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[Federal Register Volume 78, Number 144 (Friday, July 26, 2013)]
[Notices]
[Pages 45217-45231]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-17965]

[[Page 45217]]

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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

[[Page 45218]]

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

[[Page 45219]]

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.

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 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

            Key to Chart 1--Final DSH Allotments 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 determined 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 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 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.
------------------------------------------------------------------------

[[Page 45220]]

                                                                                           Chart 1--Final DSH Allotments for Fiscal Year: 2012
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                     Prior Fiscal Year
                                                                                                         (FY 2011)
                                                                                                      Allotment (Col C                                                                               Greater of Col H
                                                                 FY 2012 FMAPs     Prior FY (2011)      x 100% + Pct      FY 2012 TC MAP     FY 2012 TC DSH     FY 2012 TC MAP     ``12% Amount''     OR Col C (12%     2012 FY 2012 DSH
                            State                                  (percent)          allotments        Increases in      Exp. Including      Expenditures     Exp. Net of DSH    =Col G x .12/(1-    Limit, FY2011    Allotment MIN Col
                                                                                                           CPIU:               DSH                                 Col E-F        .12/ B)* (In FS)      Allotment)          D, Col I
                                                                                                    -------------------
                                                                                                           102.6%
A                                                                              B                  C                  D                  E                  F                  G                  H                  I                  J
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
ALABAMA......................................................             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       $315,520,769
ARIZONA......................................................              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        103,890,985
CALIFORNIA...................................................              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      1,124,844,365
COLORADO.....................................................              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         94,912,751
CONNECTICUT..................................................              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        205,216,760
DISTRICT 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         62,847,632
FLORIDA......................................................              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        205,216,760
GEORGIA......................................................              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        275,760,021
HAWAII/1.....................................................                 na                 na                 na                 na                 na                 na                 na                 na         10,000,000
ILLINOIS.....................................................              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        220,608,017
INDIANA......................................................              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        219,325,413
KANSAS.......................................................              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         42,325,957
KENTUCKY.....................................................              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        148,782,151
LOUISIANA/2..................................................                 na                 na                 na                 na                 na                 na                 na                 na        731,960,000
MAINE........................................................              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        107,738,799
MARYLAND.....................................................              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         78,238,890
MASSACHUSETTS................................................              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        312,955,559
MICHIGAN.....................................................              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        271,912,207
MISSISSIPPI..................................................              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        156,477,779
MISSOURI.....................................................              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        486,107,200
NEVADA.......................................................              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         47,456,375
NEW 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        164,274,500
NEW 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        660,541,446
NEW 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      1,648,147,103
NORTH 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        302,694,721
OHIO.........................................................              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        416,846,544
PENNSYLVANIA.................................................              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        575,889,532
RHODE 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         66,695,447
SOUTH 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        336,042,444
TENNESSEE/1..................................................                 na                 na                 na                 na                 na                 na                 na                 na        123,562,982
TEXAS........................................................              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        981,192,634
VERMONT......................................................              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         23,086,886
VIRGINIA.....................................................              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         89,892,713
WASHINGTON...................................................              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        189,825,503
WEST 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         69,260,656
                                                              --------------------------------------------------------------------------------------------------------------------------------------------------------------------------
    TOTAL....................................................  .................      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         20,901,012
ARKANSAS.....................................................              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         44,262,980
DELAWARE.....................................................              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          9,289,338
IDAHO........................................................              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         16,866,254
IOWA.........................................................              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         40,408,349
MINNESOTA....................................................              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         76,637,045
MONTANA......................................................              66.11         11,351,703         11,646,847        965,777,404         17,086,812        948,690,592        139,089,858        139,089,858         11,646,847
NEBRASKA.....................................................              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         29,036,347
NEW 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         20,901,012
NORTH DAKOTA.................................................              55.40          9,552,761          9,801,133        732,046,343          1,163,524        730,882,819        111,956,428        111,956,428          9,801,133
OKLAHOMA.....................................................              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         37,157,353
OREGON.......................................................              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         46,446,693
SOUTH DAKOTA.................................................              59.13         11,045,549         11,332,733        740,258,203            751,299        739,506,904        111,335,565        111,335,565         11,332,733
UTAH.........................................................              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         20,129,695
WISCONSIN....................................................              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

[[Page 45221]]

 
WYOMING......................................................              50.00            226,348            232,233        518,211,253            452,696        517,758,557         81,751,351         81,751,351            232,233
                                                              --------------------------------------------------------------------------------------------------------------------------------------------------------------------------
    TOTAL 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       $492,047,621
                                                              --------------------------------------------------------------------------------------------------------------------------------------------------------------------------
        TOTAL................................................  .................    $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    $11,362,099,122
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Hawaii 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 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.

[[Page 45222]]

Key to Chart 2. Preliminary DSH Allotments for FY 2013

    Key to Chart 2--Preliminary DSH Allotments for Fiscal Year: 2013
 [The Preliminary FY 2013 DSH allotments for the non-low DSH States are
 presented in the top section of this chart, and the preliminary 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) 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 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.
------------------------------------------------------------------------

[[Page 45223]]

                                                                                        Chart 2--Preliminary DSH Allotments for Fiscal Year: 2013
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                      Prior FY (2012)
                                                                                                       DSH allotment
                                                                                                      (Col C) x 100% +    FY 2013 TC MAP                        FY 2013 TC MAP   ``12% Amouunt'' =   Greater of Col H   2013 FY 2013 DSH
                            State                                FY 2013 FMAPs     Prior FY (2012)    Pct Increase in     Exp. including     FY 2013 TC DSH    EXP. Net Of DSH    Col G x .12/(1 -     Or Col C 12%    Allotment MIN Col
                                                                                    DSH allotments         CPIU:               DSH            Expenditures       (Col E - F)       12/Col B)* (In     Limit, FY 2012        I, Col D
                                                                                                    -------------------                                                                 FS)             Allotment)
                                                                                                           102.4%
A                                                                              B                  C                  D                  E                  F                  G                  H                  I                  J
ALABAMA......................................................             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       $323,093,267
ARIZONA......................................................              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        106,384,369
CALIFORNIA...................................................              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      1,151,840,630
COLORADO.....................................................              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         97,190,657
CONNECTICUT..................................................              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        210,141,962
DISTRICT 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         64,355,975
FLORIDA......................................................              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        210,141,962
GEORGIA......................................................              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        282,378,262
ILLINOIS.....................................................              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        225,902,609
INDIANA......................................................              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        224,589,223
KANSAS.......................................................              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         43,341,780
KENTUCKY.....................................................              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        152,352,923
LOUISIANA/3..................................................                 na                 na                 na                 na                 na                 na                 na                 na        731,960,000
MAINE........................................................              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        110,324,530
MARYLAND.....................................................              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         80,116,623
MASSACHUSETTS................................................              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        320,466,492
MICHIGAN.....................................................              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        278,438,100
MISSISSIPPI..................................................              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        160,233,246
MISSOURI.....................................................              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        497,773,773
NEVADA.......................................................              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         48,595,328
NEW 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        168,217,088
NEW 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        676,394,441
NEW 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      1,687,702,633
NORTH 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        309,959,394
OHIO.........................................................              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        426,850,861
PENNSYLVANIA.................................................              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        589,710,881
RHODE 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         68,296,138
SOUTH 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        344,107,463
TENNESSEE/2..................................................                 na                 na                 na                 na                 na                 na                 na                 na         53,100,000
TEXAS........................................................              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      1,004,741,257
VERMONT......................................................              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         23,640,971
VIRGINIA.....................................................              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         92,050,138
WASHINGTON...................................................              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        194,381,315
WEST 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         70,922,912
                                                              --------------------------------------------------------------------------------------------------------------------------------------------------------------------------
    TOTAL....................................................               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        679,242,474         21,402,636
ARKANSAS.....................................................              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         45,325,292
DELAWARE.....................................................              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          9,512,282
HAWAII/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         10,240,000
IDAHO........................................................              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         17,271,044
IOWA.........................................................              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         41,378,149
MINNESOTA....................................................              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         78,476,334
MONTANA......................................................              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         11,926,371
NEBRASKA.....................................................              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         29,733,219
NEW 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         21,402,636
NORTH DAKOTA.................................................              52.27          9,801,133         10,036,360        783,683,000          1,474,000        782,209,000        121,835,802        121,835,802         10,036,360
OKLAHOMA.....................................................              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         38,049,129
OREGON.......................................................              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         47,561,414
SOUTH DAKOTA.................................................              56.19         11,332,733         11,604,719        792,356,000          2,821,000        789,535,000        120,472,428        120,472,428         11,604,719
UTAH.........................................................              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         20,612,808
WISCONSIN....................................................              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

[[Page 45224]]

 
WYOMING......................................................              50.00            232,233            237,807        548,369,000            463,000        547,906,000         86,511,474         86,511,474            237,807
                                                              --------------------------------------------------------------------------------------------------------------------------------------------------------------------------
TOTAL 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        514,096,763
                                                              --------------------------------------------------------------------------------------------------------------------------------------------------------------------------
    TOTAL....................................................               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     11,543,793,966
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
FOOTNOTES:
/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 previous fiscal 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.

[[Page 45225]]

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 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 mental health
                            facility DSH expenditures as reported on the
                            Form CMS-64 as of January 1, 1997.
Column D.................  Total Inpatient & IMD & Mental Health FY 95
                            DSH Total Computable, Col. B + C. This
                            column contains the total computation of all
                            inpatient hospital DSH expenditures and
                            mental health facility DSH expenditures for
                            FY 1995 as reported on the Form CMS-64 as of
                            January 1, 1997 (representing the sum of
                            Column B and Column C).
Column E.................  Applicable Percent Col. C/D. This column
                            contains the ``applicable percentage''
                            representing the total Computable FY 1995
                            mental health facility DSH expenditures
                            divided by total computable all inpatient
                            hospital and mental health facility DSH
                            expenditures for FY 1995 (the amount in
                            Column C divided by the amount in Column D)
                            Per section 1923(h)(2)(A)(ii)(III) Of the
                            Act, for FYs after FY 2002, the applicable
                            Percentage can be no greater than 33
                            percent.
Column F.................  FY 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 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 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.
------------------------------------------------------------------------

[[Page 45226]]

                                                                                                Chart 3--Final IMD DSH Limit for FY: 2012
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                           Total inpatient
                                                          Impatient      IMD and mental   & IMD and mental                                                             FY 2012                         FY 2012  TC IMD    2012  FY 2012
                        State                         hospital service   health services  health FY 95 DSH     Applicable          FY 2012        FY 2012 FMAP    Allotments In TC  CoL E x Col H In   Limit  (Lesser    IMD Limit in FS
                                                        for FY 95 DSH    FY 95 DSH total  total computable  percent  Col C/D  Allotment  in FS                         Col F/G             TC          Of Col 1 or Col      Col G x J
                                                      total computable     computable         Col B + C                                                                                                      C)
A                                                                    B                 C                 D                 E                 F                 G                 H                 I                 J                 K
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
ALABAMA.............................................       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         3,054,805
ARIZONA.............................................        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        19,163,608
CALIFORNIA..........................................     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           777,960
COLORADO............................................       173,900,441           594,776       174,495,217             0.34%        94,912,751            50.00%       189,825,502           647,030           594,776           297,388
CONNECTICUT.........................................       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        52,786,863
DISTRICT 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         4,581,595
FLORIDA.............................................       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        67,721,531
GEORGIA.............................................       407,343,557                 0       407,343,557             0.00%       275,760,021            66.16%       416,807,771                 0                 0                 0
HAWAII..............................................                 0                 0                 0             0.00%        10,000,000            50.48%        19,809,826                 0                 0                 0
ILLINOIS............................................       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        44,704,138
INDIANA.............................................        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        72,377,386
KANSAS..............................................        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        13,967,566
KENTUCKY............................................       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        26,651,979
LOUISIANA...........................................     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        80,310,122
MAINE...............................................        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        35,553,804
MARYLAND............................................        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        25,818,834
MASSACHUSETTS.......................................       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        52,817,527
MICHIGAN............................................       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        89,731,028
MISSISSIPPI.........................................       182,608,033                 0       182,608,033             0.00%       156,477,779            74.18%       210,943,353                 0                 0                 0
MISSOURI............................................       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       131,490,365
NEVADA..............................................        73,560,000                 0        73,560,000             0.00%        47,456,375            56.20%        84,441,948                 0                 0                 0
NEW 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        47,376,974
NEW 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       178,685,231
NEW 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       302,500,000
NORTH 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        99,889,258
OHIO................................................       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        59,937,114
PENNSYLVANIA........................................       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       190,043,546
RHODE 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         1,249,751
SOUTH 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        50,626,422
TENNESSEE...........................................                 0                 0                 0             0.00%       123,562,982            66.36%       186,200,998                 0                 0                 0
TEXAS...............................................     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       170,301,413
VERMONT.............................................        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         5,223,253
VIRGINIA............................................       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         3,885,134
WASHINGTON..........................................       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        62,642,416
WEST 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        13,715,772
                                                     -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
    TOTAL...........................................    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         6,897,334
ARKANSAS............................................         2,422,649           819,351         3,242,000            25.27%        44,262,980            70.71%        62,597,907        15,820,376           819,351           579,363
DELAWARE............................................                 0         7,069,000         7,069,000            33.00%         9,289,338            54.17%        17,148,492         5,659,002         5,659,002         3,065,482
IDAHO...............................................         2,081,429                 0         2,081,429             0.00%        16,866,254            70.23%        24,015,740                 0                 0                 0
IOWA................................................        12,011,250                 0        12,011,250             0.00%        40,408,349            60.71%        66,559,626                 0                 0                 0
MINNESOTA...........................................        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         2,628,607
MONTANA.............................................           237,048                 0           237,048             0.00%        11,646,847            66.11%        17,617,376                 0                 0                 0
NEBRASKA............................................         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         1,025,941
NEW MEXICO..........................................         6,490,015           254,786         6,744,801             3.78%        20,901,012            69.36%        30,134,100         1,138,321           254,786           176,720
NORTH DAKOTA........................................           214,523           988,478         1,203,001            33.00%         9,801,133            55.40%        17,691,576         5,838,220           988,478           547,617

[[Page 45227]]

 
OKLAHOMA............................................        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         2,090,951
OREGON..............................................        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        12,566,330
SOUTH DAKOTA........................................           321,120           751,299         1,072,419            33.00%        11,332,733            59.13%        19,165,792         6,324,711           751,299           444,243
UTAH................................................         3,621,116           934,586         4,555,702            20.51%        20,129,695            70.99%        28,355,677         5,817,066           934,586           663,463
WISCONSIN...........................................         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         2,719,014
WYOMING.............................................                 0                 0                 0             0.00%           232,233            50.00%           464,466                 0                 0                 0
    TOTAL LOW DSH STATES............................        98,662,480        63,238,167       161,900,647  ................       492,047,621  ................       822,338,209       178,371,303        58,011,072        33,405,065
                                                     -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
        TOTAL.......................................    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
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

[[Page 45228]]

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 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 mental health
                            facility DSH expenditures as reported on the
                            Form CMS-64 as of January 1, 1997.
Column D.................  Total Inpatient Hospital & IMD & Mental
                            Health FY 95 DSH Total Computable, Col. B +
                            C. This column contains the total
                            computation of all inpatient hospital DSH
                            expenditures and mental health facility DSH
                            expenditures for FY 1995 as reported on the
                            Form CMS-64 as of January 1, 1997
                            (representing the sum of Column B and Column
                            C).
Column E.................  Applicable Percentage, Col. C/D. This column
                            contains the ``applicable percentage''
                            representing the total Computable FY 1995
                            mental health facility DSH expenditures
                            divided by total computable all inpatient
                            hospital and mental health facility DSH
                            expenditures for FY 1995 (the amount in
                            Column C divided by the amount in Column D)
                            Per section 1923(h)(2)(A)(ii)(III) Of the
                            Act, for FYs after FY 2002, the applicable
                            Percentage can be no greater than 33
                            percent.
Column F.................  FY 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.
------------------------------------------------------------------------

[[Page 45229]]

                                                                                             Chart 4--Preliminary IMD DSH Limit for FY: 2013
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                                                                       Applicable
                                                          Inpatient      IMD and mental    Total inpatient                                                                             percentage      FY 2013  TC IMD
                                                          hospital       health services   & IMD & mental      Applicable          FY 2013                             FY 2013        applied to FY    Limit  (lesser     2013  FY 2013
                        State                          services FY 95    FY 95 DSH total  health FY 95 DSH   percentage  Col  Allotment  in FS   FY 2013  FMAPs    Allotments  in   2013  allotments   of Col I or Col   IMD Limit in FS
                                                          DSH total        computable     total computable         C/D                                               TC  Col F/G     in TC  Col E x          C)             Col G x J
                                                         computable                           Col B + C                                                                                   Col H
A                                                                    B                 C                 D                 E                 F                 G                 H                 I                 J                 K
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
ALABAMA.............................................      $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        $3,050,798
ARIZONA.............................................        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        18,702,314
CALIFORNIA..........................................     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           777,960
COLORADO............................................       173,900,441           594,776       174,495,217              0.34        97,190,657             50.00       194,381,314           662,559           594,776           297,388
CONNECTICUT.........................................       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        52,786,863
DISTRICT 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         4,581,595
FLORIDA.............................................       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        69,346,847
GEORGIA.............................................       407,343,557                 0       407,343,557              0.00       282,378,262             65.56       430,717,300                 0                 0                 0
ILLINOIS............................................       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        44,704,138
INDIANA.............................................        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        74,114,444
KANSAS..............................................        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        14,302,787
KENTUCKY............................................       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        26,416,088
LOUISIANA...........................................     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        80,310,122
MAINE...............................................        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        36,407,095
MARYLAND............................................        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        26,438,486
MASSACHUSETTS.......................................       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        52,817,527
MICHIGAN............................................       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        91,884,573
MISSISSIPPI.........................................       182,608,033                 0       182,608,033              0.00       160,233,246             73.43       218,212,238                 0                 0                 0
MISSOURI............................................       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       127,179,885
NEVADA..............................................        73,560,000                 0        73,560,000              0.00        48,595,328             59.74        81,344,707                 0                 0                 0
NEW 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        47,376,974
NEW 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       178,685,231
NEW 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       302,500,000
NORTH 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       102,286,600
OHIO................................................       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        59,404,548
PENNSYLVANIA........................................       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       194,604,591
RHODE 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         1,229,129
SOUTH 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        50,763,367
TENNESSEE...........................................                 0                 0                 0              0.00        53,100,000             66.13        80,296,386                 0                 0                 0
TEXAS...............................................     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       173,460,560
VERMONT.............................................        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         5,083,555
VIRGINIA............................................       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         3,885,134
WASHINGTON..........................................       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        64,145,834
WEST 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        13,606,227
                                                     -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
    TOTAL...........................................    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 DSH STATES......................................  ................  ................  ................  ................  ................  ................  ................  ................  ................  ................
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         7,062,870
ARKANSAS............................................         2,422,649           819,351         3,242,000             25.27        45,325,292             70.17        64,593,547        16,324,734           819,351           574,939
DELAWARE............................................                 0         7,069,000         7,069,000             33.00         9,512,282             55.67        17,086,909         5,638,680         5,638,680         3,139,053
HAWAII..............................................                 0                 0                 0              0.00        10,240,000             51.86        19,745,469                 0                 0                 0
IDAHO...............................................         2,081,429                 0         2,081,429              0.00        17,271,044             71.00        24,325,414                 0                 0                 0
IOWA................................................        12,011,250                 0        12,011,250              0.00        41,378,149             59.59        69,438,075                 0                 0                 0
MINNESOTA...........................................        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         2,628,607
MONTANA.............................................           237,048                 0           237,048              0.00        11,926,371             66.00        18,070,259                 0                 0                 0
NEBRASKA............................................         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         1,010,002
NEW MEXICO..........................................         6,490,015           254,786         6,744,801              3.78        21,402,636             69.07        30,986,877         1,170,535           254,786           175,981

[[Page 45230]]

 
NORTH DAKOTA........................................           214,523           988,478         1,203,001             33.00        10,036,360             52.27        19,200,995         6,336,328           988,478           516,677
OKLAHOMA............................................        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         2,094,879
OREGON..............................................        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        12,472,447
SOUTH DAKOTA........................................           321,120           751,299         1,072,419             33.00        11,604,719             56.19        20,652,641         6,815,372           751,299           422,155
UTAH................................................         3,621,116           934,586         4,555,702             20.51        20,612,808             69.61        29,611,849         6,074,765           934,586           650,565
WISCONSIN...........................................         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         2,683,527
WYOMING.............................................                 0                 0                 0              0.00           237,807             50.00           475,614                 0                 0                 0
                                                     -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
    TOTAL LOW DSH STATES............................        98,662,480        63,238,167       161,900,647  ................       514,096,763  ................       869,157,055       184,510,449        58,321,822        33,431,702
        TOTAL.......................................    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
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

[[Page 45231]]

[FR Doc. 2013-17965 Filed 7-25-13; 8:45 am]
BILLING CODE 4120-01-P
```