43290 Federal Register / Vol. 77, No. 142 / Tuesday, July 24, 2012 / Notices 

PaperworkReductionActof1995, or 

Email your request, including your 

address, phone number, OMB number, 

and CMS document identifier, to 

Paperwork@cms.hhs.gov, or call the 

Reports Clearance Office on (410) 786– 

1326. 

In commenting on the proposed 

information collections please reference 

the document identifier or OMB control 

number. To be assured consideration, 

comments and recommendations must 

be submitted in one of the following 

ways by September 24, 2012: 

1. Electronically. You may submit 

your comments electronically to http:// 

www.regulations.gov. Follow the 

instructions for ‘‘Comment or 

Submission’’ or ‘‘More Search Options’’ 

to find the information collection 

document(s) accepting comments. 

2. By regular mail. You may mail 

written comments to the following 

address: CMS, Office of Strategic 

Operations and Regulatory Affairs, 

Division of Regulations Development, 

Attention: Document Identifier/OMB 

Control Number ____, Room C4–26–05, 

7500 Security Boulevard, Baltimore, 

Maryland 21244–1850. 

Dated: July 18, 2012. 

Martique Jones, 

Director, Regulations Development Group, 

Division B, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2012–17926 Filed 7–23–12; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–2383–N] 

RIN 0938–AR45 

Children’s Health Insurance Program 

(CHIP); Final Allotments to States, the 

District of Columbia, and U.S. 

Territories and Commonwealths for 

Fiscal Year 2012 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice sets forth the final 

allotments of Federal funding available 

to each State, the District of Columbia, 

and each U.S. Territory and 

Commonwealth for fiscal year 2012 

(with the qualification that potential 

increases in such allotments may be 

available for certain States). Title XXI of 

the Social Security Act (the Act) 

authorizes payment of Federal matching 

funds to States, the District of Columbia, 

and the U.S. Territories and 

Commonwealths to initiate and expand 

health insurance coverage to uninsured, 

low-income children under the 

Children’s Health Insurance Program 

(CHIP). The fiscal year allotments 

contained in this notice were 

determined in accordance with the 

funding provisions and final regulations 

published in the February 17, 2011 

Federal Register. 

DATES: This notice is effective on 

August 23, 2012. Final allotments may 

be available for expenditure by States 

beginning with October 1, 2011. 

FOR FURTHER INFORMATION CONTACT: 

Richard Strauss, (410) 786–2019. 

SUPPLEMENTARY INFORMATION: 

I. Purpose of This Notice 

This notice sets forth the allotments 

available to each State, the District of 

Columbia, and each U.S. Territory and 

Commonwealth for fiscal year (FY) 2012 

under title XXI of the Social Security 

Act (the Act). States may implement 

Children’s Health Insurance Program 

(CHIP) through a separate State program 

under title XXI of the Act, an expansion 

of a State Medicaid program under title 

XIX of the Act, or a combination of both. 

CHIP allotments for FY 2009 and 

subsequent fiscal years are available to 

match expenditures under an approved 

State child health plan for 2 fiscal years, 

including the year for which the 

allotments were provided. As specified 

by the Act, the allotments are available 

to States for FY 2012, and the 

unexpended amounts of such allotments 

for a State may be carried over to FY 

2013 for use by the State. Federal funds 

appropriated for title XXI of the Act are 

limited, and the law specifies a 

methodology to divide the total fiscal 

year appropriation into individual 

allotments available for each State, the 

District of Columbia, and each U.S. 

Territory and Commonwealth with an 

approved child health plan. 

Section 2104(b) of the Act requires 

States, the District of Columbia, and 

U.S. Territories and Commonwealths to 

have an approved child health plan for 

the fiscal year in order for the Secretary 

to provide an allotment for that fiscal 

year. All States, the District of 

Columbia, and U.S. Territories and 

Commonwealths have approved plans 

for FY 2012. Therefore, the FY 2012 

allotments contained in this notice 

pertain to all States, the District of 

Columbia, and U.S. Territories and 

Commonwealths. 

In general, funding is appropriated 

under section 2104(a) of the Act for 

purposes of providing allotments to 

States under CHIP for each fiscal year. 

However, title XXI of the Act as 

amended by section 10203(d)(1) of the 

Patient Protection and Affordable Care 

Act of 2010 (Pub. L. 111–148, enacted 

on March 23, 2010) (the Affordable Care 

Act) appropriates funding for CHIP 

fiscal year allotments through FY 2015. 

II. Methodology for Determining CHIP 

Fiscal Year Allotments for the 50 

States, the District of Columbia, and the 

U.S. Territories and Commonwealths 

A. Funding Authority for the CHIP 

Fiscal Year Allotments 

Section 2104(a)(1) through (18) of the 

Act appropriates Federal funds for 

providing States’ allotments for FYs 

2009 through 2015. In particular, the 

appropriated amounts available for 

allotments for FYs 2009 through 2015, 

are as follows: $10,562,000,000 for FY 

2009; 12,520,000,000 for FY 2010; 

$13,459,000,000 for FY 2011; 

$14,982,000,000 for FY 2012; 

$17,406,000,000 for FY 2013, 

$19,147,000,000 for FY 2014, and 

$2,850,000,000 for each of the first and 

second half of FY 2015. Also, section 

108 of the Children’s Health Insurance 

Program Reauthorization Act of 2009 

(Pub. L. 111–3, enacted on February 4, 

2009) (CHIPRA), as amended by section 

10203(d) of the Affordable Care Act, 

provides for a one-time appropriation of 

$15,361,000,000 for allotments for the 

first half of FY 2015. Therefore, the total 

appropriation for providing allotments 

during FY 2015 is $21,061,000,000 

(determined as the sum of 

$2,850,000,000, $15,361,000,000, and 

$2,850,000,000). 

B. Methodology For Determining State’s 

Fiscal Year Allotments 

1. General 

Section 2104(m) of the Act sets forth 

the methodology for determining States’ 

CHIP allotments for each of FYs 2009 

through 2015. In general, the States’ 

fiscal year allotments are provided from 

the appropriation for the respective 

fiscal year allotment, subject to a 

proration adjustment described in 

section II.B.7. of this notice. 

2. FY 2009 Through FY 2011 Allotments 

On February 17, 2011 we published a 

final rule in the Federal Register (76 FR 

9233), that set forth the methodologies 

and procedures to determine the fiscal 

year allotments of Federal funds under 

title XXI of the Act. In particular, the 

methodologies for determining the CHIP 

allotments for fiscal year FY 2009 

through FY 2011 were contained in the 

final regulations published in that 

Federal Register publication. 


sroberts on DSK5SPTVN1PROD with NOTICES
Federal Register / Vol. 77, No. 142 / Tuesday, July 24, 2012 / Notices 43291 

3. FY 2012 Allotments 

The FY 2012 allotments for the 50 

States and the District of Columbia, and 

the Commonwealths and Territories, are 

provided from the FY 2012 

appropriation ($14,982,000,000), and 

are subject to a proration adjustment 

described in section II.B.7. of this 

notice, if necessary. The FY 2012 

allotment for each State is determined 

by multiplying the allotment increase 

factor for FY 2012 for the State, by the 

sum of: the State’s FY 2011 allotment 

and any contingency fund payment 

made to the State for FY 2011, as 

determined by section 2104(n) of the 

Act. 

For the 50 States and the District of 

Columbia, in accordance with section 

2104(m)(6) of the Act, the FY 2012 

allotment may also include additional 

amounts under specified conditions for 

which States have submitted an 

expansion allotment adjustment request 

before August 31, 2011. 

4. FY 2013 Allotments 

The FY 2013 allotments for the 50 

States and the District of Columbia, and 

the Commonwealths and Territories, are 

provided from the FY 2013 

appropriation ($17,406,000,000). The 

amounts of these allotments are subject 

to a proration adjustment described in 

section II.B.7. of this notice, if 

necessary. Section 2104(m)(2)(B)(i) of 

the Act, as amended by the Affordable 

Care Act requires a ‘‘rebasing’’ process 

be used for determining the FY 2013 

allotments; the rebasing methodology 

means the States’ payments rather than 

their allotments for FY 2012 must be 

considered in calculating the FY 2013 

allotments. In particular, the FY 2013 

allotments are determined by 

multiplying the allotment increase 

factor for FY 2013 for the State by the 

sum of: Any Federal payments made 

from the States’ available allotments in 

FY 2012; any amounts provided as 

redistributed allotments in FY 2012 to 

the State; and any Federal payments 

attributable to any contingency fund 

payments made to the State for FY 2012 

determined under section 2104(n) of the 

Act. 

5. FY 2014 Allotments 

The FY 2014 allotments for the 50 

States and the District of Columbia, and 

the Commonwealths and Territories, are 

provided from the FY 2014 

appropriation of $19,147,000,000, and 

are subject to a proration adjustment 

described in section II.B.7. of this 

notice, if necessary. Under section 

2104(m)(2)(B)(ii) of the Act, as amended 

by the Affordable Care Act, the FY 2014 

allotment for each State is determined 

by multiplying the allotment increase 

factor for FY 2014 for the State, by the 

sum of: the State’s FY 2013 allotment; 

and any contingency fund payment 

made to the State for FY 2013, as 

determined in section 2104(n) of the 

Act. 

For the 50 States and the District of 

Columbia, under section 2104(m)(6) of 

the Act, the FY 2014 allotment may 

include additional amounts in 

situations where such States have 

submitted an expansion allotment 

adjustment request before August 31, 

2013. 

6. FY 2015 Allotments 

Under section 2104(m)(3) of the Act, 

the FY 2015 allotments for the 50 States 

and the District of Columbia, and the 

Commonwealths and Territories, are 

comprised of two components related to 

the first half of FY 2015 (that is, the 

period of October 1, 2014 through 

March 31, 2015) and second half of FY 

2015 (that is, April 1, 2015 through 

September 30, 2015). The FY 2015 

allotments for the first and second half 

of FY 2015 are subject to a proration 

adjustment described in section II.B.7. 

of this notice, as necessary. 

The allotments for the first half of FY 

2015 are provided from a total available 

appropriation of $18,211,000,000, 

comprised of $2,850,000,000 

appropriated under section 

2104(a)(18)(A) of the Act, and 

$15,361,000,000 appropriated by section 

108 of CHIPRA, as amended by the 

Affordable Care Act. The allotments for 

the first half of FY 2015 are equal to the 

‘‘first half ratio’’ multiplied by the 

allotment increase factor for FY 2015 

multiplied by the sum of any Federal 

payments made from the States’ 

available allotments in FY 2014; any 

amounts provided as redistributed 

allotments in FY 2014 to the State; and 

any Federal payments attributable to 

any contingency fund payments made to 

the State for FY 2014 as determined 

under section 2104(n) of the Act. The 

first half ratio is the percentage 

determined by dividing $18,211,000,000 

(calculated as the sum of $2,850,000,000 

(the appropriation for the first half of FY 

2015) and 15,361,000,000 (the one-time 

appropriation for the first half of the FY 

2015)) by $21,061,000,000 (calculated as 

the sum of $2,850,000,000 (the 

appropriation for the second half of FY 

2015) and $18,211,000,000). 

The States’ CHIP allotments for the 

second half of FY 2015 are provided 

from a total available appropriation of 

$2,850,000,000, appropriated under 

section 2104(a)(18)(B) of the Act. The 

allotments for the second half of FY 

2015 are equal to $2,850,000,000 

multiplied by a percentage equal to the 

amount of the allotment for the State for 

the first half of FY 2015 divided by the 

sum of all such first half of FY 2015 

allotments for all States. 

7. Proration Rule 

Under section 2104(m)(4) of the Act, 

if the amount of States’ (including the 

50 States, the District of Columbia, and 

the Commonwealths and Territories) 

allotments for a fiscal year, or in the 

case of FY 2015, the amount of an 

allotment for each half of the fiscal year, 

exceeds the total appropriations 

available for such periods, the total 

allotments for each of these periods will 

be reduced on a proportional basis. The 

total amount available nationally for the 

period is multiplied by a proration 

percentage determined by dividing the 

amount determined for the period by 

the sum of such amounts. 

8. The Allotment Increase Factor for a 

Fiscal Year 

Under section 2104(m)(5) of the Act, 

the allotment increase factor for a fiscal 

year is equal to the product of 2 

amounts for the fiscal year: the per 

capita health care growth factor and the 

child population growth factor. 

The per capita health care growth 

factor for a fiscal year is equal to 1 plus 

the percentage increase in the projected 

per capita amount of the National 

Health Expenditures from the calendar 

year in which the previous fiscal year 

ends to the calendar year in which the 

fiscal year involved ends, as most 

recently published by CMS before the 

beginning of the fiscal year involved. 

In general, for the 50 States and the 

District of Columbia, the Child 

Population Growth Factor (CPGF) for a 

fiscal year is equal to 1 plus the 

percentage increase (if any) in the 

population of children in the State from 

July 1 in the previous fiscal year to July 

1 in the fiscal year involved, as 

determined by CMS based on the most 

recent published estimates of the 

Census Bureau available before the 

beginning of the fiscal year involved, 

plus 1 percentage point. In the 

determination of the CPGF, section 

2104(m)(5)(B) of the Act refers to ‘‘the 

percentage increase (if any)’’ of the 

population of children in the State. In 

this regard, CPGF refers only to 

increases in the population of children. 

Thus, if there was a decrease in the 

population of children over the 

indicated period, the CPGF for such 

State would be 0.0 percent plus one 

percentage point; that is, negative 

growth in the children population 


sroberts on DSK5SPTVN1PROD with NOTICES
43292 Federal Register / Vol. 77, No. 142 / Tuesday, July 24, 2012 / Notices 

would not result in the growth factor 

being less than 101 percent. 

9. Allotments for the Commonwealths 

and Territories 

Section 2104(m)(1)(B) of the Act 

provided for 2009 allotments for the 

commonwealths and territories based 

upon the highest amount available for 

any fiscal year from 1999 through 2008, 

multiplied by the allotment increase 

factor with the term ‘‘United States’’ 

substituted for the term ‘‘the State’’ (so 

that the increase for the commonwealths 

and territories will be based on the 

CPFG rate for the entire country rather 

than specific to the commonwealth or 

territory). For fiscal years after FY 2009, 

using the same methodology described 

above for the 50 States and District of 

Columbia. The 2009 change to the 

allotment increase factor does not apply, 

and thus we will determine a 

commonwealth or territory-specific 

allotment increase factor, based on the 

CPFG for each commonwealth or 

territory, based on the most recent 

published estimates of the Census 

Bureau. In accordance with section 

602(b) of the CHIPRA, which added a 

new section 2109(b)(2)(B) of the Act, we 

will be working with the Secretary of 

the Commerce Department on 

appropriate adjustments to improve the 

Current Population Survey (CPS), or 

develop other data, to determine the 

CPGF. 

C. FY 2012 Allotments Determined in 

Accordance With Such Methodologies 

and Procedures 

We calculated the FY 2012 allotments 

as discussed in section II.B.3. of this 

notice and in accordance with section 

2104(m) of the Act and final regulations 

at 42 CFR 457.609 (published in the 

February 17, 2011 Federal Register. 

That calculation is presented in 2 tables 

described in section III. of this notice. 

Table 1 provides the calculation of the 

allotment increase factor for FY 2012, 

and Table 2 provides the calculation of 

the FY 2012 allotment. 

At this time, table 2 does not contain 

the amounts of increases, if any, to the 

FY 2012 allotments for certain States 

that applied for such increases in 

accordance the provisions of section 

2104(m)(6) of the Act. The amounts of 

such increases to the FY 2012 

allotments for any affected States will be 

determined at a later date. 

III. Tables 

Following are the keys and associated 

tables for the CHIP funding provisions 

as discussed in previous sections (note 

that for purposes of presentation and 

due to rounding, not all numbers 

following decimals are shown in the 

following tables): 

Table 1—Allotment Increase Factor 

for 2012 

Table 2—FY 2012 Children’s Health 

Insurance Program Allotments Under 

the Children’s Health Insurance 

Program 

A. Table 1—Allotment Increase Factor 

for 2012 

Key to Table 1 

Column/Description 

Column A = State. Column A contains 

the name of the State, District of 

Columbia, U.S. Commonwealth or 

Territory. 

Column B = PCNHE 2011, PCNHE 

2012, PCHCG Factor. Column B 

contains the calculation of the per 

Capita Health Care Growth (PCHCG) 

Factor for FY 2012, determined as 1 

plus the percentage increase in the per 

Capital National Health Expenditures 

(PCNHE) from calendar year 2011 to 

calendar year 2012. 

Columns C through F = Calculation of 

the Child Population Growth Factor 

(CPGF) for FY 2012: 

Column C = July 1, 2011 Child 

Population. Column C contains the 

population of children in each State or 

the United States as of July 1, 2011, as 

provided by the most recent published 

data of the Census Bureau before the 

beginning of FY 2012. 

Column D = July 1, 2012 Child 

Population. Column D contains the 

population of children in each State or 

the United States as of July 1, 2012, as 

provided by the most recent published 

data of the Census Bureau before the 

beginning of FY 2012. 

Column E = Percent Increase 2011– 

2012. Column E contains the percentage 

increase, if any, of the population of 

children in each State, or the United 

States, from July 1, 2011 to July 1, 2012, 

calculated as the difference between the 

number in Column D minus the number 

in Column C divided by the number in 

Column C. 

Column F = FY 2012 Child Population 

Growth Factor. Column F contains the 

Child Population Growth Factor (CPGF) 

for each State, determined as 1.01 plus 

the percent in Column E for the State. 

Column G = FY 2012 Allotment 

Increase Factor. Column G contains the 

FY 2012 Allotment Increase Factor, 

calculated as the PCHCG factor in 

Column B multiplied by the CPGF 

percent in Column F. 

BILLING CODE 4120–01–P 


sroberts on DSK5SPTVN1PROD with NOTICES
Federal Register / Vol. 77, No. 142 / Tuesday, July 24, 2012 / Notices 43293 


sroberts on DSK5SPTVN1PROD with NOTICESen24jy12.022</GPH>
43294 Federal Register / Vol. 77, No. 142 / Tuesday, July 24, 2012 / Notices 


sroberts on DSK5SPTVN1PROD with NOTICESen24jy12.023</GPH>
Federal Register / Vol. 77, No. 142 / Tuesday, July 24, 2012 / Notices 43295 


sroberts on DSK5SPTVN1PROD with NOTICESen24jy12.024</GPH>
43296 Federal Register / Vol. 77, No. 142 / Tuesday, July 24, 2012 / Notices 

B. Table 2—FY 2012 Children’s Health 

Insurance Program 

Key to Table 2 

Column/Description 

Column A = State. Column A contains 

the name of the State, District of 

Columbia, U.S. Commonwealth or 

Territory. 

Column B = FY 2011 CHIP 

Allotments. Column B contains, for the 

50 States and the District of Columbia 

only, the States’ FY 2011 CHIP 

allotments, as were published in the 

February 17, 2011 Federal Register (76 

FR 9233). 

Column C = FY 2011 Contingency 

Fund Payments. Column C contains the 

amounts of any contingency funds 

payments made to a State for FY 2011 

determined in accordance with the 

provisions of section 2104(n) of the Act. 

Column D = Total. Column D contains 

the total of the amounts in Columns B 

and C. 

Column E = FY 2012 Allotment 

Increase Factor. Column E contains the 

Allotment Increase Factor for each State 

as contained in Column G of Table 1. 

Column F = FY 2012 Total × Increase 

Factor. Column F contains the product 

of the total amount in Column D and the 

amount of the FY 2012 Allotment 

Increase Factor in Column E. This 

amount represents the FY 2012 CHIP 

allotment without the inclusion of any 

additional amounts available for the FY 

2012 allotment indicated in Column G. 

Column G = Additional Amount 

Available for FY 2012 Allotment. 

Column G contains, for the 50 States 

and the District of Columbia only, the 

amount of additional amounts available 

to increase the FY 2012 allotment, if 

any, as determined under the provisions 

of section 2014(m)(6) or (7) of the Act. 

Amounts of additional CHIP allotments, 

if any, will be determined at a later date 

based on updated information that must 

be obtained from affected States. 

Column H = Total FY 2012 Allotment. 

Column H contains the total FY 2012 

CHIP allotment, determined as the sum 

of the amounts in Column F and 

Column G, if any. 

BILLING CODE P 


sroberts on DSK5SPTVN1PROD with NOTICES
Federal Register / Vol. 77, No. 142 / Tuesday, July 24, 2012 / Notices 43297 


sroberts on DSK5SPTVN1PROD with NOTICESen24jy12.026</GPH>
43298 Federal Register / Vol. 77, No. 142 / Tuesday, July 24, 2012 / Notices 


sroberts on DSK5SPTVN1PROD with NOTICESen24jy12.027</GPH>
Federal Register / Vol. 77, No. 142 / Tuesday, July 24, 2012 / Notices 43299 


sroberts on DSK5SPTVN1PROD with NOTICESen24jy12.028</GPH>
43300 Federal Register / Vol. 77, No. 142 / Tuesday, July 24, 2012 / Notices 

IV. Collection of Information 

Requirements 

This document does not impose any 

information collection or recordkeeping 

requirements. Consequently, it is 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.). 

V. Waiver of Notice With Comment 

We ordinarily publish a notice with 

comment in the Federal Register and 

invite public comment. This procedure 

can be waived, however, if an agency 

finds good cause that a notice-andcomment procedure is impracticable, 

unnecessary, or contrary to the public 

interest and incorporates a statement of 

the finding and its reasons in the notice 

issued. 

On February 17, 2011 we issued a 

final rule in the Federal Register (76 FR 

9233) that set forth the methodologies 

and procedures to determine CHIP 

allotments in accordance with 

applicable Federal laws on that date. 

The CHIP allotments for FY 2012 

contained in this Federal Register 

notice were determined in accordance 

with the existing statute and the final 

regulations. 

Therefore, we find good cause to 

waive the notice with comment and to 

issue this final notice. 

VI. Regulatory Impact Analysis 

A. Overall 

We have examined the impacts of this 

notice as required by Executive Order 

12866 on Regulatory Planning and 

Review (September 30, 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 (Pub. L. 104–4) (UMRA), 

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). We have determined that 

this final notice is not economically 

significant, since it does not provide the 

methodologies under which State 

allotments for FY 2012 are calculated; 

rather, this notice contains the FY 2012 

CHIP allotments determined in 

accordance with existing statute and 

regulations. 

The RFA requires agencies to analyze 

options for regulatory relief of small 

entities, if a rule has a significant impact 

on a substantial number of small 

entities. For purposes of the RFA, we 

estimate that most hospitals and most 

other providers and suppliers are small 

entities as that term is used in the RFA 

nonprofit organizations. The great 

majority of hospitals and most other 

health care providers and suppliers are 

small entities, either by being nonprofit 

organizations or by meeting the SBA 

definition of a small business having 

revenues of less than $7.0 million to 

$34.5 million in any 1 year. Individuals 

and States are not included in the 

definition of a small entity. We are not 

preparing an analysis for the RFA 

because we have determined that this 

final notice will not have a significant 

economic impact on a substantial 

number of small entities. 

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. We are not preparing an analysis 

for section 1102(b) of the Act because 

we have determined that this final 

notice will not have a significant impact 

on the operations of a substantial 

number of small rural hospitals. 

Section 202 of the UMRA 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 2012, that threshold is approximately 

$139 million. This notice will not create 

an unfunded mandate on States, tribal, 

or local governments in the aggregate, or 

by the private sector in the amount of 

$139 million in any one year. 

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. 

We have determined that this final 

notice will not significantly affect 

States’ rights, roles, and responsibilities. 

Low-income children will benefit 

from payments under this program 

through increased opportunities for 

health insurance coverage. We believe 

this notice will have an overall positive 

impact by informing States, the District 

of Columbia, and Commonwealths and 

Territories of the extent to which they 

are permitted to expend funds under 

their child health plans using the 

additional funds provided by the FY 

2009 allotment amounts. 

B. Anticipated Effects 

1. Effects on the CHIP Program 

This notice provides the FY 2012 

CHIP allotments determined in 

accordance with the CHIP statute and 

regulations. States will be able to 

administer their CHIP programs with 

the appropriate levels of funding made 

available by such allotments. 

2. Effects on Other Entities 

This notice will have no effects on 

other entities; it is only promulgating 

the FY 2012 CHIP allotments 

determined in accordance with existing 

statute and regulations. 

C. Alternatives Considered 

The FY 2012 CHIP allotments 

contained in this notice were 

determined in accordance with existing 

statute and regulations; accordingly, no 

alternatives were considered. 

D. Accounting Statement 

As required by OMB Circular A–4 

(available at http://www.whitehouse.

gov/sites/default/files/omb/assets/omb/

circulars/a004/a-4.pdf), in table 3, we 

have prepared an accounting statement 

showing the classification of the 

expenditures associated with the 

provisions of this rule. This table 

provides our best impact estimate of the 

rule, as it implements the CHIP, under 

which approximately up to $8.9 billion 

in additional Federal funds is made 

available for FY 2012. All expenditures 

are classified as transfers from the 

Federal Government to States. 


sroberts on DSK5SPTVN1PROD with NOTICES
Federal Register / Vol. 77, No. 142 / Tuesday, July 24, 2012 / Notices 43301 

TABLE 3—ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED EXPENDITURES, FY 2012 

[In $billions] 

Category TRANSFERS 

Year 

dollar 

Units discount rate Period covered 

Annualized Monetized Transfers ..................................................................................... ............ 7% 3% ............................

2012 $8.9 $8.9 FY–2012 

From Whom To Whom? .................................................................................................. Federal Government to States. 

In accordance with the provisions of 

Executive Order 12866, this final notice 

was reviewed by the Office of 

Management and Budget. 

Authority: Section 1102 of the Social 

Security Act (42 U.S.C. 1302) 

(Catalog of Federal Domestic Assistance 

Program No. 93.778, Medical Assistance 

Program) 

(Catalog of Federal Domestic Assistance 

Program No. 93.767, State Children’s Health 

Insurance Program). 

Dated: May 14, 2012. 

Marilyn Tavenner, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

Dated: June 11, 2012. 

Kathleen Sebelius, 

Secretary, Department of Health and Human 

Services. 

[FR Doc. 2012–17953 Filed 7–20–12; 11:15 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–2384–N] 

RIN 0938–AR46 

Medicaid Program; Disproportionate 

Share Hospital Allotments and 

Institutions for Mental Diseases 

Disproportionate Share Hospital Limits 

for FYs 2010, 2011, and Preliminary FY 

2012 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 FY (FY) 2010, 2011 and the 

preliminary Federal share DSH 

allotments for FY 2012. This notice also 

announces the final FY 2010, 2011 and 

the preliminary FY 2012 limits on 

aggregate DSH payments that States may 

make to institutions for mental diseases 

(IMD) and other mental health facilities. 

In addition, this notice includes 

background information describing the 

methodology for determining the 

amounts of States’ FY DSH allotments. 

DATES: Effective Date: This notice is 

effective on August 23, 2012. 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 

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

Security Act (the Act), States’ Federal 

fiscal year (FY) 2003 disproportionate 

share hospital (DSH) allotments were 

calculated by increasing the amounts of 

the FY 2002 allotments for each State 

(as specified in the chart, entitled ‘‘DSH 

Allotment (in millions of dollars)’’, 

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

Act) by the percentage change in the 

Consumer Price Index for all Urban 

Consumers (CPI–U) for the prior fiscal 

year. The allotment, determined in this 

way, is subject to the limitation that an 

increase to a State’s DSH allotment for 

a FY cannot result in the DSH allotment 

exceeding the greater of the State’s DSH 

allotment for the previous FY or 12 

percent of the State’s total medical 

assistance expenditures for the 

allotment year (this is referred to as the 

12 percent limit). 

However, section 1001(a) of the 

Medicare Prescription Drug, 

Improvement, and Modernization Act of 

2003 (Pub. L. 108–173, enacted on 

December 8, 2003) (MMA) amended 

section 1923(f)(3) of the Act to provide 

for a ‘‘Special, Temporary Increase In 

Allotments On A One-Time, NonCumulative Basis.’’ Under this 

provision, States’ FY 2004 DSH 

allotments were determined by 

increasing their FY 2003 allotments by 

16 percent and the FY DSH allotment 

amounts determined were not subject to 

the 12 percent limit. 

Also, under section 1923(h) of the 

Act, Federal financial participation 

(FFP) is not available for DSH payments 

to institutions for mental diseases 

(IMDs) and other mental health facilities 

that are in excess of State-specific 

aggregate limits. Under this provision, 

this aggregate limit for DSH payments to 

IMDs and other mental health facilities 

is the lesser of a State’s FY 1995 total 

computable (State and Federal share) 

IMD and other mental health facility 

DSH expenditures applicable to the 

State’s FY 1995 DSH allotment (as 

reported on the Form CMS–64 as of 

January 1, 1997), or the amount equal to 

the product of the State’s current year 

total computable DSH allotment and the 

applicable percentage. 

In general, we initially determine 

States’ DSH allotments and IMD DSH 

limits for a FY using estimates of 

medical assistance expenditures, 

including DSH expenditures in their 

Medicaid programs. These estimates are 

provided by States each year on the 

August quarterly Medicaid budget 

reports (Form CMS–37) before the FY 

for which the DSH allotments and IMD 

DSH limits are being determined. Also, 

as part of the basic determination of 

preliminary DSH allotments for a FY, 

we use the available CPI–U percentage 

increase that is available before the 

beginning of the FY for which the 

allotment is being determined to 

determine the preliminary FY DSH 

allotment. For example, in determining 

the preliminary FY 2012 DSH allotment, 

we would apply the CPI–U percentage 

increase for FY 2011 that was available 

just before the beginning of FY 2012 on 

October 1, 2011. 

Section 5002 of the American 

Recovery and Reinvestment Act of 2009 

(Pub. L. 111–5, enacted on February 17, 

2009) (Recovery Act), added a new 

section 1923(f)(3)(E) of the Act; that 

provided fiscal relief to States during 

the recent national economic downturn. 

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

of the Act, as created by section 5002 of 

the Recovery Act, required that, in 

general, States’ DSH allotments for FY 


sroberts on DSK5SPTVN1PROD with NOTICES