## 45217 Federal Register / Vol. 78, No. 144 / Friday, July 26, 2013 / Notices

**DEPARTMENT OF HEALTH AND**

**HUMAN SERVICES**

**Centers for Medicare & Medicaid**

**Services**

**[CMS–2342–N]**

**RIN 0938–AR91**



### Medicaid Program; Disproportionate **Share Hospital Allotments and**

**Institutions for Mental Diseases Disproportionate Share Hospital Limits** 
**for FY 2012, and Preliminary FY 2013 Disproportionate Share Hospital** 

**Allotments and Limits**

**AGENCY** 

### : Centers for Medicare &

Medicaid Services (CMS), HHS.

**ACTION** 

### : Notice.

**SUMMARY** 

### : This notice announces the final federal share disproportionate share hospital (DSH) allotments for federal fiscal year (FY) 2012 and the preliminary federal share DSH

allotments for FY 2013. This notice also

announces the final FY 2012 and the preliminary FY 2013 limits on aggregate DSH payments that states may make to

institutions for mental diseases (IMDs)

and other mental health facilities. This notice also includes background information describing the methodology for determining the amounts of states’

FY DSH allotments and IMD DSH

limits.

**DATES** 

### : Effective Date: This notice is effective on August 26, 2013. 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

In general, in accordance with the methodology specified under section 1923(f)(3) of the Social Security Act (the Act), a state’s federal fiscal year (FY) disproportionate share hospital (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. Also in accordance with

section 1923(f)(3) of the Act, a state’s DSH allotment for a FY is subject to the

limitation that an increase to a state’s

DSH allotment for a FY cannot result in the DSH allotment exceeding the greater

of the state’s DSH allotment for the previous FY or 12 percent of the state’s total medical assistance expenditures for the allotment year (this is referred to as the 12 percent limit). Furthermore, under section 1923(h) of the Act, federal financial participation (FFP) for DSH payments to institutions

for mental diseases (IMDs) and other

mental health facilities is limited to state-specific aggregate amounts

determined in accordance with the methodology specified under such section. 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 and IMD DSH limits for a 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 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 2012

Federal Share State DSH Allotments, and the Preliminary FY 2013 Federal

Share State DSH Allotments

1. Final FY 2012 Federal Share State

DSH Allotments

Chart 1 of the Addendum to this notice provides the states’ final FY 2012

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 2012 DSH allotments, the preceding final fiscal year DSH allotments (for FY 2011) were

contained in the Federal Register published on July 24, 2012 (77 FR 43301). For purposes of calculating the

states’ final FY 2012 DSH allotments we are using the actual Medicaid expenditures for FY 2012. Finally, for purposes of calculating the states’ final FY 2012 DSH allotments, the applicable historical percentage change in the CPI– U for the previous FY (FY 2011) was 2.6 percent; we note that this is an increase from the estimated 2.4 percentage change in the CPI–U for FY 2011 that

was available and used in the calculation of the preliminary FY 2012 DSH allotments which were published in the July 24, 2012 Federal Register (77
FR 43301).

2. Calculation of the Preliminary FY

2013 Federal Share State DSH

Allotments

Chart 2 of the Addendum to this notice provides the preliminary FY 2013

DSH allotments determined in

accordance with section 1923(f)(3) of the Act. The preliminary FY 2013 DSH

allotments contained in this notice were

determined based on the most recent

available estimates from states of their FY 2013 total computable Medicaid expenditures. Also, the preliminary FY

2013 allotments contained in this notice were determined by increasing the final

FY 2012 DSH allotments as contained in

this notice (and described in section II.A.1. above) by 2.4 percent, representing the most recent available estimate of the percentage increase in the CPI–U for FY 2012 (the previous FY to FY 2013). In this regard, we note that in September of 2012 for purposes of calculating preliminary FY 2013 DSH

allotments for states (which at that time was prior to the beginning FY 2013), we


## 45218 Federal Register / Vol. 78, No. 144 / Friday, July 26, 2013 / Notices

calculated such preliminary FY 2013 allotments by increasing states’ preliminary FY 2012 allotments by 2.5 percent, representing the estimate of the percentage change in the CPI–U for FY 2012 available at that time. Again, we note that the preliminary FY 2013

allotments contained in this notice were determined using the final FY 2012 DSH

allotments contained in this notice, the

most recent available estimates of FY 2013 Medicaid expenditures, and the

most recent available estimate of the percentage change in the CPI–U for FY

2012.

States’ final FY 2013 DSH allotments will be published in future rulemaking based on the states’ four quarterly Medicaid expenditure reports (Form

CMS–64) for FY 2013 available following the end of FY 2013 and the actual change in the CPI–U for FY 2012.

B. Calculation of the Final FY 2012 and the Preliminary FY 2013 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 2012 and the preliminary FY 2013

IMD DSH Limits determined in accordance with the provisions

discussed above.

Charts 3 and 4 of the ‘‘Addendum’’ to

this notice detail each state’s final FY 2012 and preliminary FY 2013 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. The requirements and burden associated

with Form CMS–37 (OMB No. 0938–

0101), and Form CMS–64 (OMB No. 0938–0067) are unaffected by this notice. Consequently, this notice, the

Form CMS–37, and Form CMS–64 are not subject to Office of Management and Budget review under the authority of the Paperwork Reduction Act of 1995

(44 U.S.C. 3501 et seq. ).

IV. Regulatory Impact Statement

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 2012 DSH allotments being published in this notice are approximately $20 million more than the preliminary FY 2012 DSH allotments published in the July 24,

2012 Federal Register (77 FR 43301).

The increase in the final FY 2012 DSH

allotments is due to the difference between the actual percentage change in

the CPI–U for FY 2011 used in the

calculation of the final FY 2012 allotments [2.6 percent) as compared to the estimated percentage change in the

CPI–U for FY 2011 used in the calculation of the preliminary FY 2012 allotments (2.4 percent). The final FY 2012 IMD DSH limits being published in this notice are approximately $1 million more than the preliminary FY 2012 IMD DSH limits published in the July 24, 2012 Federal Register (77 FR
43301). 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 2012 DSH allotments were increased as compared to the preliminary FY 2012 DSH allotments,

the associated FY 2012 IMD DSH limits

for some states were also increased.

The preliminary FY 2013 DSH allotments being published in this

notice are about $182 million more than the final FY 2012 DSH allotments being published in this notice. 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 2013 IMD DSH limits being published in this notice are

about $13 million more than the final FY 2012 IMD DSH limits being published in this notice. The increase in

the IMD DSH limits is because the DSH allotment for a FY is a factor in the

determination of the IMD DSH limit for the FY. Since the preliminary FY 2013 DSH allotments are greater than the

final FY 2012 DSH allotments, the associated preliminary FY 2013 IMD

DSH limits for some states also

increased.

The RFA requires agencies to analyze options for regulatory relief of small businesses, if a rule has a significant impact on a substantial number of small entities. For purposes of the RFA, small

entities include small businesses, nonprofit organizations, and small governmental jurisdictions. Most hospitals and most other providers and suppliers are small entities, either by nonprofit status or by having revenues

of less than $7.0 million to $34.5 million in any one year. Individuals and

states are not included in the definition of a small entity. We are not preparing an analysis for the RFA because the Secretary has determined that this notice will not have significant economic impact on a substantial number of small entities. Specifically, any impact on providers is due to the effect of the various controlling statutes; providers are not impacted as a result of the independent regulatory action in publishing this notice. The purpose of

the notice is to announce the latest 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 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


## 45219 Federal Register / Vol. 78, No. 144 / Friday, July 26, 2013 / Notices

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 2013, that threshold is approximately

$141 million. This notice will have no consequential effect on state, local, or tribal governments, in the aggregate, or on the private sector.

Executive Order 13132 establishes certain requirements that an agency must meet when it promulgates a proposed rule (and subsequent final rule) that imposes substantial direct requirement costs on state and local governments, preempts state law, or otherwise has Federalism implications. Since this notice does not impose any costs on state or local governments, the requirements of E.O. 13132 are not applicable.

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 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 2012 to FY 2013.



### T ABLE 

### 1—A CCOUNTING 

### S TATEMENT 

### : C LASSIFICATION OF 

### E STIMATED 

### E X



### PENDITURES



### , FROM THE 

### FY 2012 TO



### FY 2013

[in Millions]

Category Transfers

Annualized Monetized

Transfers. $182

From Whom To

Whom?. Federal Government

to States.



### Congressional Review Act

This proposed regulation is subject to the Congressional Review Act provisions of the Small Business Regulatory Enforcement Fairness Act of 1996 (5 U.S.C. 801 et seq.) and has been transmitted to the Congress and the Comptroller General for review.

In accordance with the provisions of

Executive Order 12866, this notice was reviewed by the Office of Management and Budget.

(Catalog of Federal Domestic Assistance
Program No. 93.778, Medical Assistance
Program)

Dated: June 20, 2013.

Marilyn Tavenner,

Administrator, Centers for Medicare &

Medicaid Services.

Dated: July 19, 2013.

Kathleen Sebelius,

Secretary, Department of Health and Human

Services.



### 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 2012



### K EY TO 

### C HART 

### 1—F INAL 

### DSH A LLOTMENTS FOR 

### FY 2012.

[The Final FY 2012 DSH allotments for the non-low DSH States are presented in the top section of this chart, and the final FY 2012 DSH allotments for the low-DSH States are presented in the bottom section of this chart]

Column Description

Column A .......... State.
Column B .......... FY 2012 FMAPs. This column contains the states’ FY 2012 Federal Medical Assistance Percentages.
Column C ......... Prior FY (2011) DSH Allotments. This column contains the states’ prior FY 2011 DSH Allotments as would be dete rmined
without the application of section 5002 of ARRA. Column D ......... Prior Fiscal Year (FY 2011) Allotment x (100% + Percentage Increase in CPI–U): 102.6%. This column contains the amount
in Column D increased by 1 plus the percentage increase in the CPI–U for the prior FY (2.6 percent).
Column E .......... FY 2012 TC MAP Exp. Including DSH.This column contains the amount of the states’ FY 2012 total computable (TC) medical
assistance expenditures including DSH expenditures.
Column F .......... FY 2012 TC DSH Expenditures. This column contains the amount of the states’ FY 2012 total computable DSH expe nditures.Column G ......... FY 2012 TC MAP Exp. Net of DSH. This column contains the amount of the states’ projected FY 2012 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% Amount. This column contains the amount of the ‘‘12 percent limit’’ in federal share for the fiscal year, determined in accordance with the provisions of section 1923(f)(3) of the Act. Column I ........... Greater of FY 2011 Allotment or 12% Limit. This column contains the greater of the state’s prior FY (FY 2011) DSH allotment

or the amount of the 12% Limit, determined as the maximum of the amount in Column C or Column I.

Column J .......... FY 2012 DSH Allotment. This column contains the states’ final FY 2012 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 chart.


## 45220 Federal Register / Vol. 78, No. 144 / Friday, July 26, 2013 / NoticesCHART1—FINALDSH ALLOTMENTS FORFISCALYEAR: 2012StateFY 2012 FMAPs(percent)Prior FY (2011) al-lotmentsPrior Fiscal Year(FY 2011) Allotment (Col C×100% + Pct Increases in CPIU:FY 2012 TC MAPExp. IncludingDSHFY 2012 TC DSHExpendituresFY 2012 TC MAPExp. Net of DSHCol E–F‘‘12% Amount’’=Col G×.12/(1-.12/ B)*(In FS)Greater of Col HOR Col C(12% Limit,FY2011 Allotment)2012FY 2012 DSH AllotmentMIN Col D, Col I102.6%A B C D E F G H I JALABAMA .........................68.62% $307,525,116 $315,520,769 $4,980,627,414 $458,470,904 $4,522,156,510 $657,669,473 $657,669,473 $315,520,769ARIZONA ..........................67.30 101,258,270 103,890,985 7,902,936,657 194,651,219 7,708,285,438 1,125,716,333 1,125,716,333 103,890,985CALIFORNIA ....................50.00 1,096,339,537 1,124,844,365 48,965,395,434 2,101,502,957 46,863,892,477 7,399,561,970 7,399,561,970 1,124,844,365COLORADO .....................50.00 92,507,555 94,912,751 4,686,399,553 189,455,472 4,496,944,081 710,043,802 710,043,802 94,912,751CONNECTICUT ................50.00 200,016,335 205,216,760 6,463,271,670 478,109,955 5,985,161,715 945,025,534 945,025,534 205,216,760DISTRICT OF COLUMBIA70.00 61,255,002 62,847,632 2,099,098,380 61,103,120 2,037,995,260 295,157,934 295,157,934 62,847,632FLORIDA ..........................56.04 200,016,335 205,216,760 17,794,004,730 365,483,097 17,428,521,633 2,661,292,513 2,661,292,513 205,216,760GEORGIA .........................66.16 268,771,950 275,760,021 8,299,066,366 415,817,421 7,883,248,945 1,155,588,811 1,155,588,811 275,760,021HAWAII/1 ..........................na na na na na na na na 10,000,000ILLINOIS ...........................50.00 215,017,560 220,608,017 13,216,199,698 443,954,241 12,772,245,457 2,016,670,335 2,016,670,335 220,608,017INDIANA ...........................66.96 213,767,459 219,325,413 7,450,053,558 -1,293,679 7,451,347,237 1,089,393,474 1,089,393,474 219,325,413KANSAS ...........................56.91 41,253,369 42,325,957 2,633,525,501 74,168,771 2,559,356,730 389,186,350 389,186,350 42,325,957KENTUCKY ......................71.18 145,011,843 148,782,151 5,564,881,723 208,470,796 5,356,410,927 773,104,420 773,104,420 148,782,151LOUISIANA/2 ....................na na na na na na na na 731,960,000MAINE ...............................63.27 105,008,576 107,738,799 2,369,701,164 41,241,661 2,328,459,503 344,813,652 344,813,652 107,738,799MARYLAND ......................50.00 76,256,228 78,238,890 7,564,182,204 36,324,863 7,527,857,341 1,188,609,054 1,188,609,054 78,238,890MASSACHUSETTS ..........50.00 305,024,911 312,955,559 12,660,753,3400 12,660,753,340 1,999,066,317 1,999,066,317 312,955,559MICHIGAN ........................66.14 265,021,644 271,912,207 12,377,302,267 276,022,328 12,101,279,939 1,774,019,923 1,774,019,923 271,912,207MISSISSIPPI .....................74.18 152,512,455 156,477,779 4,432,068,902 210,532,157 4,221,536,745 604,349,172 604,349,172 156,477,779MISSOURI ........................63.45 473,788,694 486,107,200 8,620,708,926 755,588,598 7,865,120,328 1,163,946,087 1,163,946,087 486,107,200NEVADA ...........................56.20 46,253,777 47,456,375 1,730,509,323 85,540,193 1,644,969,130 250,988,050 250,988,050 47,456,375NEW HAMPSHIRE ...........50.00 160,111,598 164,274,500 1,174,440,051 41,992,778 1,132,447,273 178,807,464 178,807,464 164,274,500NEW JERSEY ..................50.00 643,802,579 660,541,446 10,263,014,973 1,242,812,460 9,020,202,513 1,424,242,502 1,424,242,502 660,541,446NEW YORK ......................50.00 1,606,381,192 1,648,147,103 51,477,488,275 3,250,438,690 48,227,049,585 7,614,797,303 7,614,797,303 1,648,147,103NORTH CAROLINA ..........65.28 295,024,095 302,694,721 12,074,012,547 310,365,066 11,763,647,481 1,729,574,116 1,729,574,116 302,694,721OHIO .................................64.15 406,283,181 416,846,544 16,241,807,775 544,474,576 15,697,333,199 2,317,125,042 2,317,125,042 416,846,544PENNSYLVANIA ..............55.07 561,295,840 575,889,532 20,215,741,634 1,161,609,171 19,054,132,463 2,923,550,707 2,923,550,707575,889,532RHODE ISLAND ...............52.12 65,005,309 66,695,447 1,841,508,177 127,714,099 1,713,794,078 267,167,340 267,167,340 66,695,447SOUTH CAROLINA ..........70.24 327,526,749 336,042,444 4,611,047,760 457,157,861 4,153,889,899 601,172,857 601,172,857 336,042,444TENNESSEE/1 .................na na na na na na na na 123,562,982TEXAS ..............................58.22 956,328,103 981,192,634 27,523,481,436 1,515,965,665 26,007,515,771 3,931,174,993 3,931,174,993 981,192,634VERMONT ........................57.58 22,501,838 23,086,886 1,332,991,907 37,448,781 1,295,543,126 196,395,015 196,395,015 23,086,886VIRGINIA ..........................50.00 87,614,730 89,892,713 6,806,627,571 214,541,182 6,592,086,389 1,040,855,746 1,040,855,746 89,892,713WASHINGTON .................50.00 185,015,110 189,825,503 7,452,641,090 392,480,601 7,060,160,489 1,114,762,182 1,114,762,182 189,825,503WEST VIRGINIA ...............72.62 67,505,513 69,260,656 2,772,398,537 75,461,531 2,696,937,006 387,696,929 387,696,929 69,260,656TOTAL ....................... .............................. 9,751,002,453 10,004,528,517 343,597,888,543 15,767,606,535 327,830,282,008 50,271,525,401 50,271,525,401 10,870,051,501**LOW DSH STATES**ALASKA ............................50.00 20,371,357 20,901,012 1,323,188,957 19,859,459 1,303,329,498 205,788,868 205,788,868 20,901,012ARKANSAS ......................70.71 43,141,306 44,262,980 4,105,082,591 61,447,395 4,043,635,196 584,415,830 584,415,830 44,262,980DELAWARE ......................54.17 9,053,936 9,289,338 1,484,381,209 12,647,971 1,471,733,238 226,863,997 226,863,997 9,289,338IDAHO ...............................70.23 16,438,844 16,866,254 1,420,520,599 23,407,154 1,397,113,445 202,203,559 202,203,55916,866,254IOWA ................................60.71 39,384,356 40,408,349 3,416,666,341 51,985,041 3,364,681,300 503,230,881 503,230,88140,408,349MINNESOTA .....................50.00 74,694,976 76,637,045 8,661,424,765 47,645,449 8,613,779,316 1,360,070,418 1,360,070,418 76,637,045MONTANA ........................66.11 11,351,703 11,646,847 965,777,404 17,086,812 948,690,592 139,089,858 139,089,858 11,646,847NEBRASKA ......................56.64 28,300,533 29,036,347 1,675,943,349 41,928,603 1,634,014,746 248,791,923 248,791,923 29,036,347NEW MEXICO ..................69.36 20,371,357 20,901,012 3,420,434,313 56,394,276 3,364,040,037 488,137,692 488,137,692 20,901,012NORTH DAKOTA .............55.40 9,552,761 9,801,133 732,046,343 1,163,524 730,882,819 111,956,428 111,956,428 9,801,133OKLAHOMA ......................63.88 36,215,744 37,157,353 4,397,686,300 36,151,183 4,361,535,117 644,444,557 644,444,557 37,157,353OREGON ..........................62.91 45,269,681 46,446,693 4,542,895,184 69,278,705 4,473,616,479 663,371,155 663,371,155 46,446,693SOUTH DAKOTA .............59.13 11,045,549 11,332,733 740,258,203 751,299 739,506,904 111,335,565 111,335,565 11,332,733UTAH ................................70.99 19,619,586 20,129,695 1,870,691,982 32,876,938 1,837,815,044 265,400,556 265,400,55620,129,695WISCONSIN .....................60.53 94,540,543 96,998,597 6,978,470,509 101,257 6,978,369,252 1,044,469,048 1,044,469,048 96,998,597


## 45221 Federal Register / Vol. 78, No. 144 / Friday, July 26, 2013 / NoticesWYOMING ........................50.00 226,348 232,233 518,211,253 452,696 517,758,557 81,751,351 81,751,351 232,233TOTAL LOW DSHSTATES ................. .............................. $479,578,580 $492,047,623 $46,253,679,302 $473,177,762 $45,780,501,540 $6,881,321,686 $6,881,321,686 $492,047,621TOTAL ................ .............................. $10,230,581,033 $10,496,576,140 $389,851,567,845 $16,240,784,297 $373,610,783,548 $57,152,847,088 $57,152,847,088 $11,362,099,1221Hawaii and Tennessee DSH allotments are determined under section 1923(f)(6) of the Act. Under this provision, for FY 2012, Tennessee’s DSH payments are limited to $70,108,895 and Hawaii’s DSH allotment islimited to $10,000,000.2FY 2012 DSH allotment for Louisiana determined under the provisions of section 1903(f)(3)(C) and (D) of the Act.


## 45222 Federal Register / Vol. 78, No. 144 / Friday, July 26, 2013 / Notices

Key to Chart 2. Preliminary DSH Allotments for FY 2013



### K EY TO 

### C HART 

### 2—P RELIMINARY 

### DSH A LLOTMENTS FOR 

### F ISCAL 

### Y EAR 

### : 2013

[The Preliminary FY 2013 DSH allotments for the non-low DSH States are presented in the top section of this chart, and thepreliminary FY 2013 DSH allotments for the low-DSH States are presented in the bottom section of this chart]

Column Description

Column A .......... State.
Column B .......... FY 2013 FMAPs. This column contains the States’ FY 2013 Federal Medical Assistance Percentages.
Column C ......... Prior FY (2012) DSH Allotments. This column contains the States’ prior FY 2012 DSH Allotments.
Column D ......... Prior FY (2012) DSH Allotments (Col C) × (100% + Percentage Increase in CPIU): 102.4%. This column contains the amount
in Column D increased by 1 plus the estimated percentage increase in the CPI–U for the prior FY (102.4 percent).
Column E .......... FY 2013 TC MAP Exp. Including DSH. This column contains the amount of the States’ projected FY 2013 total com putable (TC) medical assistance expenditures including DSH expenditures.
Column F .......... FY 2013 TC DSH Expenditures. This column contains the amount of the States’ projected FY 2013 total computable DSH expenditures.Column G ......... FY 2013 TC MAP Exp. Net of DSH. This column contains the amount of the States’ projected FY 2013 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% 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 2012 Allotment or 12% Limit. This column contains the greater of the State’s prior FY (FY 2012 ) DSH allotment

or the amount of the 12% Limit, determined as the maximum of the amount in Column C or Column H.
Column J .......... FY 2013 DSH Allotment. This column contains the States’ preliminary FY 2013 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 chart.


## 45223 Federal Register / Vol. 78, No. 144 / Friday, July 26, 2013 / NoticesCHART2—PRELIMINARYDSH ALLOTMENTS FORFISCALYEAR: 2013StateFY 2013 FMAPsPrior FY (2012)DSH allotmentsPrior FY (2012)DSH allotment(Col C)×100% +Pct Increase inCPIU:FY 2013 TC MAPExp. includingDSHFY 2013 TC DSHExpendituresFY 2013 TC MAPEXP. Net Of DSH(Col E¥F)‘‘12% Amouunt’’ =Col G×.12/(1¥12/Col B)*(In FS)Greater of Col HOr Col C12% Limit, FY2012 Allotment)2013FY 2013 DSH AllotmentMIN Col I, Col D102.4%A B C D E F G H I JALABAMA .........................68.53% $315,520,769 $323,093,267 $5,329,850,000 $471,003,000 $4,858,847,000 $706,832,022 $706,832,022 $323,093,267ARIZONA ..........................65.68 103,890,985 106,384,369 8,671,536,000 213,742,000 8,457,794,000 1,241,820,961 1,241,820,961 106,384,369CALIFORNIA ....................50.00 1,124,844,365 1,151,840,630 66,298,257,000 919,513,000 65,378,744,000 10,322,959,579 10,322,959,579 1,151,840,630COLORADO .....................50.00 94,912,751 97,190,657 5,051,411,000 192,614,000 4,858,797,000 767,178,474 767,178,474 97,190,657CONNECTICUT ................50.00 205,216,760 210,141,962 6,431,510,000 290,445,000 6,141,065,000 969,641,842 969,641,842 210,141,962DISTRICT OF COLUMBIA70.00 62,847,632 64,355,975 2,263,613,000 57,226,000 2,206,387,000 319,545,703 319,545,703 64,355,975FLORIDA ..........................58.08 205,216,760 210,141,962 19,230,077,000 383,399,000 18,846,678,000 2,850,560,048 2,850,560,048 210,141,962GEORGIA .........................65.56 275,760,021 282,378,262 8,369,129,000 415,995,000 7,953,134,000 1,168,201,938 1,168,201,938 282,378,262ILLINOIS ...........................50.00 220,608,017 225,902,609 15,891,835,000 492,771,000 15,399,064,000 2,431,431,158 2,431,431,158 225,902,609INDIANA ...........................67.16 219,325,413 224,589,223 8,205,160,000 296,676,000 7,908,484,000 1,155,475,965 1,155,475,965 224,589,223KANSAS ...........................56.51 42,325,957 43,341,780 2,631,311,000 75,425,000 2,555,886,000 389,395,061 389,395,061 43,341,780KENTUCKY ......................70.55 148,782,151 152,352,923 6,003,011,000 207,429,000 5,795,582,000 838,008,492 838,008,492 152,352,923LOUISIANA/3 ....................na na na na na na na na 731,960,000MAINE ...............................62.57 107,738,799 110,324,530 2,411,890,000 38,474,000 2,373,416,000 352,393,844 352,393,844 110,324,530MARYLAND ......................50.00 78,238,890 80,116,623 7,990,885,000 28,789,000 7,962,096,000 1,257,173,053 1,257,173,053 80,116,623MASSACHUSETTS ..........50.00 312,955,559 320,466,492 14,457,969,0000 14,457,969,000 2,282,837,211 2,282,837,211 320,466,492MICHIGAN ........................66.39 271,912,207 278,438,100 13,054,597,000 489,458,000 12,565,139,000 1,840,484,453 1,840,484,453 278,438,100MISSISSIPPI .....................73.43 156,477,779 160,233,246 4,938,125,000 306,480,000 4,631,645,000 664,369,251 664,369,251 160,233,246MISSOURI ........................61.37 486,107,200 497,773,773 9,167,121,000 731,848,000 8,435,273,000 1,258,268,675 1,258,268,675 497,773,773NEVADA ...........................59.74 47,456,375 48,595,328 1,788,469,000 81,265,000 1,707,204,000 256,359,532 256,359,532 48,595,328NEW HAMPSHIRE ...........50.00 164,274,500 168,217,088 1,194,634,000 76,100,000 1,118,534,000 176,610,632 176,610,632 168,217,088NEW JERSEY ..................50.00 660,541,446 676,394,441 10,885,937,000 1,285,149,000 9,600,788,000 1,515,913,895 1,515,913,895 676,394,441NEW YORK ......................50.00 1,648,147,103 1,687,702,633 60,543,793,000 3,138,550,000 57,405,243,000 9,063,985,737 9,063,985,737 1,687,702,633NORTH CAROLINA ..........65.51 302,694,721 309,959,394 12,152,941,000 348,212,000 11,804,729,000 1,734,242,863 1,734,242,863 309,959,394OHIO .................................63.58 416,846,544 426,850,861 17,759,856,0000 17,759,856,000 2,626,998,785 2,626,998,785426,850,861PENNSYLVANIA ..............54.28 575,889,532 589,710,881 21,684,533,000 811,678,000 20,872,855,000 3,215,644,000 3,215,644,000 589,710,881RHODE ISLAND ...............51.26 66,695,447 68,296,138 2,138,378,000 133,105,000 2,005,273,000 314,183,272 314,183,272 68,296,138SOUTH CAROLINA ..........70.43 336,042,444 344,107,463 4,819,642,000 488,104,000 4,331,538,000 626,534,769 626,534,769 344,107,463TENNESSEE/2 .................na na na na na na na na 53,100,000TEXAS ..............................59.30 981,192,634 1,004,741,257 30,522,421,000 2,362,443,000 28,159,978,000 4,236,499,016 4,236,499,016 1,004,741,257VERMONT ........................56.04 23,086,886 23,640,971 1,453,569,000 37,449,000 1,416,120,000 216,238,051 216,238,051 23,640,971VIRGINIA ..........................50.00 89,892,713 92,050,138 7,614,317,000 292,128,000 7,322,189,000 1,156,135,105 1,156,135,105 92,050,138WASHINGTON .................50.00 189,825,503 194,381,315 7,263,797,000 408,769,000 6,855,028,000 1,082,372,842 1,082,372,842 194,381,315WEST VIRGINIA ...............72.04 69,260,656 70,922,912 3,049,170,000 70,185,000 2,978,985,000 428,926,208 428,926,208 70,922,912TOTAL .......................0.00 10,004,528,519 10,244,637,203 389,268,744,000 15,144,424,000 374,124,320,000 57,467,222,436 57,467,222,436 11,029,697,203**LOW DSH STATES** ALASKA ............................50.00 20,901,012 21,402,636 4,345,689,000 43,820,000 4,301,869,000 679,242,473.68 679,242,47421,402,636ARKANSAS ......................70.17 44,262,980 45,325,292 1,580,616,000 16,393,000 1,564,223,000 226,429,145 226,429,145 45,325,292DELAWARE ......................55.67 9,289,338 9,512,282 1,656,878,000 19,283,000 1,637,595,000 250,510,411 250,510,411 9,512,282HAWAII/1 ..........................51.86 10,000,000 10,240,000 15,891,835,000 492,771,000 15,399,064,000 2,404,201,080.90 2,404,201,081 10,240,000IDAHO ...............................71.00 16,866,254 17,271,044 1,804,672,000 22,633,000 1,782,039,000 257,338,513.22 257,338,513 17,271,044IOWA ................................59.59 40,408,349 41,378,149 3,701,627,000 53,705,000 3,647,922,000 548,131,133 548,131,13341,378,149MINNESOTA .....................50.00 76,637,045 78,476,334 9,033,277,000 127,149,000 8,906,128,000 1,406,230,737 1,406,230,737 78,476,334MONTANA ........................66.00 11,646,847 11,926,371 1,035,493,000 18,023,000 1,017,470,000 149,228,933 149,228,933 11,926,371NEBRASKA ......................55.76 29,036,347 29,733,219 1,982,015,000 40,798,000 1,941,217,000 296,825,210 296,825,210 29,733,219NEW MEXICO ..................69.07 20,901,012 21,402,636 3,663,793,000 21,380,000 3,642,413,000 528,995,548 528,995,548 21,402,636NORTH DAKOTA .............52.27 9,801,133 10,036,360 783,683,000 1,474,000 782,209,000 121,835,802 121,835,802 10,036,360OKLAHOMA ......................64.00 37,157,353 38,049,129 4,822,776,000 49,525,000 4,773,251,000 704,972,455 704,972,455 38,049,129OREGON ..........................62.44 46,446,693 47,561,414 5,261,131,000 100,645,000 5,160,486,000 766,583,852 766,583,852 47,561,414SOUTH DAKOTA .............56.19 11,332,733 11,604,719 792,356,000 2,821,000 789,535,000 120,472,428 120,472,428 11,604,719UTAH ................................69.61 20,129,695 20,612,808 2,104,256,000 29,583,000 2,074,673,000 300,818,582 300,818,58220,612,808WISCONSIN .....................59.74 96,998,597 99,326,563 7,576,743,000 159,936,000 7,416,807,000 1,113,732,845 1,113,732,845 99,326,563


## 45224 Federal Register / Vol. 78, No. 144 / Friday, July 26, 2013 / NoticesCHART2—PRELIMINARYDSH ALLOTMENTS FORFISCALYEAR: 2013—ContinuedStateFY 2013 FMAPsPrior FY (2012)DSH allotmentsPrior FY (2012)DSH allotment(Col C)×100% +Pct Increase inCPIU:FY 2013 TC MAPExp. includingDSHFY 2013 TC DSHExpendituresFY 2013 TC MAPEXP. Net Of DSH(Col E¥F)‘‘12% Amouunt’’ =Col G×.12/(1¥12/Col B)*(In FS)Greater of Col HOr Col C12% Limit, FY2012 Allotment)2013FY 2013 DSH AllotmentMIN Col I, Col D102.4%A B C D E F G H I JWYOMING ........................50.00 232,233 237,807 548,369,000 463,000 547,906,000 86,511,474 86,511,474 237,807TOTAL LOW DSHSTATES ........................ 0.00 502,047,621 514,096,764 66,585,209,000 1,200,402,000 65,384,807,000 9,962,060,622 9,962,060,622 514,096,763TOTAL .......................0.00 10,506,576,140 10,758,733,967 455,853,953,000 16,344,826,000 439,509,127,000 67,429,283,058 67,429,283,058 11,543,793,966FOOTNOTES:/1 Begining FY 2013, under section 1923(f)(6)(B)(II) of the Act, Hawaii’s DSH allotments are determined as for low-DSH states. This means its allotments are determined as for all States, by increasing the previousfiscal year allotment by the CPI–U for the previous fiscal year./2 Tennessee’s DSH allotments are determined under section 1923(f)(6)(A)(v)(II) of the Act. Under this provision, Tennessee’s DSH payments for FY 2013 are limited to $53,100,000/3 FY 2013 DSH allotment for Louisiana determined under the provisions of section 1903(f)(3)(C) and (D) of the Act.


## 45225 Federal Register / Vol. 78, No. 144 / Friday, July 26, 2013 / Notices

Key to Chart 3. Final IMD DSH Limit for

FY 2012



### K EY TO 

### C HART 

### 3—F INAL 

### IMD DSH L IMIT 

### F OR 

### FY: 2012

The final FY 2012 IMD DSH limits for the non-low DSH States are presented in the top section of this chart and the final FY 2012 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 m ental 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 c omputation 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 2012 Federal Share DSH Allotment. This column contains the states’ final FY 2012 DSH allotments.

Column G ......... FY 2012 FMAP.
Column H ......... FY 2012 DSH Allotments in Total Computable Col. F/G. This column contains States’ FY 2012 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 2012 total computable DSH allotment (calculated as
the percentage in Column E multiplied by the amount in Column H)
Column J .......... FY 2012 TC IMD DSH Limit. Lesser of Col. C or I. This column contains the total computable amount of the FY 2 012 TC IMD
DSH Limit equal to the lesser of the amount in Column C or Column I.

Column K .......... FY 2012 IMD DSH Limit in Federal Share, Col. G × J. This column contains the FY 2012 federal share IMD DSH limit determined by converting the total computable FY 2012 IMD DSH Limit from Column J into a federal share amount by multiplying it by the FY 2012 FMAP in Column G.


## 45226 Federal Register / Vol. 78, No. 144 / Friday, July 26, 2013 / NoticesCHART3—FINALIMD DSH LIMIT FORFY: 2012StateImpatient hospital service forFY 95 DSH totalcomputableIMD and mentalhealth servicesFY 95 DSH totalcomputableTotal inpatient &IMD and mentalhealth FY 95DSH total computableCol B + CApplicable percentCol C/DFY 2012 Allotmentin FSFY 2012 FMAPFY 2012 Allotments In TCCol F/GCoL E x Col H InTCFY 2012TC IMD Limit(Lesser Of Col 1or Col C)2012FY 2012IMD Limit in FSCol G x JA B C D E F G H I J KALABAMA ........... 413,006,229 4,451,770 417,457,999 1.07% 315,520,769 68.62% 459,808,757 4,903,398 4,451,770 3,054,805ARIZONA ............ 93,916,100 28,474,900 122,391,000 23.27% 103,890,985 67.30% 154,369,963 35,914,971 28,474,900 19,163,608CALIFORNIA ...... 2,189,879,543 1,555,919 2,191,435,462 0.07% 1,124,844,365 50.00% 2,249,688,730 1,597,279 1,555,919 777,960COLORADO ....... 173,900,441 594,776 174,495,217 0.34% 94,912,751 50.00% 189,825,502 647,030 594,776 297,388CONNECTICUT .. 303,359,275 105,573,725 408,933,000 25.82% 205,216,760 50.00% 410,433,520 105,961,112 105,573,725 52,786,863DISTRICT OFCOLUMBIA ...... 39,532,234 6,545,136 46,077,370 14.20% 62,847,632 70.00% 89,782,331 12,753,279 6,545,136 4,581,595FLORIDA ............ 184,468,014 149,714,986 334,183,000 33.00% 205,216,760 56.04% 366,196,931 120,844,987 120,844,987 67,721,531GEORGIA ........... 407,343,557 0407,343,557 0.00%275,760,021 66.16%416,807,771 0 0 0HAWAII ...............0 0 0 0.00% 10,000,000 50.48% 19,809,826 0 0 0ILLINOIS ............. 315,868,508 89,408,276 405,276,784 22.06% 220,608,017 50.00% 441,216,034 97,336,849 89,408,276 44,704,138INDIANA ............. 79,960,783 153,566,302 233,527,085 33.00% 219,325,413 66.96% 327,546,913 108,090,481 108,090,481 72,377,386KANSAS ............. 11,587,208 76,663,508 88,250,716 33.00% 42,325,957 56.91% 74,373,497 24,543,254 24,543,254 13,967,566KENTUCKY ........ 158,804,908 37,443,073 196,247,981 19.08% 148,782,151 71.18% 209,022,409 39,880,366 37,443,073 26,651,979LOUISIANA ......... 1,078,512,169 132,917,149 1,211,429,318 10.97% 731,960,000 61.09% 1,198,166,639 131,461,977 131,461,977 80,310,122MAINE ................. 99,957,958 60,958,342 160,916,300 33.00% 107,738,799 63.27% 170,284,177 56,193,779 56,193,779 35,553,804MARYLAND ........ 22,226,467 120,873,531 143,099,998 33.00% 78,238,890 50.00% 156,477,780 51,637,667 51,637,667 25,818,834MASSACHUSETTS ............. 469,653,946 105,635,054 575,289,000 18.36% 312,955,559 50.00% 625,911,118 114,930,330 105,635,054 52,817,527MICHIGAN .......... 133,258,800 304,765,552 438,024,352 33.00% 271,912,207 66.14% 411,116,128 135,668,322 135,668,322 89,731,028MISSISSIPPI ....... 182,608,033 0182,608,033 0.00%156,477,779 74.18%210,943,353 0 0 0MISSOURI .......... 521,946,524 207,234,618 729,181,142 28.42% 486,107,200 63.45% 766,126,399 217,734,528 207,234,618 131,490,365NEVADA ............. 73,560,000 0 73,560,000 0.00% 47,456,375 56.20% 84,441,948 0 0 0NEW HAMPSHIRE ............. 92,675,916 94,753,948 187,429,864 33.00% 164,274,500 50.00% 328,549,000 108,421,170 94,753,948 47,376,974NEW JERSEY .... 736,742,539 357,370,461 1,094,113,000 32.66% 660,541,446 50.00% 1,321,082,892 431,505,706 357,370,461 178,685,231NEWYORK ........ 2,418,869,368 605,000,000 3,023,869,368 20.01% 1,648,147,103 50.00% 3,296,294,206 659,505,340 605,000,000 302,500,000NORTH CAROLINA ................ 193,201,966 236,072,627 429,274,593 33.00% 302,694,721 65.28% 463,686,766 153,016,633 153,016,633 99,889,258OHIO ................... 535,731,956 93,432,758 629,164,714 14.85% 416,846,544 64.15% 649,799,757 96,497,121 93,432,758 59,937,114PENNSYLVANIA 388,207,319 579,199,682 967,407,001 33.00% 575,889,532 55.07% 1,045,740,933 345,094,508 345,094,508 190,043,546RHODE ISLAND 108,503,167 2,397,833 110,901,000 2.16% 66,695,447 52.12% 127,965,171 2,766,784 2,397,833 1,249,751SOUTH CAROLINA ................ 366,681,364 72,076,341 438,757,705 16.43% 336,042,444 70.24% 478,420,336 78,591,867 72,076,341 50,626,422TENNESSEE ......0 0 0 0.00%123,562,982 66.36%186,200,998 0 0 0TEXAS ................ 1,220,515,401 292,513,592 1,513,028,993 19.33% 981,192,634 58.22% 1,685,318,849 325,822,355 292,513,592 170,301,413VERMONT .......... 19,979,252 9,071,297 29,050,549 31.23% 23,086,886 57.58% 40,095,321 12,520,127 9,071,297 5,223,253VIRGINIA ............ 129,313,480 7,770,268 137,083,748 5.67% 89,892,713 50.00% 179,785,426 10,190,712 7,770,268 3,885,134WASHINGTON ... 171,725,815 163,836,435 335,562,250 33.00% 189,825,503 50.00% 379,651,006 125,284,832 125,284,832 62,642,416WEST VIRGINIA 66,962,606 18,887,045 85,849,651 22.00% 69,260,656 72.62% 95,374,079 20,982,433 18,887,045 13,715,772TOTAL ......... 13,402,460,846 4,118,758,904 17,521,219,750 ............................ 10,870,051,501 ............................ 19,310,314,466 3,630,299,198 3,392,027,231 1,907,882,783.**LOW DSH STATES**ALASKA .............. 2,506,827 17,611,765 20,118,592 33.00% 20,901,012 50.00% 41,802,024 13,794,668 13,794,668 6,897,334ARKANSAS ........ 2,422,649 819,351 3,242,000 25.27% 44,262,980 70.71% 62,597,907 15,820,376 819,351 579,363DELAWARE ........0 7,069,000 7,069,000 33.00% 9,289,338 54.17% 17,148,492 5,659,002 5,659,002 3,065,482IDAHO ................. 2,081,429 0 2,081,429 0.00% 16,866,254 70.23% 24,015,740 0 0 0IOWA .................. 12,011,250 0 12,011,250 0.00% 40,408,349 60.71% 66,559,626 0 0 0MINNESOTA ....... 24,240,000 5,257,214 29,497,214 17.82% 76,637,045 50.00% 153,274,090 27,317,654 5,257,214 2,628,607MONTANA ..........237,048 0 237,048 0.00% 11,646,847 66.11% 17,617,376 0 0 0NEBRASKA ........ 6,449,102 1,811,337 8,260,439 21.93% 29,036,347 56.64% 51,264,737 11,241,257 1,811,337 1,025,941NEW MEXICO .... 6,490,015 254,786 6,744,8013.78% 20,901,01269.36% 30,134,100 1,138,321 254,786 176,720NORTH DAKOTA214,523 988,478 1,203,00133.00% 9,801,13355.40% 17,691,576 5,838,220 988,478 547,617


## 45227 Federal Register / Vol. 78, No. 144 / Friday, July 26, 2013 / NoticesOKLAHOMA ........ 20,019,969 3,273,248 23,293,217 14.05% 37,157,353 63.88% 58,167,428 8,173,900 3,273,248 2,090,951OREGON ............ 11,437,908 19,975,092 31,413,000 33.00% 46,446,693 62.91% 73,830,381 24,364,026 19,975,092 12,566,330SOUTH DAKOTA 321,120 751,299 1,072,419 33.00% 11,332,733 59.13% 19,165,792 6,324,711 751,299 444,243UTAH .................. 3,621,116 934,586 4,555,702 20.51% 20,129,695 70.99% 28,355,677 5,817,066 934,586 663,463WISCONSIN ....... 6,609,524 4,492,011 11,101,535 33.00% 96,998,597 60.53% 160,248,797 52,882,103 4,492,011 2,719,014WYOMING ..........0 0 0 0.00% 232,233 50.00% 464,466 0 0 0TOTAL LOWDSHSTATES ... 98,662,480 63,238,167 161,900,647 ............................ 492,047,621 ............................ 822,338,209 178,371,303 58,011,072 33,405,065TOTAL .. 13,501,123,326 4,181,997,071 17,683,120,397 ............................ 11,362,099,122 ............................ 20,132,652,675 3,808,670,501 3,450,038,303 1,941,287,848


## 45228 Federal Register / Vol. 78, No. 144 / Friday, July 26, 2013 / Notices

Key to Chart 4. Preliminary IMD DSH

Limit for FY 2013



### K EY TO 

### C HART 

### 4—P RELIMINARY 

### IMD DSH L IMIT 

### FOR FY: 2013

[The preliminary FY 2013 IMD DSH Limits for the non-low DSH States are presented in the top section of this chart and the preliminary FY 2013 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 m ental 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 2013 Federal Share DSH Allotment. This column contains the states’ preliminary FY 2012 DSH allotments.

Column G ......... FY 2013 FMAP.
Column H ......... FY 2013 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 2013 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 2013 TC IMD DSH Limit. Lesser of Col. I or C. This column contains the total computable FY 2013 TC IMD DSH Limit
equal to the lesser of the amount in Column I or Column C.

Column K .......... FY 2013 IMD DSH Limit in Federal Share, Col. G x J. This column contains the FY 2013 Federal Share IMD DSH limit determined by converting the total computable FY 2013 IMD DSH Limit from Column J into a federal share amount by multiplying it by the FY 2013 FMAP in Column G.


## 45229 Federal Register / Vol. 78, No. 144 / Friday, July 26, 2013 / NoticesCHART4—PRELIMINARYIMD DSH LIMIT FORFY: 2013StateInpatient hospitalservices FY 95DSH total computableIMD and mentalhealth servicesFY 95 DSH totalcomputableTotal inpatient &IMD & mentalhealth FY 95DSH total computableCol B + CApplicable percentageCol C/DFY 2013Allotmentin FSFY 2013FMAPsFY 2013Allotmentsin TCCol F/GApplicable percentageapplied to FY2013allotments in TCCol E×Col HFY 2013TC IMD Limit(lesser of Col I orCol C)2013FY 2013IMD Limit in FSCol G×JA B C D E F G H I J KALABAMA ........... $413,006,229 $4,451,770 $417,457,999 1.07 $323,093,267 68.53 $471,462,523 $5,027,674 $4,451,770 $3,050,798ARIZONA ............ 93,916,100 28,474,900 122,391,000 23.27 106,384,369 65.68 161,973,765 37,684,035 28,474,900 18,702,314CALIFORNIA ...... 2,189,879,543 1,555,919 2,191,435,462 0.07 1,151,840,630 50.00 2,303,681,260 1,635,614 1,555,919 777,960COLORADO ....... 173,900,441 594,776 174,495,217 0.34 97,190,657 50.00 194,381,314 662,559 594,776 297,388CONNECTICUT .. 303,359,275 105,573,725 408,933,000 25.82 210,141,962 50.00 420,283,924 108,504,179 105,573,725 52,786,863DISTRICT OFCOLUMBIA ...... 39,532,234 6,545,136 46,077,370 14.20 64,355,975 70.00 91,937,107 13,059,358 6,545,136 4,581,595FLORIDA ............ 184,468,014 149,714,986 334,183,000 33.00 210,141,962 58.08 361,814,673 119,398,842 119,398,842 69,346,847GEORGIA ........... 407,343,557 0407,343,557 0.00282,378,262 65.56430,717,300 0 0 0ILLINOIS ............. 315,868,508 89,408,276 405,276,784 22.06 225,902,609 50.00 451,805,218 99,672,933 89,408,276 44,704,138INDIANA ............. 79,960,783 153,566,302 233,527,085 33.00 224,589,223 67.16 334,409,206 110,355,038 110,355,038 74,114,444KANSAS ............. 11,587,208 76,663,508 88,250,716 33.00 43,341,780 56.51 76,697,540 25,310,188 25,310,188 14,302,787KENTUCKY ........ 158,804,908 37,443,073 196,247,981 19.08 152,352,923 70.55 215,950,281 41,202,167 37,443,073 26,416,088LOUISIANA ......... 1,078,512,169 132,917,149 1,211,429,318 10.97 731,960,000 61.24 1,195,231,875 131,139,977 131,139,977 80,310,122MAINE ................. 99,957,958 60,958,342 160,916,300 33.00 110,324,530 62.57 176,321,768 58,186,183 58,186,183 36,407,095MARYLAND ........ 22,226,467 120,873,531 143,099,998 33.00 80,116,623 50.00 160,233,246 52,876,971 52,876,971 26,438,486MASSACHUSETTS ............. 469,653,946 105,635,054 575,289,000 18.36 320,466,492 50.00 640,932,984 117,688,658 105,635,054 52,817,527MICHIGAN .......... 133,258,800 304,765,552 438,024,352 33.00 278,438,100 66.39 419,397,650 138,401,225 138,401,225 91,884,573MISSISSIPPI ....... 182,608,033 0182,608,033 0.00160,233,246 73.43218,212,238 0 0 0MISSOURI .......... 521,946,524 207,234,618 729,181,142 28.42 497,773,773 61.37 811,102,775 230,516,896 207,234,618 127,179,885NEVADA ............. 73,560,000 0 73,560,000 0.00 48,595,328 59.74 81,344,707 0 0 0NEW HAMPSHIRE ............. 92,675,916 94,753,948 187,429,864 33.00 168,217,088 50.00 336,434,176 111,023,278 94,753,948 47,376,974NEW JERSEY .... 736,742,539 357,370,461 1,094,113,000 32.66 676,394,441 50.00 1,352,788,882 441,861,843 357,370,461 178,685,231NEW YORK ........ 2,418,869,368 605,000,000 3,023,869,368 20.01 1,687,702,633 50.00 3,375,405,266 675,333,468 605,000,000 302,500,000NORTH CAROLINA ................ 193,201,966 236,072,627 429,274,593 33.00 309,959,394 65.51 473,148,212 156,138,910 156,138,910 102,286,600OHIO ................... 535,731,956 93,432,758 629,164,714 14.85 426,850,861 63.58 671,360,272 99,698,919 93,432,758 59,404,548PENNSYLVANIA 388,207,319 579,199,682 967,407,001 33.00 589,710,881 54.28 1,086,423,878 358,519,880 358,519,880 194,604,591RHODE ISLAND 108,503,167 2,397,833 110,901,000 2.16 68,296,138 51.26 133,234,760 2,880,720 2,397,833 1,229,129SOUTH CAROLINA ................ 366,681,364 72,076,341 438,757,705 16.43 344,107,463 70.43 488,580,808 80,260,965 72,076,341 50,763,367TENNESSEE ......0 0 0 0.00 53,100,000 66.13 80,296,386 0 0 0TEXAS ................ 1,220,515,401 292,513,592 1,513,028,993 19.33 1,004,741,257 59.30 1,694,336,015 327,565,642 292,513,592 173,460,560VERMONT .......... 19,979,252 9,071,297 29,050,549 31.23 23,640,971 56.04 42,185,887 13,172,925 9,071,297 5,083,555VIRGINIA ............ 129,313,480 7,770,268 137,083,748 5.67 92,050,138 50.00 184,100,276 10,435,289 7,770,268 3,885,134WASHINGTON ... 171,725,815 163,836,435 335,562,250 33.00 194,381,315 50.00 388,762,630 128,291,668 128,291,668 64,145,834WEST VIRGINIA 66,962,606 18,887,045 85,849,651 22.00 70,922,912 72.04 98,449,350 21,658,997 18,887,045 13,606,227TOTAL ......... 13,402,460,846 4,118,758,904 17,521,219,750 ............................ 11,029,697,203 ............................ 19,623,398,153 3,718,165,001 3,418,809,673 1,921,150,660............................. ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................LOW DSHSTATES .......... ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ALASKA .............. 2,506,827 17,611,765 20,118,592 33.00 21,402,636 50.00 42,805,272 14,125,740 14,125,740 7,062,870ARKANSAS ........ 2,422,649 819,351 3,242,000 25.27 45,325,292 70.17 64,593,547 16,324,734 819,351 574,939DELAWARE ........0 7,069,000 7,069,000 33.00 9,512,282 55.67 17,086,909 5,638,680 5,638,680 3,139,053HAWAII ...............0 0 0 0.00 10,240,000 51.86 19,745,469 0 0 0IDAHO ................. 2,081,429 0 2,081,429 0.00 17,271,044 71.00 24,325,414 0 0 0IOWA .................. 12,011,250 0 12,011,250 0.00 41,378,149 59.59 69,438,075 0 0 0MINNESOTA ....... 24,240,000 5,257,214 29,497,214 17.82 78,476,334 50.00 156,952,668 27,973,278 5,257,214 2,628,607MONTANA ..........237,048 0 237,048 0.00 11,926,371 66.00 18,070,259 0 0 0NEBRASKA ........ 6,449,102 1,811,337 8,260,439 21.93 29,733,219 55.76 53,323,563 11,692,713 1,811,337 1,010,002NEW MEXICO .... 6,490,015 254,786 6,744,8013.78 21,402,63669.07 30,986,877 1,170,535 254,786 175,981


## 45230 Federal Register / Vol. 78, No. 144 / Friday, July 26, 2013 / NoticesCHART4—PRELIMINARYIMD DSH LIMIT FORFY: 2013—ContinuedStateInpatient hospitalservices FY 95DSH total computableIMD and mentalhealth servicesFY 95 DSH totalcomputableTotal inpatient &IMD & mentalhealth FY 95DSH total computableCol B + CApplicable percentageCol C/DFY 2013Allotmentin FSFY 2013FMAPsFY 2013Allotmentsin TCCol F/GApplicable percentageapplied to FY2013allotments in TCCol E×Col HFY 2013TC IMD Limit(lesser of Col I orCol C)2013FY 2013IMD Limit in FSCol G×JA B C D E F G H I J KNORTH DAKOTA 214,523 988,478 1,203,001 33.00 10,036,360 52.27 19,200,995 6,336,328 988,478 516,677OKLAHOMA ........ 20,019,969 3,273,248 23,293,217 14.05 38,049,129 64.00 59,451,764 8,354,379 3,273,248 2,094,879OREGON ............ 11,437,908 19,975,092 31,413,000 33.00 47,561,414 62.44 76,171,387 25,136,558 19,975,092 12,472,447SOUTH DAKOTA 321,120 751,299 1,072,419 33.00 11,604,719 56.19 20,652,641 6,815,372 751,299 422,155UTAH .................. 3,621,116 934,586 4,555,702 20.51 20,612,808 69.61 29,611,849 6,074,765 934,586 650,565WISCONSIN ....... 6,609,524 4,492,011 11,101,535 33.00 99,326,563 59.74 166,264,752 54,867,368 4,492,011 2,683,527WYOMING ..........0 0 0 0.00 237,807 50.00 475,614 0 0 0TOTAL LOWDSHSTATES ... 98,662,480 63,238,167 161,900,647 ............................ 514,096,763 ............................ 869,157,055 184,510,449 58,321,822 33,431,702TOTAL .. 13,501,123,326 4,181,997,071 17,683,120,397 ............................ 11,543,793,966 ............................ 20,492,555,208 3,902,675,450 3,477,131,494 1,954,582,362


## 45231 Federal Register / Vol. 78, No. 144 / Friday, July 26, 2013 / Notices

[FR Doc. 2013–17965 Filed 7–25–13; 8:45 am]

**BILLING CODE 4120–01–P**



### DEPARTMENT OF HEALTH AND

**HUMAN SERVICES**

**Centers for Medicare & Medicaid**

**Services**

**[CMS–3280–FN]**



### Medicare and Medicaid Programs; **Initial Approval of Center for Improvement in Healthcare Quality’s** 
**(CIHQ’s) Hospital Accreditation**
**Program**

**AGENCY** 

### : Centers for Medicare and

Medicaid Services, HHS.

**ACTION** 

### : Final notice.

**SUMMARY** 

### : This final notice announces our decision to approve the Center for Improvement in Healthcare Quality (CIHQ) as a national accrediting organization for hospitals that wish to participate in the Medicare or Medicaid

programs.

**DATES** 

### : This final notice is effective July 26, 2013 through July 26, 2017.

**FOR FURTHER INFORMATION CONTACT** 

### : Cindy Melanson, (410) 786–0310.

Monda Shaver, (410) 786–3410. Patricia

Chmielewski, (410) 786–6899.

**SUPPLEMENTARY INFORMATION** 

### :

I. Background

Under the Medicare program, eligible beneficiaries may receive covered services in a hospital provided certain requirements are met. Section 1861(e) of the Social Security Act (the Act)

establishes distinct criteria for facilities seeking designation as a hospital. Regulations concerning provider agreements are at 42 CFR part 489 and those pertaining to activities relating to the survey and certification of facilities are at 42 CFR part 488. The regulations at 42 CFR part 482 specify the conditions that a hospital must meet to participate in the Medicare program, the scope of covered services, and the conditions for Medicare payment for hospitals.

Generally, to enter into an agreement, a hospital must first be certified by a State survey agency as complying with the conditions or requirements set forth in part 482. Thereafter, the hospital is subject to regular surveys by a State survey agency to determine whether it continues to meet these requirements.

However, there is an alternative to surveys by State agencies. Certification by a nationally recognized accreditation program can substitute for ongoing State

review. Section 1865(a)(1) of the Act provides that, if a provider entity demonstrates through accreditation by an approved national accrediting organization (AO) that all applicable Medicare conditions

are met or exceeded, we will deem that provider entity as having met the requirements. Accreditation by an AO is voluntary and is not required for Medicare participation.

If an AO is recognized by the Secretary as having standards for

accreditation that meet or exceed Medicare requirements, any provider entity accredited by the national accrediting body’s approved program

would be deemed to have met the

Medicare conditions. A national AO applying for approval of its accreditation program under part 488, subpart A, must provide CMS with

reasonable assurance that the AO requires the accredited provider entities to meet requirements that are at least as stringent as the Medicare conditions. Our regulations concerning the approval

of AOs are set forth at § 488.4 and § 488.8(d)(3). The regulations at § 488.8(d)(3) require AOs to reapply for continued approval of their accreditation program every 6 years, or sooner, as determined by CMS.

II. Application Approval Process

Section 1865(a)(3)(A) of the Act provides a statutory timetable to ensurethat our review of applications for CMSapproval of an accreditation program is conducted in a timely manner. The Act provides us 210 days after the date of receipt of a complete application, with any documentation necessary to make the determination, to complete our survey activities and application process. Within 60 days after receiving a complete application, we must publish a notice in the Federal Register that identifies the national accrediting body making the request, describes the request, and provides no less than a 30- day public comment period. At the end of the 210-day period, we must publish

a notice in the Federal Register approving or denying the application.

III. Provisions of the Proposed Notice

On February 22, 2013, we published a proposed notice in the Federal
Register (78 FR 12325) announcing CIHQ’s request for approval of its hospital accreditation program. In the proposed notice, we detailed our

evaluation criteria. Under section

1865(a)(2) of the Act, and in our regulations at § 488.4 and § 488.8, we conducted a review of CIHQ’s application in accordance with the criteria specified by our regulations, which include, but are not limited to, the following:

• An onsite administrative review of CIHQ’s: (1) Corporate policies; (2)

financial and human resources available to accomplish the proposed surveys; (3) procedures for training, monitoring, and evaluation of its surveyors; (4) ability to investigate and respond appropriately to complaints against accredited facilities;and, (5) survey review and decisionmaking process for accreditation.

• The comparison of CIHQ’s

accreditation to our current Medicare hospital conditions of participation.

• A documentation review of CIHQ’s survey process to determine the following:

++ Determine the composition of the survey team, surveyor qualifications, and CIHQ’s ability to provide
continuing surveyor training.

++ Compare CIHQ’s processes to those of State survey agencies, including survey frequency, and the ability to investigate and respond appropriately to complaints against accredited facilities.

++ Evaluate CIHQ’s procedures for monitoring hospitals out of compliance with CIHQ’s program requirements. The monitoring procedures are used only when CIHQ identifies noncompliance. If noncompliance is identified through validation reviews, the State survey agency monitors corrections as specified

at § 488.7(d).

++ Assess CIHQ’s ability to report deficiencies to the surveyed facilities and respond to the facility’s plan of correction in a timely manner.

++ Establish CIHQ’s ability to provide CMS with electronic data and reports necessary for effective validation and assessment of the organization’s

survey process.

++ Determine the adequacy of staff

and other resources.

++ Confirm CIHQ’s ability to provide adequate funding for performing required surveys.

++ Confirm CIHQ’s policies with respect to whether surveys are

announced or unannounced.

++ Obtain CIHQ’s agreement to provide CMS with a copy of the most current accreditation survey together with any other information related to the survey as we may require, including corrective action plans.

In accordance with section 1865(a)(3)(A) of the Act, the February 22, 2013 proposed notice also solicited public comments regarding whether CIHQ’s requirements met or exceeded the Medicare conditions of participation for hospitals. We received 56 comments in response to our proposed notice. The commenters expressed unanimous support for CIHQ’s hospital