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# CMS-2342-N 2

I. Background

In general, in accordance with the methodology specified under section 1923(f)(3)

of the Social Security Act (the Act), a stat e's federal fiscal year (FY) disproportionate

share hospital (DSH) allotment is calcula ted 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 fo r 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 allotm ent 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 (IMD s) and other mental

health facilities is limited to state-specif ic aggregate amounts determined in accordance

with the methodology specified under such sec tion. 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 sh are) 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).

# CMS-2342-N 3

In general, we determine states' DSH a llotments and IMD DSH limits for a FY

using the most recent available estimates of or actual medical assi stance 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 e xpenditures are obtained from states for each

relevant FY from the most recent availa ble quarterly Medicaid budget reports (Form

CMS-37) or quarterly Medicaid expenditu re 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 fo r 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 s ubject 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 be ginning of the FY for

determining the states’ preliminary FY DSH allotments; such estimated CPI-U

percentage change is subject to update a nd 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 actu al expenditures for the FY and actual CPIU percentage change for the previous FY.

# CMS-2342-N 4

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 sec tion 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 allo tments we are usi ng the actual Medicaid

expenditures for FY 2012. Finally, for purpos es 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 not e 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 DS H allotments which we re 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 noti ce provides the preliminary FY 2013 DSH

allotments determined in accordance with sec tion 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

# CMS-2342-N 5

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 increas e in the CPI-U for FY 2012 (the previous FY

to FY 2013). In this regard, we note th at 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 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 a llotments contained in this notice were

determined using the final FY 2012 DSH allotm ents contained in this notice, the most

recent available estimates of FY 2013 Medi caid expenditures, and the most recent

available estimate of the percentage change in the CPI-U for FY 2012.

States' s 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 accordan ce with the provisions discussed above.

# CMS-2342-N 6

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 requireme nts and burden associated with Form CMS37 (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 B udget 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 th is notice as required by Executive Order

12866 on Regulatory Planning and Review (Sep tember 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 alternativ es and, if regulation is necessary, to select regulatory

approaches that maximize net benefits (inc luding potential economi c, 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

# CMS-2342-N 7

threshold and thus is considered a majo r rule under the Congre ssional Review Act.

The final FY 2012 DSH allotments be ing 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 betweenthe actual percentage change in the CPIU for FY 2011 used in the calculation of th e final FY 2012 allotments [2.6 percent) as

compared to the estimated percentage cha nge in the CPI-U for FY 2011 used in the

calculation of the preliminary FY 2012 allotments (2.4 perc ent). The final FY 2012 IMD

DSH limits being published in this notice ar e 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 lim its for some states were also increased.

The preliminary FY 2013 DSH allotments be ing published in this notice are about

$182 million more than the final FY 2012 DSH allo tments 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 prio r fiscal year allotm ents are increased by

the percentage increase in th e CPI-U for the prior fiscal year. The preliminary FY 2013

IMD DSH limits being published in this noti ce 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 preliminar y FY 2013 DSH allotments are greater than

# CMS-2342-N 8

the final FY 2012 DSH allotments, the asso ciated 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 in clude 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. In dividuals 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. Specifi cally, any impact on providers is due to the

effect of the various controlling statutes; pr oviders 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 opera tions of a substantial number

of small rural hospitals. This analysis mu st conform to the provisions of section 604 of

the RFA. For purposes of section 1102(b) of th e Act, we define a small rural hospital as

a hospital that is located out side of a Core-Based Statis tical 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 de termined 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 me thodology for determining the amounts of

# CMS-2342-N 9

states' DSH allotments and IMD DSH limits; an d 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 applicab le 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; rath er, 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 Re form Act of 1995 also requires that

agencies assess anticipated costs and benef its 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 approxi mately $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 requ irements that an agency must meet

when it promulgates a proposed rule (and subseq uent final rule) that imposes substantial

direct requirement costs on state and local gov ernments, preempts state law, or otherwise

has Federalism implications. Since this noti ce 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 st ates’ 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

# CMS-2342-N 10

notice does not put forward any further di scretionary administrative policies for

determining such allotments.

Accounting Statement

As required by OMB Circul ar A-4 (available at

http://www.whitehouse.gov/om b/circulars/a004/a-4.pdf ), in the Table 1, we have

prepared an accounting statement showi ng 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 fede ral share of states’ Medicaid DSH payments

resulting from the application of the provisi ons of the Medicaid st atute relating to the

calculation of states’ FY DSH allotments a nd the increase in the FY DSH allotments

from FY 2012 to FY 2013.

Table 1 -- Accounting Statement: Classification of Estimated Expenditures,

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 th e 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.

# CMS-2342-N

(Catalog of Federal Domestic Assistan ce Program No. 93.778, Me dical 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.

BILLING CODE 4120-01-P

# CMS-2342-N 12

Addendum

This addendum contains the charts 1 through 4 (preced ed by associated keys) that are referred to in the

preamble of this notice.

Key to Chart 1. Final DS H Allotments for FY 2012

.

# CMS-2342-N 13

Key to Chart 1.— FINAL DSH ALLO TMENTS FOR FISCAL YEAR: 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 Lo w-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 determined without th e 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 assist ance expenditures including DSH

expenditures.

Column F FY 2012 TC DSH Expenditures.

This column contains the amount of the states’ FY 2012 total

computable DSH expenditures.

Column G FY 2012 TC MAP Exp. Net of DSH.

This column contains the amount of the states’ projected FY 2012

total computable medical assi stance 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.

# CMS-2342-N 14

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.CMS-2342-N 15CHART 1 - FINAL DSH ALLOTMENTS FOR FISCAL YEAR: 20122012ABCDEFGHIJFY 2012Prior FY (2011)Prior Fiscal YearFY 2012FY 2012FY 2012"12% Amount"Greater ofFY 2012STATEFMAPsAllotments(FY 2011) Allotment (Col C) xTC MAP Exp.TC DSHTC MAP Exp.=Col G xCol H OR Col CDSH Allotment100% + Pct Increase in CPIU:Including DSHExpendituresNet of DSH.12/(1-.12/COL B)*(12% Limit, FY 2011102.6%Col E - F(In FS)Allotment)MIN Col D, Col IALABAMA 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 COLUMBIA 70.00% $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 $12,660,753,340 $0 $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 $2,923,550,707 $575,889,532CMS-2342-N 162012ABCDEFGHIJFY 2012Prior FY (2011)Prior Fiscal YearFY 2012FY 2012FY 2012"12% Amount"Greater ofFY 2012STATEFMAPsAllotments(FY 2011) Allotment (Col C) xTC MAP Exp.TC DSHTC MAP Exp.=Col G xCol H OR Col CDSH Allotment100% + Pct Increase in CPIU:Including DSHExpendituresNet of DSH.12/(1-.12/COL B)*(12% Limit, FY 2011102.6%Col E - F(In FS)Allotment)MIN Col D, Col IRHODE 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 $10,870,051,501LOW DSH STATESALASKA 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 $202,203,559 $16,866,254IOWA 60.71% $39,384,356 $40,408,349 $3,416,666,341 $51,985,041 $3,364,681,300 $503,230,881 $503,230,881 $40,408,349MINNESOTA 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 $265,400,556 $20,129,695WISCONSIN 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 $96,998,597WYOMING 50.00% $226,348 $232,233 $518,211,253 $452,696 $517,758,557 $81,751,351 $81,751,351 $232,233CMS-2342-N 172012ABCDEFGHIJFY 2012Prior FY (2011)Prior Fiscal YearFY 2012FY 2012FY 2012"12% Amount"Greater ofFY 2012STATEFMAPsAllotments(FY 2011) Allotment (Col C) xTC MAP Exp.TC DSHTC MAP Exp.=Col G xCol H OR Col CDSH Allotment100% + Pct Increase in CPIU:Including DSHExpendituresNet of DSH.12/(1-.12/COL B)*(12% Limit, FY 2011102.6%Col E - F(In FS)Allotment)MIN Col D, Col ITOTAL LOW DSH STATES $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 $11,362,099,122FOOTNOTES:/1 Hawaii and Tennessee DSH allotments are determined under section1923(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 is limited to $10,000,000./2 FY 2012 DSH allotment for Louisiana determined under the provisions of section 1903(f)(3)(C) and (D) of the Act.

# CMS-2342-N 18

Key to Chart 2. Preliminary DSH Allotments for FY 2013

.

Key to Chart 2.— PRELIMINARY DS H ALLOTMENTS FOR FISCAL

YEAR: 2013

The Preliminary FY 2013 DSH Allotment s for the NON-Low DSH States are

presented in the top section of this chart, and the

Preliminary FY 2013 DSH Allo tments for the Low-DSH St ates 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) x (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 computable (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 assi stance 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)

# CMS-2342-N 19

Key to Chart 2.— PRELIMINARY DS H ALLOTMENTS FOR FISCAL

YEAR: 2013

The Preliminary FY 2013 DSH Allotment s for the NON-Low DSH States are

presented in the top section of this chart, and the

Preliminary FY 2013 DSH Allo tments for the Low-DSH St ates are presented in

the bottom section of this chart.

Column Description

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 St ates’ 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.CMS-2342-N 20CHART 2 - PRELIMINARY DSH ALLOTMENTS FOR FISCAL YEAR: 20132013ABCDEFGHIJFY 2013Prior FY (2012)Prior FY (2012)FY 2013FY 2013FY 2013"12% Amount"Greater ofFY 2013 DSHSTATEFMAPsDSH AllotmentsDSH Allotment (Col C) xTC MAP Exp.TC DSHTC MAP EXP.=Col G xCol H Or Col CAllotment100% + Pct Increase in CPIU:Including DSHExpendituresNet Of DSH.12/(1-.12/Col B)*(12% Limit, FY 2012102.4%Col E - F(In FS)Allotment)MIN Col I, Col DALABAMA 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 COLUMBIA 70.00% $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 $14,457,969,000 $0 $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 $17,759,856,000 $0 $17,759,856,000 $2,626,998,785 $2,626,998,785 $426,850,861PENNSYLVANIA 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 $68,296,138CMS-2342-N 212013ABCDEFGHIJFY 2013Prior FY (2012)Prior FY (2012)FY 2013FY 2013FY 2013"12% Amount"Greater ofFY 2013 DSHSTATEFMAPsDSH AllotmentsDSH Allotment (Col C) xTC MAP Exp.TC DSHTC MAP EXP.=Col G xCol H Or Col CAllotment100% + Pct Increase in CPIU:Including DSHExpendituresNet Of DSH.12/(1-.12/Col B)*(12% Limit, FY 2012102.4%Col E - F(In FS)Allotment)MIN Col I, Col DSOUTH 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 $11,029,697,203LOW DSH STATESALASKA 50.00% $20,901,012$21,402,636 $4,345,689,000 $43,820,000 $4,301,869,000 $679,242,473.68$679,242,474 $21,402,636ARKANSAS 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 $548,131,133 $41,378,149MINNESOTA 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 $300,818,582 $20,612,808WISCONSIN 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 $99,326,563WYOMING 50.00% $232,233 $237,807 $548,369,000 $463,000 $547,906,000 $86,511,474 $86,511,474 $237,807CMS-2342-N 222013ABCDEFGHIJFY 2013Prior FY (2012)Prior FY (2012)FY 2013FY 2013FY 2013"12% Amount"Greater ofFY 2013 DSHSTATEFMAPsDSH AllotmentsDSH Allotment (Col C) xTC MAP Exp.TC DSHTC MAP EXP.=Col G xCol H Or Col CAllotment100% + Pct Increase in CPIU:Including DSHExpendituresNet Of DSH.12/(1-.12/Col B)*(12% Limit, FY 2012102.4%Col E - F(In FS)Allotment)MIN Col I, Col DTOTAL LOW DSH STATES 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, byincreasing the previous fiscalyear 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'sDSH 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.

# CMS-2384-N CPL 5/31/2012 23

Key to Chart 3. Final IMD DSH Limit for FY 2012

Key to Chart 3.--FINAL IMD DSH LIMIT FOR FY: 2012

The final FY 2012 IMD DSH Limits for th e 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 Hea lth 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 inpati ent 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 af ter FY 2002, the applicable

Percentage can be no greater than 33 percent.

Column F FY 2012 Federal Share DSH Allo tment. 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 x 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

2012 TC IMD DSH Limit equal to the lesser of the amount in

# CMS-2342-N 24

Key to Chart 3.--FINAL IMD DSH LIMIT FOR FY: 2012

The final FY 2012 IMD DSH Limits for th e 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 C or Column I.

Column K FY 2012 IMD DSH Limit in Federal Share, Col. G x 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.CMS-2384-N CPL 5/31/2012 25CHART 3 - FINAL IMD DSH LIMIT FOR FY: 2012: 2012A B C D EFGHIJKInpatient HospitalIMD AndTotal Inpatient & IMD &ApplicableFY 2012FY 2012FY 2012CoL E x Col HFY 2012FY 2012Services for FY 95 DSHMental HealthMental Health FY 95 DSHPercentAllotmentFMAPAllotmentsIn TCTC IMD LimitIMD LimitSTATETotal ComputableServices FY 95 DSHTotal ComputableIn TC(Lesser OfIn FSTotal ComputableCol B + CCol C/DIn FSCol F/GCol I or Col C)Col G x JALABAMA $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 OF COLUMBIA $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 $0 $407,343,557 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 $0 $182,608,033 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 $178,685,231NEW YORK $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 $50,626,422CMS-2342-N 26: 2012A B C D EFGHIJKInpatient HospitalIMD AndTotal Inpatient & IMD &ApplicableFY 2012FY 2012FY 2012CoL E x Col HFY 2012FY 2012Services for FY 95 DSHMental HealthMental Health FY 95 DSHPercentAllotmentFMAPAllotmentsIn TCTC IMD LimitIMD LimitSTATETotal ComputableServices FY 95 DSHTotal ComputableIn TC(Lesser OfIn FSTotal ComputableCol B + CCol C/DIn FSCol F/GCol I or Col C)Col G x JTENNESSEE $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 $1,907,882,783LOW DSH STATESALASKA $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 $6,744,801 3.78% $20,901,012 69.36% $30,134,100 $1,138,321 $254,786 $176,720NORTH DAKOTA $214,523 $988,478 $1,203,001 33.00% $9,801,133 55.40% $17,691,576 $5,838,220 $988,478 $547,617OKLAHOMA $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 LOW DSH STATES $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

# CMS-2384-N CPL 5/31/2012 27

Key to Chart 4. Preliminary IMD DSH Limit for FY 2013

Key to Chart 4.--PRELIMINARY IMD DSH LIMIT FOR FY: 2013

The preliminary FY 2013 IMD DSH Limi ts 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 a re 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 e xpenditures as reported on the

Form CMS-64.

Column C IMD and Mental Hea lth Services FY 95 DSH Total

Computable. This column contains the total computable

FY 1995 mental health facility DSH expenditures as reported on the

Form CMS-64 as of January 1, 1997.

Column D Total Inpatient Hospital & IMD & Mental Health FY 95 DSH Total

Computable, Col. B + C. This column contains the total

computation of all inpati ent 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, Co l. 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 af ter FY 2002, the applicable

Percentage can be no greater than 33 percent.

Column F FY 2013 Federal Share DSH Allo tment. 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).

# CMS-2342-N 28

Key to Chart 4.--PRELIMINARY IMD DSH LIMIT FOR FY: 2013

The preliminary FY 2013 IMD DSH Limi ts 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 a re presented in the bottom section of

the chart

Column Description

Column I Applicable Percentage Applie d 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.CMS-2342-N 29CHART 4 - PRELIMINARY IMD DSH LIMIT FOR FY: 20132013A B C D EFGHIJKInpatient HospitalIMD AndTotal Inpatient & IMD &ApplicableFY 2013FY2013FY 2013ApplicablePercentageFY 2013FY 2013Services FY 95 DSHMental HealthMental Health FY 95 DSHPercentageAllotmentFMAPsAllotmentsApplied to FY 2013TC IMD LimitIMD LimitSTATETotal ComputableServices FY 95 DSHTotal Computablein TCAllotments in TC(Lesser OfIn FSTotal ComputableCol B + CCol C/DIn FSCol F/GCol E x Col HCol I or Col C)Col G x JALABAMA$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 OF COLUMBIA$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 $0 $407,343,557 0.00% $282,378,262 65.56% $430,717,300 $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 $0 $182,608,033 0.00% $160,233,246 73.43% $218,212,238 $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$194,604,591CMS-2342-N 302013A B C D EFGHIJKInpatient HospitalIMD AndTotal Inpatient & IMD &ApplicableFY 2013FY2013FY 2013ApplicablePercentageFY 2013FY 2013Services FY 95 DSHMental HealthMental Health FY 95 DSHPercentageAllotmentFMAPsAllotmentsApplied to FY 2013TC IMD LimitIMD LimitSTATETotal ComputableServices FY 95 DSHTotal Computablein TCAllotments in TC(Lesser OfIn FSTotal ComputableCol B + CCol C/DIn FSCol F/GCol E x Col HCol I or Col C)Col G x JRHODE 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 $1,921,150,660LOW DSH STATESALASKA$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 $6,744,801 3.78% $21,402,636 69.07% $30,986,877 $1,170,535 $254,786$175,981NORTH 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$0CMS-2342-N 312013A B C D EFGHIJKInpatient HospitalIMD AndTotal Inpatient & IMD &ApplicableFY 2013FY2013FY 2013ApplicablePercentageFY 2013FY 2013Services FY 95 DSHMental HealthMental Health FY 95 DSHPercentageAllotmentFMAPsAllotmentsApplied to FY 2013TC IMD LimitIMD LimitSTATETotal ComputableServices FY 95 DSHTotal Computablein TCAllotments in TC(Lesser OfIn FSTotal ComputableCol B + CCol C/DIn FSCol F/GCol E x Col HCol I or Col C)Col G x JTOTAL LOW DSH STATES $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[FR Doc. 2013-17965 Filed 07/25/2013 at 8:45 am; Publication Date: 07/26/2013]