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 


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2009 be equal to 102.5 percent of the FY 

2009 allotments that would otherwise 

have been determined; this Recovery 

Act provision does not apply to certain 

States. 

For a detailed description of the 

background of this notice, please refer to 

‘‘Final FY 2009 and Preliminary FY 

2011 Disproportionate Share Hospital 

Allotments, and Final FY 2009 and 

Preliminary FY 2011 Institutions for 

Mental Diseases Disproportionate Share 

Hospital Limits’’ notice published in the 

January 3, 2011 Federal Register (76 FR 

148). 

II. Provisions of the Notice 

A. Calculation of the Final FY 2010, 

Final FY 2011 Federal Share State DSH 

Allotments, and the Preliminary FY 

2012 Federal Share State DSH 

Allotments 

1. Final FY 2010 and FY 2011 Federal 

Share State DSH Allotments 

Chart 1 and Chart 2 of the Addendum 

to this notice provides the States’ final 

FY 2010 and final FY 2011 DSH 

allotments, respectively. As described in 

the previous Federal Register notices in 

determining non-Low DSH States’ DSH 

allotments for FYs after FY 2004 under 

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

allotments, we determined States’ DSH 

allotments under a ‘‘parallel’’ process. 

Under the parallel process, for each FY 

for each State, we determine whether 

the fiscal year specified (as defined in 

section 1923(f)(3)(D) of the Act) has 

occurred. Section 1923(f)(3)(D) of the 

Act describes the fiscal year specified is 

determined separately for each State 

and ‘‘is the first FY for which the 

Secretary estimates that the DSH 

allotment for that State will equal (or no 

longer exceed) the DSH allotment for 

that State under the law as in effect 

before the date of enactment’’ of MMA. 

The process in effect before the 

enactment in MMA is the process 

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

Act; in this process each States’ DSH 

allotment since FY 2003 is increased by 

the CPI–U increase for the prior FY and 

the result is then compared to the 

State’s FY 2004 DSH allotment, as 

determined by section 1923(f)(3)(C)(i) of 

the Act. The fiscal year specified for a 

State is the FY when the FY 2004 

allotment is no longer greater than the 

parallel process DSH allotment. 

In accordance to the parallel process 

provision, we determined that FY 2009 

was the fiscal year specified for all nonLow DSH States (except Louisiana). 

Therefore, in section 1923(f)(3)(C)(ii) of 

the Act, the Final FY 2009 DSH 

allotment for all non-Low DSH States 

(except Louisiana) is equal to the prior 

FY 2008 DSH allotment increased by the 

CPI–U increase for FY 2008 (4.4 

percent). 

Chart 1 contains the final FY 2010 

DSH allotments and Chart 2 contains 

the final FY 2011 DSH allotments. For 

the non-Low DSH States for which the 

FY 2009 is the fiscal year specified, that 

fiscal year and for following fiscal years, 

the FY DSH allotments are calculated by 

increasing the prior FY DSH allotment 

by the CPI–U increase for the prior fiscal 

year. 

For Low-DSH States, the FY 2009 

DSH allotments were calculated using 

the same methodology as for the nonLow DSH States for which the fiscal 

year specified has occurred. That is, for 

FY 2009 and following FYs, the DSH 

allotment for Low-DSH States is 

calculated by increasing the prior FY 

DSH allotment by the percentage change 

in the CPI–U for the prior fiscal year. 

As discussed in the ‘‘Background’’ 

section of this notice, under section 

5002 of the Recovery Act, the 

preliminary FY 2010 DSH allotment was 

determined as the higher of 102.5 

percent of the FY 2009 DSH allotment 

(as determined under the Recovery Act) 

or the FY 2010 DSH allotment as would 

have been determined without 

application of the Recovery Act 

provisions. Accordingly, the 

preliminary FY 2010 DSH allotments 

were initially determined using the 

States’ August 2009 expenditure 

estimates submitted by the States on the 

Form CMS–37, and the percentage 

increase in the CPI–U for the previous 

FY that was available before the 

beginning of FY 2010. Then, this 

amount was compared to the DSH 

allotment amount equal to 102.5 percent 

of the FY 2009 DSH allotments as 

determined under the Recovery Act 

provisions. For all applicable states the 

Recovery Act provision resulted in a 

higher FY 2010 DSH allotment. 

The final FY 2011 DSH allotments 

were determined by first determining 

the FY 2010 DSH allotments as they 

would have been calculated without 

application of the Recovery Act 

provisions. That is, first the amount of 

the final FY 2010 DSH allotments were 

determined by adjusting the amount of 

the final FY 2009 DSH allotments (also 

determined without application of the 

Recovery Act provisions) by the CPI–U 

percentage increase for FY 2009; this 

final FY 2010 DSH allotment amount 

(determined without application of the 

Recovery Act provisions) was then 

increased by the CPI–U percentage 

increase for FY 2010 to determine the 

final FY 2011 DSH allotments contained 

in this notice. 

2. Calculation of the Preliminary FY 

2012 Federal Share State DSH 

Allotments 

Chart 3 of the Addendum to this 

notice provides the preliminary FY 2012 

DSH allotments determined in 

accordance with the section 1923(f)(3) 

of the Act. As described in the 

‘‘Background’’ section of the January 3, 

2011 Federal Register (76 FR 148) 

notice, the Recovery Act provisions 

which increased States’ DSH allotments 

for FY 2009 and FY 2010 are not 

applicable for determining States’ FY 

2012 DSH allotments and following 

fiscal years. That is, the preliminary FY 

2012 DSH allotments were determined 

using States’ estimates of FY 2012 

expenditures and increasing the FY 

2011 allotments by the percentage 

increase in the CPI–U for FY 2011. 

States’ final FY 2012 DSH allotments 

will be published in the Federal 

Register following receipt of the States’ 

four quarterly Medicaid expenditure 

reports (Form CMS–64) for FY 2012 

following the end of FY 2012. 

B. Calculation of the Final FY 2010, the 

Final FY 2011, and the Preliminary FY 

2012 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 2010, the final FY 2011, and the 

preliminary FY 2012 IMD DSH Limits 

determined in accordance with the 

provisions discussed above, and for FY 

2010 reflecting the DSH allotments for 

the FY determined under the provisions 

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

amended by section 5002 of the 

Recovery Act. 

Charts 4, 5, and 6 of the ‘‘Addendum’’ 

to this notice detail each State’s final FY 

2010, final FY 2011, and preliminary FY 

2011 IMD DSH Limits, 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 CMS–37 (OMB 0938–0101) are 

unaffected by this notice. Consequently, 

this notice and CMS–37 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.). 


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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 does not 

reach the $100 million economic 

threshold and thus is not considered a 

major rule under the Congressional 

Review Act. 

There are no changes between the 

final FY 2010 DSH allotments and FY 

2010 IMD DSH limits and the 

preliminary FY 2010 DSH allotments 

and FY 2010 IMD DSH limits published 

in the April 23, 2010 Federal Register 

(75 FR 21314). 

The final FY 2011 DSH allotments 

being published in this notice are 

approximately $10 million less than the 

preliminary FY 2011 DSH allotments 

published in the January 3, 2011 

Federal Register (76 FR 148). The final 

FY 2011 IMD DSH limits being 

published in this notice are 

approximately $1 million less than the 

preliminary FY 2011 IMD DSH limits 

published in the January 3, 2011 

Federal Register on (76 FR 148). The 

decrease in the FY 2011 DSH allotments 

are due to the difference between the 

final percentage change in the CPI–U for 

FY 2010 used in the calculation of the 

final FY 2011 allotments (1.7 percent) as 

compared to the estimated percentage 

change in the CPI–U for FY 2010 used 

in the calculation of the preliminary 

allotments (1.8 percent). The decreases 

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, and since the final FY 2011 DSH 

allotments were decreased as compared 

to the preliminary FY 2011 DSH 

allotments, the associated FY 2011 IMD 

DSH limits for some States were also 

decreased. 

The preliminary FY 2012 DSH 

allotments being published in this 

notice are about $64 million more than 

the final FY 2011 DSH allotments being 

published in the Federal Register. The 

preliminary FY 2012 IMD DSH limits 

being published in this notice are about 

$11 million more than the final FY 2011 

IMD DSH limits being published in the 

Federal Register. 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 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, and since the preliminary FY 

2012 DSH allotments were greater than 

the final FY 2011 DSH allotments, the 

associated FY 2012 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 $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 a significant economic impact on 

a substantial number of small entities. 

Specifically, the effects of the various 

controlling statutes on providers are not 

impacted by a result of any independent 

regulatory impact and not this notice. 

The purpose of the notice is to 

announce the latest distributions as 

required by the statute. 

In addition, section 1102(b) of the Act 

requires us to prepare a regulatory 

impact analysis if a rule may have a 

significant impact on the operations of 

a substantial number of small rural 

hospitals. This analysis must conform to 

the provisions of section 604 of the 

RFA. For purposes of section 1102(b) of 

the Act, we define a small rural hospital 

as a hospital that is located outside of 

a Core-Based Statistical Area for 

Medicaid payment regulations and has 

fewer than 100 beds. We are not 

preparing analysis for section 1102(b) of 

the Act because the Secretary has 

determined that this notice will not 

have a significant impact on the 

operations of a substantial number of 

small rural hospitals. 

The Medicaid statute specifies the 

methodology for determining the 

amounts of States’ DSH allotments and 

IMD DSH limits; and as described 

previously, results in the decreases or 

increases in States’ DSH allotments and 

IMD DSH limits for the FYs referred to. 

The statute applicable to these 

allotments and limits does not apply to 

the determination of the amounts of 

DSH payments made to specific DSH 

hospitals; rather, these allotments and 

limits represent an overall limit on the 

total of such DSH payments. In this 

regard, we do not believe that this 

notice will have a significant economic 

impact on a substantial number of small 

entities. 

Section 202 of the Unfunded 

Mandates Reform Act of 1995 also 

requires that agencies assess anticipated 

costs and benefits before issuing any 

rule whose mandates require spending 

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 have no 

consequential effect on State, local, or 

tribal governments, in the aggregate, or 

on the private sector. 

Executive Order 13132 establishes 

certain requirements that an agency 

must meet when it promulgates a 

proposed rule (and subsequent final 

rule) that imposes substantial direct 

requirement costs on State and local 

governments, preempts State law, or 

otherwise has Federalism implications. 

Since this notice does not impose any 

costs on State or local governments, the 

requirements of E.O. 13132 are not 

applicable. 

Alternatives Considered 

The methodologies for determining 

the States’ fiscal year DSH allotments 

and IMD DSH Limits, as reflected in this 

notice, were established in accordance 

with the methodologies and formula for 

determining States’ allotments as 

specified in statute. This notice does not 

put forward any further discretionary 

administrative policies for determining 

such allotments. 

Accounting Statement 

As required by OMB Circular A–4 

(available at 

http://www.whitehouse.gov/omb/ 

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

below, we have prepared an accounting 

statement showing the classification of 

the estimated expenditures associated 

with the provisions of this notice. This 

table provides our best estimate of the 

change (decrease) in the Federal share of 

States’ Medicaid DSH payments 

resulting from the application of the 

provisions of the Medicaid statute 


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relating to the calculation of States’ FY 

DSH allotments and the increase in the 

FY DSH allotments from FY 2010 to FY 

2011. 

TABLE—ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED EXPENDITURES, FROM THE FY 2010 TO FY 2012 

[In millions] 

Category Transfers 

Annualized Monetized Transfers ................................................................................................................................................. $54. 

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

In accordance with the provisions of 

Executive Order 12866, this notice was 

reviewed by the Office of Management 

and Budget. 

(Catalog of Federal Domestic Assistance 

Program No. 93.778, Medical Assistance 

Program) 

Dated: May 14, 2012. 

Marilyn Tavenner, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

Dated: June 11, 2012. 

Kathleen Sebelius, 

Secretary. 

Addendum 

This addendum contains the charts 1 

through 6 (preceded by associated keys) 

that are referred to in the preamble of 

this notice. 

Key to Chart 1. Final DSH Allotments 

for FY 2010 

KEY TO CHART 1—FINAL DSH ALLOTMENTS FOR FISCAL YEAR: 2010 

[The Final FY 2010 DSH Allotments for the NON-Low DSH States are presented in the top section of this chart, and the Final FY 2010 DSH 

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

Column Description 

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

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

DSH States, determined in accordance with section 1923(f)(3)(D) of the Act. ‘‘YES’’ indicates the FY Specified 

has occurred; ‘‘NOT MET’’ indicates that the FY Specified has not occurred; and ‘‘na’’ indicates that this provision is not applicable. This provision is not applicable for Low-DSH States indicated in the bottom portion of 

chart 1. 

Columns C–N ....................... For all States, the entries in Columns B through K present the determination of the final FY 2010 DSH allotments 

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

of ARRA. For all States, the entries in Columns L through N present the calculation of the final FY 2010 DSH 

Allotments, determined in accordance with the provisions of section 5002 of ARRA. 

For Non-Low DSH States indicated in the top portion of Chart 1, entries in Columns C through K are only for 

States meeting the ‘‘FY Specified’’ test (‘‘YES’’ in Column B). For States not meeting the test indicated in Column B, these Columns indicate ‘‘na’’, and for States for which such test is not applicable, these Columns indicate ‘‘na’’. 

For Low DSH States, entries are in the bottom portion of Chart 1. 

Column C ............................. FY 2010 FMAPS. This column contains the States’ FY 2009 Federal Medical Assistance Percentages. 

Column D ............................. FY 2009 DSH Allotment for States Meeting Test. This column contains the States’ prior FY 2009 DSH Allotments. 

Column E ............................. FY 2009 Allotments X (1 + Percentage Increase in CPI–U): 1.00. This column contains the amount in Column D 

increased by 1 plus the percentage increase in the CPI–U for the prior FY (0.0 percent). 

Column F .............................. FY 2010 TC MAP Exp. Incl. DSH. This column contains the amount of the States’ actual FY 2010 total computable medical assistance expenditures including DSH expenditures. 

Column G ............................. FY 2010 TC MAP Exp. Net of DSH. This column contains the amount of the States’ actual FY 2010 total computable DSH expenditures. 

Column H ............................. FY 2010 TC MAP Exp. Net of DSH. This column contains the amount of the States’ actual FY 2010 total computable medical assistance expenditures net of DSH expenditures, calculated as the amount in Column F minus 

the amount in Column G. 

Column I ............................... 12% AMOUNT. This column contains the amount of the ‘‘12 percent limit’’ in Federal share, determined in accordance with the provisions of section 1923(f)(3) of the Act. 

Column J .............................. Greater of FY 2009 Allotment or 12% Limit. This column contains the greater of the State’s prior FY (FY 2009) 

DSH allotment or the amount of the 12% Limit, determined as the maximum of the amount in Column D or Column I. 

Column K ............................. FY 2010 DSH Allotment. This column contains the States’ FY 2010 DSH allotments as would be determined without the application of the provisions of section 5002 of ARRA, determined as the minimum of the amount in 

Column J or Column E. For Non-Low DSH States that have not met the ‘‘FY Specified’’ test (entry in Column B 

is ‘‘NOT MET’’), the amount in Column K is equal to the State’s FY 2004 DSH allotment. For States for which 

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

Column L .............................. FY 2009 DSH Allotment Under ARRA. This column contains the State’s FY 2009 DSH allotment as determined in 

accordance with section 5002 of ARRA. 

Column M ............................. FY 2010 DSH Allotment Under ARRA. This column contains the State’s FY 2010 DSH allotment as determined in 

accordance section 5002 of ARRA, and calculated as the amount in Column L multiplied by 102.5 percent. 


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KEY TO CHART 1—FINAL DSH ALLOTMENTS FOR FISCAL YEAR: 2010—Continued 

[The Final FY 2010 DSH Allotments for the NON-Low DSH States are presented in the top section of this chart, and the Final FY 2010 DSH 

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

Column Description 

Column N ............................. FY 2010 DSH Allotment. (Max of Col K or M). This column contains the State’s final FY 2010 DSH allotment as 

determined as the higher of the amount in Column K (the FY 2010 DSH allotment as determined without the 

application of section 5002 of ARRA) and the amount in Column M (102.5 percent of the amount of the State’s 

FY 2009 DSH allotment determined in accordance with section 5002 of ARRA). 

BILLING CODE P 


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Key to Chart 2. Final DSH Allotments 

for FY 2011 

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

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

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

Column Description 

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

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

DSH States, determined in accordance with section 1923(f)(3)(D) of the Act. ‘‘YES’’ indicates the FY Specified 

has occurred; ‘‘NOT MET’’ indicates that the FY Specified has not occurred; and ‘‘na’’ indicates that this provision is not applicable. This provision is not applicable for Low-DSH States indicated in the bottom portion of 

chart 3. 

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

as would be calculated without the application of section 5002 of ARRA since such provisions were only applicable for FY 2009 and FY 2010. 

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

States meeting the ‘‘FY Specified’’ test (‘‘YES’’ in Column B). For States not meeting the test indicated in Column B, these Columns indicate ‘‘NA‘‘, and for States for which such test is not applicable, these Columns indicate ‘‘na‘‘. For Low DSH States, entries are in the bottom portion of Chart 2. 

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

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

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

Column E ............................. FY 2010 Allotments X (1 + Percentage Increase in CPI–U): 1.017. This column contains the amount in Column D 

increased by 1 plus the percentage increase in the CPI–U for the prior FY (1.7 percent). 

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

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

Column H ............................. FY 2011 TC MAP Exp. Net of DSH. This column contains the amount of the States’ projected FY 2011 total computable medical assistance expenditures net of DSH expenditures, calculated as the amount in Column F 

minus the amount in Column G. 

Column I ............................... 12% AMOUNT. This column contains the amount of the ‘‘12 percent limit’’ in Federal share, determined in accordance with the provisions of section 1923(f)(3) of the Act. 

Column J .............................. Greater of FY 2010 Allotment or 12% Limit. This column contains the greater of the State’s prior FY (FY 2010) 

DSH allotment or the amount of the 12% Limit, determined as the maximum of the amount in Column D or Column I. 

Column K ............................. FY 2011 DSH Allotment. This column contains the States’ FY 2011 DSH allotments as would be determined without the application of the provisions of section 5002 of ARRA, determined as the minimum of the amount in 

Column J or Column E. 

For Non-Low DSH States that have not met the ‘‘FY Specified’’ test (entry in Column B is ‘‘NOT MET’’), the 

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

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

Act. 

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Key to Chart 3—Preliminary DSH 

Allotments for FY 2012 

KEY TO CHART 3—PRELIMINARY DSH ALLOTMENTS FOR FISCAL YEAR: 2012 

[The Preliminary FY 2012 DSH Allotments for the NON-Low DSH States are presented in the top section of this chart, and the Preliminary 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 ............................. 1923(f)(3)(D) Test Met. This column indicates whether the ‘‘FY Specified’’ has occurred with respect to Non-Low 

DSH States, determined in accordance with section 1923(f)(3)(D) of the Act. ‘‘YES’’ indicates the FY Specified 

has occurred; ‘‘NOT MET’’ indicates that the FY Specified has not occurred; and ‘‘na’’ indicates that this provision is not applicable. This provision is not applicable for Low-DSH States indicated in the bottom portion of 

chart 3. 

Columns C–K ....................... For Non-Low DSH States indicated in the top portion of Chart 3, entries in Columns C through J are only for 

States meeting the ‘‘FY Specified’’ test (‘‘YES’’ in Column B). For States not meeting the test indicated in Column B, these Columns indicate ‘‘na,’’ and for States for which such test is not applicable, these Columns indicate ‘‘na.’’ For Low DSH States, entries are in the bottom portion of Chart 3. 

Column C ............................. FY 2012 FMAPS. This column contains the States’ FY 2012 Federal Medical Assistance Percentages. 

Column D ............................. FY 2011 DSH Allotment For States Meeting Test. This column contains the States’ prior FY 2010 DSH Allotments as would be determined without the application of section 5002 of ARRA. 

Column E ............................. FY 2011 Allotments X (1 + Percentage Increase in CPI–U): 1.024. 

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

prior FY (1.024 percent). 

Column F .............................. FY 2012 TC MAP Exp. Incl. DSH. This column contains the amount of the States’ projected FY 2012 total computable medical assistance expenditures including DSH expenditures. 

Column G ............................. FY 2012 TC DSH Expenditures. This column contains the amount of the States’ projected FY 2012 total computable DSH expenditures. 

Column H ............................. 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 F 

minus the amount in Column G 

Column I ............................... 12% AMOUNT. This column contains the amount of the ‘‘12 percent limit’’ in Federal share, determined in accordance with the provisions of section 1923(f)(3) of the Act. 

Column J .............................. Greater of FY 2010 Allotment or 12% Limit. This column contains the greater of the State’s prior FY (FY 2011) 

DSH allotment or the amount of the 12% Limit, determined as the maximum of the amount in Column D or Column I 

Column K ............................. FY 2012 DSH Allotment. This column contains the States’ preliminary FY 2012 DSH allotments, determined as 

the minimum of the amount in Column J or Column E. 

For Non-Low DSH States that have not met the ‘‘FY Specified’’ test (entry in Column B is ‘‘NOT MET’’), the 

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

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

Act. 

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Key to Chart 4—Final IMD DSH Limit 

for FY 2010 

KEY TO CHART 4—FINAL IMD DSH LIMT FOR FY: 2010 

[Key to the Chart of the Final FY 2010 IMD Limitations.—The Final FY 2010 IMD DSH Limits for the regular States are presented in the top 

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

Column Description 

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

Column B ............................. Inpatient Hospital Services FY 95 DSH Total Computable. This column contains the States’ total computable FY 

1995 inpatient hospital DSH expenditures as reported on the Form CMS–64. 

Column C ............................. IMD and Mental Health Services FY 95 DSH Total Computable. This column contains the total computable FY 

1995 mental health facility DSH expenditures as reported on the Form CMS–64 as of January 1, 1997. 

Column D ............................. Total Inpatient & IMD & Mental Health FY 95 DSH Total Computable, Col B + C. This column contains the total 

computation of all inpatient hospital DSH expenditures and mental health facility DSH expenditures for FY 1995 

as reported on the Form CMS–64 as of January 1, 1997 (representing the sum of Column B and Column C). 

Column E ............................. Applicable Percentage Col C/D. This column contains the ‘‘applicable percentage’’ representing the total computable FY 1995 mental health facility DSH expenditures divided by total computable all inpatient hospital and 

mental health facility DSH expenditures for FY 1995 (the amount in Column C divided by the amount in Column D). Per section 1923(h)(2)(A)(ii)(III) of the Act, for FYs after FY 2002, the applicable percentage can be no 

greater than 33 percent. 

Column F .............................. FY 2010 Allotment in FS Under ARRA. This column contains the States’ final FY 2010 DSH allotments as determined under ARRA. 

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

Column H ............................. FY 2010 DSH Allotments in TC. Col. F/G. This column contains the FY 2010 total computable DSH Allotment 

(determined as the amount in Column F divided by the amount in Column G). 

Column I ............................... Col E * Col H in TC. This column contains the applicable percent of FY 2010 total computable DSH allotment 

(calculated as the amount in Column E multiplied by the amount in Column H). 

Column J .............................. FY 2010 TC IMD DSH Limit. Lesser of Col. C or I. This column contains the FY 2010 TC IMD DSH Limit equal to 

the lesser of the amount in Column C or Column I. 

Column K ............................. FY 2010 IMD DSH Limit in FS U/ARRA. Col. G × J. This column contains the FY 2010 Federal share IMD DSH 

limit determined by converting the total computable FY 2010 IMD DSH Limit from Column J into a Federal 

share amount by multiplying it by the FY 2010 FMAP in Column G. 

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Key to Chart 5. Preliminary IMD DSH 

Limit for FY 2011 

KEY TO CHART 5—FINAL IMD DSH LIMIT FOR FY: 2011 

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

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

Column Description 

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

Column B ............................. Inpatient Hospital Services FY 95 DSH Total Computable. This column contains the States’ total computable FY 

1995 inpatient hospital DSH expenditures as reported on the Form CMS–64. 

Column C ............................. IMD and Mental Health Services FY 95 DSH Total Computable. This column contains the total computable FY 

1995 mental health facility DSH expenditures as reported on the Form CMS–64 as of January 1, 1997. 

Column D ............................. Total Inpatient & IMD & Mental Health FY 95 DSH Total Computable, Col. B + C. This column contains the total 

computation of all inpatient hospital DSH expenditures and mental health facility DSH expenditures for FY 1995 

as reported on the Form CMS–64 as of January 1, 1997 (representing the sum of Column B and Column C). 

Column E ............................. Applicable Percent Col. C/D. This column contains the ‘‘applicable percentage’’ representing the total Computable 

FY 1995 mental health facility DSH expenditures divided by total computable all inpatient hospital and mental 

health facility DSH expenditures for FY 1995 (the amount in Column C divided by the amount in Column D) 

Per section 1923(h)(2)(A)(ii)(III) Of the Act, for FYs after FY 2002, the applicable Percentage can be no greater 

than 33 percent. 

Column F .............................. FY 2011 Federal Share DSH Allotment. This column contains the States’ final FY 2011 DSH allotments. 

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

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

DSH allotment (determined as Column F/Column G). 

Column I ............................... Col E * Col H in TC. This column contains the applicable percent of FY 2010 total computable DSH allotment 

(calculated as the percentage in Column E multiplied by the amount in Column H) 

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

the lesser of the amount in Column C or Column I. 

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

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

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

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Key to Chart 6. Preliminary IMD DSH 

Limit for FY 2012 

KEY TO CHART 6—PRELIMINARY IMD DSH LIMIT FOR FY: 2012 

[Key to the Chart of the FY 2012 IMD Limitations.—The preliminary FY 2012 IMD DSH Limits for the Non-Low DSH States are presented in the 

top section of this chart and the preliminary 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’ preliminary FY 2012 DSH allotments. 

Column G ............................. FY 2012 FMAP. This columns contains the States’ FY 2010 FMAPs. 

Column H ............................. FY 2012 DSH Allotments in Total Computable Col. F/G. This column contains States’ FY 2012 total computable 

DSH allotment (determined as Column F/Column G). 

Column I ............................... Col E * Col H in TC. This column contains the applicable percent of FY 2012 total computable DSH allotment 

(calculated as the percentage in Column E multiplied by the amount in Column H). 

Column J .............................. FY 2012 TC IMD DSH Limit. Lesser of Col. C or I. This column contains the 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 × 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. 

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[FR Doc. 2012–17954 Filed 7–20–12; 11:15 am] 

BILLING CODE C 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–2385–N] 

RIN 0938–AR47 

Medicaid Program; State Allotments 

for Payment of Medicare Part B 

Premiums for Qualifying Individuals 

(QIs) for FY 2012 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice sets forth the 

States’ final allotments available to pay 

the Medicare Part B premiums for 

Qualifying Individuals (QIs) for the 

Federal fiscal year (FY) 2011 and the 

preliminary QI allotments for FY 2012. 

The amounts of these QI allotments 

were determined in accordance with the 

methodology set forth in regulations and 

reflect funding for the QI program made 

available under recent legislation as 

described in this notice. 

DATES: The final QI allotments for 

payment of Medicare Part B premiums 

for FY 2011 are effective October 1, 

2010. The preliminary QI allotments for 

FY 2012 are effective October 1, 2011. 

FOR FURTHER INFORMATION CONTACT: 

Richard Strauss, (410) 786–2019. 

SUPPLEMENTARY INFORMATION: 

I. Background 

A. QI Allotments for FY 2011 and 

Thereafter 

Section 5005 of the American 

Recovery and Reinvestment Act of 2009 

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

2009) (Recovery Act) extended the 

authority and funding for the QI 

program by providing $150 million in 

additional funds for the first quarter of 

FY 2011 (that is, through December 31, 

2010). Section 3 of the Emergency Aid 

to American Survivors of the Haiti 

Earthquake Act (Pub. L. 111–127, 

enacted on January 27, 2010) (Haiti 

Earthquake Act) provided an additional 

$15 million for States’ FY 2011 QI 

allotments; that brought the total funds 

available for the QI program for FY 2011 

through December 31, 2010 to $165 

million. Section 110 of the Medicare 

and Medicaid Extenders Act of 2010 

(Pub. L. 111–309, enacted on December 

15, 2010) (MMEA) extended authority 

and funding for the QI program for FY 

2011 by providing an additional $720 

million for the QI program for the last 

3 quarters of FY 2011 in addition to the 

previously available $165 million; 

which brought the total funding 

available for the QI program for FY 2011 

to $885 million. 

B. QI Allotments for FY 2012 and 

Thereafter 

Section 110 of the MMEA also 

extended the authority and funding for 

the QI program for the first quarter of FY 

2012 (that is, through December 31, 

2011) by providing $280 million 

available for the first quarter of FY 2012. 

Section 310 of the Temporary Payroll 

Tax Cut Continuation Act of 2011 (Pub. 

L. 112–78, enacted on December 23, 

2011) (TPTCA) provided temporary 

continued authority and an additional 

$150 million in funding for the QI 

program for the period January 1, 2012 

through February 29, 2012. With the 

enactment of TPTCA, the QI program 

was authorized and funded at a total 

amount nationally of $430 million ($280 

million plus $150 million) for FY 2012 

through February 29, 2012. Most 

recently, section 3101 of the Middle 

Class Tax Relief and Job Creation Act of 

2012 (Pub. L. 112–96, enacted on 

February 22, 2012) extended the 

authority and funding for the QI 

program for FY 2012 by increasing the 

amount of funding previously made 

available under TPTCA for FY 2012 

from $150 million to $450 million, and 

extending the period in FY 2012 this 

funding is available to September 30, 

2012 (that is, to the end of FY 2012). 

Therefore the total funding available for 

the QI program for FY 2012 is $730 

million ($280 million plus $450 

million). 

Finally, section 3101 of Middle Class 

Tax Relief and Job Creation Act also 

extended the authority and funding for 

the QI program by providing $280 

million to be available for the period 

October 1, 2012 through December 31, 

2012, the first quarter of FY 2013. 

C. Methodology for Calculating the 

Fiscal Year QI Allotments 

The amounts of the final FY 2011 and 

preliminary FY 2012 QI allotments, 

contained in this notice, were 

determined in accordance with the 

methodology set forth in existing 

regulations at 42 CFR 433.10(c)(5) and 

reflect funding for the QI program made 

available under the legislation discussed 

above. 

II. Charts 

The final QI allotments for FY 2011 

and the preliminary QI allotments for 

FY 2011 are shown by State in Chart 1 

and Chart 2 below, respectively: 

Chart 1—Final Qualifying Individuals 

Allotments for October 1, 2010 through 

September 30, 2011. 

Chart 2—Preliminary Qualifying 

Individuals Allotments for October 1, 

2011 through September 30, 2012. 

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