits for FY 2009 and FY 

2010, the FYs for which the Recovery 

Act provisions are applicable, were 

determined as under the existing 

provisions. As described in section E 

above, States’ DSH allotments are an 

element of the determination of the IMD 

DSH limit. Therefore, the DSH 

allotments for FY 2009 and FY 2010, as 

determined under the Recovery Act 

provisions, were used in calculating 

States’ Final FY 2009 (as contained in 

this Federal Register notice) and States’ 

preliminary FY 2010 (as previously 

published in the Federal Register on 

April 23, 2010, 75 FR 21314) IMD DSH 

limits. This is the same application of 

States’ DSH allotments for purposes of 

determining States’ IMD DSH limits as 

was applied under section 1923(h) of 

the Act, regardless of the Recovery Act 

provision. 

II. Provisions of the Notice 

A. Calculation of the Final FY 2009 

Federal Share State DSH Allotments, 

and the Preliminary FY 2011 Federal 

Share State DSH Allotments 

1. Final FY 2009 Federal Share State 

DSH Allotments 

Chart 1 of the Addendum to this 

notice provides the States’ final FY 2009 

DSH allotments as discussed above in 

section I.H.1 of this notice. As discussed 

in that section of this notice, the revised 

preliminary FY 2009 DSH allotments 

were previously published in the 

Federal Register on April 23, 2010. As 

described above and in previous 

Federal Register notices in determining 

non-Low DSH States’ DSH allotments 

for FYs after FY 2004 under section 

1923(f)(3)(C) of the Act for DSH 

allotments, we determined States’ DSH 

allotments under a ‘‘parallel’’ process. 

Under the parallel process, for each FY 

for each State, we have been 

determining whether the fiscal year 

specified (as defined in section 

1923(f)(3)(D) of the Act) has occurred. 

Under section 1923(f)(3)(D) of the Act, 

the fiscal year specified is determined 

separately for each State and ‘‘is the first 

FY for which the Secretary estimates 

that the DSH allotment for that State 

will equal (or no longer exceed) the DSH 

allotment for that State under the law as 

in effect before the date of enactment’’ 

of MMA. The process in effect before 

the enactment in MMA is the process 

described in section 1923(f)(3)(A) of the 

Act; under this process each States’ DSH 

allotment since FY 2003 is increased by 

the CPI–U increase for the prior FY and 

the result is then compared to the 

State’s FY 2004 DSH allotment, as 

determined under section 

1923(f)(3)(C)(i) of the Act (under which 

the States’ FY 2003 DSH allotments 

were increased by 16 percent). The 

fiscal year specified for a State is the FY 

when the FY 2004 allotment is no 

longer greater than the parallel process 

DSH allotment. 

We are reiterating the parallel process 

provision because we determined that 

FY 2009 was the fiscal year specified for 

all non-Low DSH States (except 

Louisiana). Therefore, as indicated in 

section 1923(f)(3)(C)(ii) of the Act, the 

Final FY 2009 DSH allotment for all 

non-Low DSH States (except Louisiana) 

is equal to the prior FY 2008 DSH 

allotment increased by the CPI–U 

increase for FY 2008 (4.4 percent). Chart 

1 contains the final FY 2009 DSH 

allotments. For the non-Low DSH States 

for which the FY 2009 is the fiscal year 

specified, the FY 2010 and subsequent 

FY DSH allotments are calculated by 

increasing the prior FY DSH allotment 

by the CPI–U increase for the prior fiscal 

year. 

For Low-DSH States, the FY 2009 

DSH allotment is calculated using the 

same methodology as for the non-Low 

DSH States for which the fiscal year 

specified has occurred. That is, for FY 

2009 and following FYs, the DSH 

allotment for Low-DSH States is 

calculated by increasing the prior FY 

DSH allotment by the percentage change 

in the CPI–U for the prior fiscal year. 

The preliminary FY 2009 allotments 

were initially determined using the 

States’ August 2008 expenditure 

estimates submitted by the States on the 

Form CMS–37, and the percentage 

increase in the CPI–U for the previous 

FY that was available before the 

beginning of FY 2009. As discussed in 

section I.H.1 above, based on the 

updated CPI–U percentage increase for 

FY 2008 (from 4.0 percent to 4.4 

percent), and the enactment of section 

5002 of the Recovery Act (which 

provides that States’ FY 2009 DSH 

allotments are equal to 102.5 percent of 

these allotments as would otherwise be 

determined for the FY), we revised the 

preliminary FY 2009 DSH allotments, 

which were published in the Federal 

Register on April 23, 2010. States’ final 

FY 2009 DSH allotments as contained in 


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this Federal Register were determined 

based on States’ four quarterly Medicaid 

expenditure reports (Form CMS–64) for 

FY 2009 received following the end of 

FY 2009 and the final applicable 

percentage increase to CPI–U for the 

previous FY 2008. 

2. Calculation of the Preliminary FY 

2011 Federal Share State DSH 

Allotments 

Chart 2 of the Addendum to this 

notice provides the preliminary FY 2011 

DSH allotments determined in 

accordance with the section 1923(f)(3) 

of the Act, as described in section I.H.2. 

As described in that section of this 

notice, the Recovery Act provisions 

which increased States’ DSH allotments 

for FY 2009 and FY 2010 are not 

applicable for determining States’ FY 

2011 DSH allotments. States’ final FY 

2011 DSH allotments will be published 

in the Federal Register following receipt 

of the States’ four quarterly Medicaid 

expenditure reports (Form CMS–64) for 

FY 2010 following the end of FY 2011. 

B. Calculation of the Final FY 2009 and 

Preliminary FY 2011 IMD DSH Limits 

As discussed in section I.E. and I.H.3 

above of this notice, 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 2009 IMD DSH 

Limit and the preliminary FY 2011 IMD 

DSH Limit determined in accordance 

with the provisions discussed above, 

and for FY 2009, reflecting the DSH 

allotments for the FY determined under 

the provisions of section 1923(f)(3)(E) of 

the Act, as amended by section 5002 of 

the Recovery Act. 

Charts 3 and 4 of the Addendum to 

this notice detail each State’s final IMD 

DSH Limit for FY 2009 and the 

preliminary IMD DSH Limit for FY 

2011, respectively, determined in 

accordance with section 1923(h) of the 

Act. 

III. Collection of Information 

Requirements 

This document does not impose 

information collection and 

recordkeeping requirements. 

Consequently, it need not be reviewed 

by the Office of Management and 

Budget under the authority of the 

Paperwork Reduction Act of 1995 (44 

U.S.C. 35). 

IV. Regulatory Impact Statement 

We have examined the impact of this 

rule 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 Social Security 

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 does reach 

the $100 million economic threshold 

and thus is considered a major rule 

under the Congressional Review Act. 

There are no changes between the 

revised preliminary and final FY 2009 

DSH allotments and FY 2009 IMD DSH 

limits. 

The preliminary FY 2011 DSH 

allotments being published in this 

notice are about $365 million less than 

the preliminary FY 2010 DSH 

allotments published in the Federal 

Register on April 23, 2010 (75 FR 

21314). These decreases are a direct 

result of the application of the 

provisions of section 1923(f)(3) of the 

Act in the calculation of States’ DSH 

allotments, and in particular the 

provisions of section 1923(f)(3)(E) of the 

Act as amended by the Recovery Act 

(which provided for a temporary 

increase in States’ DSH allotments for 

FY 2009 and FY 2010 during the 

specified recession period) do not apply 

with respect to the FY 2011 and 

following FY DSH allotments. 

The preliminary FY 2011 IMD DSH 

Limits being published in this notice are 

about $23 million less than the 

preliminary FY 2010 IMD DSH Limits 

published in Federal Register on April 

23, 2010 (75 FR 21314). This is because 

the DSH allotment for a FY is a factor 

in the determination of the IMD DSH 

limit for the FY, and since the 

preliminary FY 2011 DSH allotments 

were decreased as compared to the 

preliminary FY 2010 DSH allotments, 

the associated FY 2011 IMD DSH limits 

for some States were also decreased. 

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 $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, the effects of the various 

controlling statutes on providers are not 

impacted by a result of any independent 

regulatory impact and not 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 

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 (including as 

most recently amended by the Recovery 

Act) specifies the methodology for 

determining the amounts of States’ DSH 

allotments and IMD DSH limits; and as 

described previously, results in 

increases in States’ DSH allotments and 

IMD DSH limits for the FYs referred to. 

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 


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in any 1 year of $100 million in 1995 

dollars, updated annually for inflation. 

In 2010, that threshold is approximately 

$135 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. 

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. 

Accounting Statement 

As required by OMB Circular A–4 

(available at http:// 

www.whitehouse.gov/omb/circulars/ 

a004/a-4.pdf), in the table below, we 

have prepared an accounting statement 

showing the classification of the 

estimated expenditures associated with 

the provisions of this notice. This table 

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 2010 to FY 2011. 

TABLE—ACCOUNTING STATEMENT: 

CLASSIFICATION OF ESTIMATED EXPENDITURES, FROM FY 2010 TO FY 

2011 

[In millions] 

Category Transfers 

Annualized Monetized 

Transfers.

¥$365. 

From Whom To 

Whom?.

Federal Government 

to States. 

In accordance with the provisions of 

Executive Order 12866, this notice was 

reviewed by the Office of Management 

and Budget. 

Addendum 

This addendum contains the charts 1 

through 4 (preceded by associated keys) 

that are referred to in the preamble of 

this notice. 

Key to Chart 1. Final DSH Allotments 

for FY 2009. 

KEY TO CHART 1—FINAL DSH ALLOTMENTS FOR FISCAL YEAR: 2009 

[The Final FY 2009 DSH Allotments for the NON-Low DSH States are presented in the top section of this chart, and the Final FY 2009 DSH 

Allotments for the Low-DSH States are presented in the bottom section of this chart.] 

Column Description 

Column A ................... State. 

Column B ................... 1923(f)(3)(D) Test Met. This column indicates whether the ‘‘FY Specified’’ has occurred with respect to Non-Low DSH 

States, determined in accordance with section 1923(f)(3)(D) of the Act. ‘‘YES’’ indicates the FY Specified has occurred; ‘‘NOT MET’’ indicates that the FY Specified has not occurred; and ‘‘na’’ indicates that this provision is not applicable. This provision is not applicable for Low-DSH States indicated in the bottom portion of chart 2. 

Columns C–L ............. For all States, the entries in Columns C through K present the determination of the final FY 2009 DSH allotments as 

would be calculated without the application of section 1923(f)(3)(E) of the Act as amended by section 5002 of ARRA. 

For all States, the entries in Column M present the calculation of the final FY 2009 DSH Allotments, determined in accordance with the provisions of section 5002 of ARRA. 

For Non-Low DSH States indicated in the top portion of Chart 2, entries in Columns C through K are only for States 

meeting the ‘‘FY Specified’’ test (‘‘YES’’ in Column B). For States not meeting the test indicated in Column B, these 

Columns indicate ‘‘NA’’, and for States for which such test is not applicable, these Columns indicate ‘‘na’’. For Low 

DSH States, entries are in the bottom portion of Chart 2. 

Column C .................. FY 2009 FMAPS. This column contains the States’ FY 2009 Federal Medical Assistance Percentages. 

Column D .................. FY 2008 DSH Allotment For States Meeting Test. This column contains the States’ prior FY 2008 DSH Allotments. 

Column E ................... FY 2008 Allotments X (1 + Percentage Increase in CPI–U): 1.044. This column contains the amount in Column D increased by 1 plus the percentage increase in the CPI–U for the prior FY (4.4 percent). 

Column F ................... FY 2009 TC MAP Exp. Incl. DSH. This column contains the amount of the States’ actual FY 2009 total computable 

medical assistance expenditures including DSH expenditures. 

Column G .................. FY 2009 TC MAP Exp. Net of DSH. This column contains the amount of the States’ actual FY 2009 total computable 

DSH expenditures. 

Column H .................. FY 2009 TC MAP Exp. Net of DSH. This column contains the amount of the States’ actual FY 2009 total computable 

medical assistance expenditures net of DSH expenditures, calculated as the amount in Column F minus the amount 

in Column G. 

Column I .................... 12% 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 J ................... Greater of FY 2008 Allotment or 12% Limit. This column contains the greater of the State’s prior FY (FY 2008) DSH allotment or the amount of the 12% Limit, determined as the maximum of the amount in Column D or Column I. 

Column K ................... FY 2009 DSH Allotment PRE–ARRA. This column contains the States’ FY 2009 DSH allotments as would be determined prior to ARRA, determined as the minimum of the amount in Column J or Column E. For Non-Low DSH States 

that have not met the ‘‘FY Specified’’ test (entry in Column B is ‘‘NOT MET’’), the amount in Column K is equal to the 

State’s FY 2004 DSH allotment. For States for which the entry in Column B is ‘‘na’’, the amount in Column K is determined in accordance with the provisions of section 1923(f)(6) of the Act. 

Column L ................... FY 2009 DSH Allotment Under ARRA. This column contains the State’s FY 2009 DSH allotment as determined in accordance with section 5002 of ARRA, and calculated as the amount in Column K multiplied by 1.025. 

Column M .................. Final FY 2009 DSH Allotment Under ARRA. (Max of Col K or L.) This column contains the State’s final FY 2009 DSH 

allotment as determined in accordance with section 1923(f)(3)(E) of the Act as amended by section 5002 of ARRA, 

and determined as the maximum of the amount in Column K or L. 


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Key to Chart 2. Preliminary DSH 

Allotments for FY 2011. 

KEY TO CHART 2—PRELIMINARY DSH ALLOTMENTS FOR FISCAL YEAR: 2011 

[The Preliminary FY 2011 DSH Allotments for the NON-Low DSH States are presented in the top section of this chart, and the Preliminary FY 

2011 DSH Allotments for the Low-DSH States are presented in the bottom section of this chart.] 

Column Description 

Column A ................... State. 

Column B ................... 1923(f)(3)(D) Test Met. This column indicates whether the ‘‘FY Specified’’ has occurred with respect to Non-Low DSH 

States, determined in accordance with section 1923(f)(3)(D) of the Act. ‘‘YES’’ indicates the FY Specified has occurred; ‘‘NOT MET’’ indicates that the FY Specified has not occurred; and ‘‘na’’ indicates that this provision is not applicable. This provision is not applicable for Low-DSH States indicated in the bottom portion of chart 3. 

Columns C–K ............ For all States, the entries in Columns B through K present the determination of the preliminary FY 2011 DSH allotments 

as would be calculated without the application of section 5002 of ARRA since such provisions were only applicable for 

FY 2009 and FY 2010. 

For Non-Low DSH States indicated in the top portion of Chart 2, entries in Columns C through J are only for States 

meeting the ‘‘FY Specified’’ test (‘‘YES’’ in Column B). For States not meeting the test indicated in Column B, these 

Columns indicate ‘‘NA’’, and for States for which such test is not applicable, these Columns indicate ‘‘na’’. For Low 

DSH States, entries are in the bottom portion of Chart 2. 

Column C .................. FY 2011 FMAPS. This column contains the States’ FY 2011 Federal Medical Assistance Percentages. 

Column D .................. FY 2010 DSH Allotment For States Meeting Test. This column contains the States’ prior FY 2010 DSH Allotments as 

would be determined without the application of section 5002 of ARRA. 

Column E ................... FY 2010 Allotments X (1 + Percentage Increase in CPI–U): 1.018. 

This column contains the amount in Column D increased by 1 plus the percentage increase in the CPI–U for the prior 

FY (1.8 percent). 

Column F ................... FY 2011 TC MAP Exp. Incl. DSH. This column contains the amount of the States’ projected FY 2011 total computable 

medical assistance expenditures including DSH expenditures. 

Column G .................. FY 2011 TC DSH Expenditures. This column contains the amount of the States’ projected FY 2011 total computable 

DSH expenditures. 

Column H .................. FY 2011 TC MAP Exp. Net of DSH. 

This column contains the amount of the States’ projected FY 2011 total computable medical assistance expenditures 

net of DSH expenditures, calculated as the amount in Column F minus the amount in Column G. 

Column I .................... 12% 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 J ................... Greater of FY 2010 Allotment or 12% Limit. This column contains the greater of the State’s prior FY (FY 2010) DSH allotment or the amount of the 12% Limit, determined as the maximum of the amount in Column D or Column I. 

Column K ................... FY 2011 DSH Allotment. This column contains the States’ FY 2011 DSH allotments as would be determined without the 

application of the provisions of section 5002 of ARRA, determined as the minimum of the amount in Column J or Column E. For Non-Low DSH States that have not met the ‘‘FY Specified’’ test (entry in Column B is ‘‘NOT MET’’), the 

amount in Column K is equal to the State’s FY 2004 DSH allotment. For States for which the entry in Column B is 

‘‘na’’, the amount in Column K is determined in accordance with the provisions of section 1923(f)(6) of the Act. 

Key to Chart 3. Final IMD DSH Limit 

for FY 2009. 

KEY TO CHART 3—FINAL IMD DSH LIMIT FOR FY: 2009 

[Key to the Chart of the Final FY 2009 IMD Limitations.—The Final FY 2009 IMD DSH Limits for the regular States are presented in the top 

section of this chart and the final FY IMD DSH Limits for the Low-DSH States are presented in the bottom section of the chart.]

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 & 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 2009 Allotment in FS Under ARRA. This column contains the States’ final FY 2009 DSH allotments as determined 

under ARRA. 

Column G .................. FY 2009 FMAP. This column contains the States’ FY 2009 FMAPs. 

Column H .................. FY 2009 DSH Allotments in TC. Col. F/G. This column contains the FY 2009 total computable DSH Allotment (determined as the amount in Column F divided by the amount in Column G). 

Column I .................... Col E * Col H in TC. This column contains the applicable percent of FY 2008 total computable DSH allotment (calculated as the amount in Column E multiplied by the amount in Column H). 


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KEY TO CHART 3—FINAL IMD DSH LIMIT FOR FY: 2009—Continued 

[Key to the Chart of the Final FY 2009 IMD Limitations.—The Final FY 2009 IMD DSH Limits for the regular States are presented in the top 

section of this chart and the final FY IMD DSH Limits for the Low-DSH States are presented in the bottom section of the chart.]

Column Description 

Column J ................... FY 2009 TC IMD DSH Limit. Lesser of Col. C or I. This column contains the FY 2009 TC IMD DSH Limit equal to the 

lesser of the amount in Column C or Column I. 

Column K ................... FY 2009 IMD DSH Limit in FS U/ARRA. Col. G × J. This column contains the FY 2009 Federal share IMD DSH limit determined by converting the total computable FY 2009 IMD DSH Limit from Column J into a Federal share amount by 

multiplying it by the FY 2009 FMAP in Column G. 

Key to Chart 4. Preliminary IMD DSH 

Limit for FY 2011. 

KEY TO CHART 4—PRELIMINARY IMD DSH LIMIT FOR FY: 2011 

[Key to the Chart of the FY 2011 IMD Limitations—The preliminary FY 2011 IMD DSH Limits for the Non-Low DSH States are presented in the 

top section of this chart and the preliminary FY 2011 IMD DSH Limits for the Low-DSH States are presented in the bottom section of the chart.] 

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 & 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 Percent 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 2011 Federal Share DSH Allotment. This column contains the States’ preliminary FY 2011 DSH allotments. 

Column G .................. FY 2011 FMAP. This column contains the States’ FY 2010 FMAPs. 

Column H .................. FY 2011 DSH Allotments in Total Computable Col. F/G. This column contains States’ FY 2011 total computable DSH allotment (determined as Column F/Column G). 

Column I .................... Col E * Col H in TC. This column contains the applicable percent of FY 2010 total computable DSH allotment (calculated as the percentage in Column E multiplied by the amount in Column H). 

Column J ................... FY 2011 TC IMD DSH Limit. Lesser of Col. C or I. This column contains the FY 2011 TC IMD DSH Limit equal to the 

lesser of the amount in Column C or Column I. 

Column K ................... FY 2011 IMD DSH Limit in Federal Share, Col. G x J. This column contains the FY 2011 Federal share IMD DSH limit 

determined by converting the total computable FY 2011 IMD DSH Limit from Column J into a Federal share amount 

by multiplying it by the FY 2011 FMAP in Column G. 

BILLING CODE 4120–01–P 


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(Catalog of Federal Domestic Assistance 

Program No. 93.778, Medical Assistance 

Program) 

Dated: October 20, 2010. 

Donald M. Berwick, 

Administrator, Centers for Medicare & 

Medicaid Services. 

Dated: November 17, 2010. 

Kathleen Sebelius, 

Secretary. 

[FR Doc. 2010–32979 Filed 12–30–10; 8:45 am] 

BILLING CODE 4120–01–C 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Health Resources and Services 

Administration 

Discretionary Grant Program 

AGENCY: Health Resources and Services 

Administration (HRSA), HHS. 

ACTION: Notice of noncompetitive 

program supplemental award. 

SUMMARY: HRSA will be issuing noncompetitive supplemental grant funding 

to the University of Wisconsin, 

Laboratory of Hygiene, Madison, 

Wisconsin, under the Maternal Child 

and Health Bureau’s Blood Lead 

Proficiency Testing Program. The 

University of Wisconsin will use these 

funds to initiate an orderly closeout of 

HRSA-funded activities which clearly 

fall within the purview of the Centers 

for Disease Control and Prevention’s 

‘‘Preventing Lead Poisoning in Young 

Children’’ initiative at their National 

Center for Environmental Health. This 

action will also accord the University of 

Wisconsin and the Center additional 

time to solicit recommendations from 

the CDC’s Advisory Committee on 

Childhood Lead Poisoning Prevention 

with respect to future funding for this 

activity. 

The Maternal and Child Health 

Bureau (MCHB) has continuously 

supported the National Blood Lead and 

Erythrocyte Protoprophyrin (EP) 

Proficiency Testing Program through the 

University of Wisconsin since 1988. 

Childhood lead poisoning is a wellcharacterized public health problem in 


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