### 11436 Federal Register / Vol. 79, No. 40 / Friday, February 28, 2014 / Notices

amendments to the Social Security Act made by the ACA, and the implementing regulations. The AEs, which are state entities administering Insurance Affordability Programs, will use the data, accessed through the CMS Data Services Hub (Hub), to make Eligibility Determinations for Insurance Affordability Programs and certificates of exemption.

The AEs shall report suspected or confirmed incidents affecting loss or suspected loss of PII within one hour of discovery to their designated Center for

Consumer Information and Insurance Oversight State Officer who will then notify the affected Federal agency data sources, i.e., Internal Revenue Service, Department of Defense, Department of Homeland Security, Social Security Administration, Peace Corps, Office of Personnel Management and Veterans Health Administration. Additionally,

AEs shall contact the office of the appropriate Special Agent-in-Charge, Treasury Inspector General for Tax Administration (TIGTA), and the IRS Office of Safeguards within 24 hours of discovery of any potential breach, loss,

or misuse of Return Information. Form

Number: CMS–10496 (OCN: 0938– 1216); Frequency: Occasionally; Affected Public: State, Local or Tribal
governments; Number of Respondents:

18; Total Annual Responses: 936; Total

Annual Hours: 234. (For policy questions regarding this collection

contact Theodora Wills at 410–786– 1504.)

Dated: February 24, 2014.

Martique Jones,
Deputy Director, Regulations Development Group, Office of Strategic Operations and Regulatory Affairs.

[FR Doc. 2014–04327 Filed 2–27–14; 8:45 am]

**BILLING CODE 4120–01–P**

**DEPARTMENT OF HEALTH AND**

**HUMAN SERVICES**

**Centers for Medicare & Medicaid**

**Services**

**[CMS–2389–N]**

**Medicaid Program; Preliminary Disproportionate Share Hospital**  **Allotments (DSH) for Fiscal Year (FY) 2014 and the Preliminary Institutions**  **for Mental Diseases Disproportionate Share Hospital Limits for FY 2014** 

**AGENCY :**  Centers for Medicare & Medicaid Services (CMS), HHS.

**ACTION :**  Notice.

**SUMMARY :**  This notice announces the preliminary federal share DSH

allotments for FY 2014 and the preliminary federal share FY 2014 limits on aggregate DSH payments that states may make to institutions for mental diseases (IMDs) and other mental health

facilities. This notice also includes additional information regarding the

calculation of the FY 2014 DSH

allotments and FY 2014 IMD DSH

limits.

**DATES :**  Effective Date: This notice is effective on March 31, 2014. The final

allotments and limitations set forth in

this notice are effective for the fiscal years specified.

**FOR FURTHER INFORMATION CONTACT :**  Rory Howe, (410) 786–4878; or Richard Strauss, (410) 786–2019.

**SUPPLEMENTARY INFORMATION :** 

I. Background

A. Fiscal Year DSH Allotments

A state’s federal fiscal year (FY) disproportionate share hospital (DSH) allotment represents the aggregate limit

on the federal share amount of the state’s payments to DSH hospitals in the

state for the FY. The amount of such

allotment is determined in accordance with the provisions of section 1923(f)(3) of the Social Security Act (the Act). Under such provisions, in general a

state’s FY 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.

The Affordable Care Act amended Medicaid DSH provisions, adding section 1923(f)(7) of the Act which would have required reductions to states’ FY DSH allotments beginning with FY 2014, the calculation of which was described in the Disproportionate Share Hospital Payment Reduction final rule published in the September 18,

2013 Federal Register (78 FR 57293). Under the DSH reduction methodology, first, each state’s unreduced FY DSH

allotment would have been calculated in accordance with the provisions of section 1923(f) of the Act, excluding section 1923(f)(7) of the Act; then, the

reduction amount for each state would

have been determined under the provisions of section 1923(f)(7) of the Act and implementing regulations at 42 CFR 447.294; and, finally, the net FY

DSH allotment for each state would have been determined by subtracting the

DSH reduction amount for the state

from its unreduced FY 2014 DSH

allotment.

The reductions under section 1923(f)(7) of the Act were delayed and modified by section 1204 of Division B (Medicare and Other Health Provisions) of the ‘‘Pathway for SGR Reform Act of 2013’’ (Pub. L. 113–67), which was enacted on December 26, 2013. The reductions of states’ fiscal year DSH allotments under section 1923(f)(7) of the Act that were applicable to FY 2014 and 2015 were repealed, and the FY 2016 was increased substantially.

Because there is no reduction to DSH

allotments for FY 2014 under section 1923(f)(7) of the Act, this notice contains only the state-specific FY 2014 DSH allotments, as calculated under the statute without application of the

reductions that would have been imposed under the Affordable Care Act provisions beginning with FY 2014. This notice also provides information

on the calculation of such FY DSH allotments, the calculation of the states’ IMD DSH limits, and the amounts of states’ preliminary FY 2014 IMD DSH

limits.

B. Determination of Fiscal Year DSH

Allotments

Generally, in accordance with the methodology specified under section 1923(f)(3) of the Act, a state’s FY DSH allotment is calculated by increasing the

amount of its DSH allotment for the preceding FY by the percentage change in the 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. 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 for a FY and the IMD DSH limits for the same FY using the most


### 11437 Federal Register / Vol. 79, No. 40 / Friday, February 28, 2014 / Notices

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 the 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 Preliminary FY

2014 Federal Share State DSH Allotments and the Preliminary FY 2014

IMD DSH Limits

1. Calculation of the Preliminary FY

2014 Federal Share State DSH

Allotments

Addendum 1 to this notice provides the preliminary FY 2014 DSH

allotments determined in accordance with section 1923(f)(3) of the Act. The preliminary FY 2014 DSH allotments

contained in this notice were

determined based on the most recent

available estimates from states of their FY 2014 total computable Medicaid expenditures. Also, the preliminary FY

2014 allotments contained in this notice were determined by increasing the preliminary FY 2013 DSH allotments as contained in the notice published in the Federal Register on July 26, 2013 (78 FR 45217) by 1.5 percent, representing the

most recent available estimate of the percentage increase in the CPI–U for FY 2013 (the previous FY to FY 2014).

We will publish states’s final FY 2014

DSH allotments in future notices based on the states’ four quarterly Medicaid expenditure reports (Form CMS–64) for FY 2014 available following the end of FY 2014 and the actual change in the

CPI–U for FY 2013.

B. Calculation of the Preliminary FY

2014 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 preliminary FY 2014 IMD DSH Limits

determined in accordance with the provisions discussed above.

Addendum 2 to this notice details each state’s preliminary FY 2014 IMD DSH Limit, 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, recordkeeping, or third-party disclosure requirements. The currently approved requirements and burden estimates associated with Form CMS–37 (OCN 0938–0101) and Form CMS–64 (OCN 0938–0067) are unaffected by this notice. Consequently, this notice, 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 Analysis

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 preliminary FY 2014 DSH allotments being published in this
notice are about $108 million more than the preliminary FY 2013 DSH allotments previously published in the July 26, 2013 Federal Register (78 FR 45217). The increase in the FY 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 2014 IMD DSH limits being published in this notice are
about $9 million more than the preliminary FY 2013 IMD DSH limits previously published in the FR on July 26, 2013 (78 FR 45217). 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 2014

DSH allotments were increased as compared to the preliminary FY 2013 DSH allotments previously published in

the Federal Register , the associated FY

2014 IMD DSH limits for some states

were 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 less than $35.5 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 state 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


### 11438 Federal Register / Vol. 79, No. 40 / Friday, February 28, 2014 / Notices

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 changes 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 payments a state can make. 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. Currently the threshhold 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. A. Alternatives Considered

We calculated the state-specific FY

2014 DSH allotments and the associated state-specific IMD DSH limits in accordance with the methodologies specified in statute and regulation. This notice does not put forward any further discretionary administrative policies for determining such allotments.

B. 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 2013 to FY 2014.



### T ABLE 

### 1—A CCOUNTING 

### S TATEMENT 

### : C LASSIFICATION OF 

### E STIMATED 

### E XPENDITURES 

### , F ROM THE 

### FY 2013 TO 

### FY 2014

[In millions]

Category Transfers

Annualized Monetized Transfers ................................................................................................. ............................ $108.

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

C. 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: January 24, 2014.
Marilyn Tavenner,
Administrator, Centers for Medicare &

Medicaid Services.

Dated: February 11, 2014.

Kathleen Sebelius,

Secretary.

Department of Health and Human

Services.



### K EY TO 

### ADDENDUM 1—P RELIMINARY 

### DSH A LLOTMENTS FOR 

### FY 2014.

Column Description

**The Preliminary FY 2014 DSH Allotments for the NON-Low DSH States are presented in the top section of this addendum, and the Preliminary FY 2014 DSH Allotments for the Low-DSH States are presented in the bottom section of this addendum.** 

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

Column B .......... FY 2014 FMAPs. This column contains the States’ FY 2014 Federal Medical Assistance Percentages.
Column C ......... Prior FY (2013) DSH Allotments.
This column contains the States’ prior FY 2013 DSH Allotments. Column D ......... Prior FY (2013) DSH Allotments (Col C) x (100 percent + Percentage Increase in CPIU): 101.5 percent. This column contains the amount in Column C increased by 1 plus the estimated percentage increase in the CPI–U for the

prior FY (101.5 percent). Column E .......... FY 2014 TC MAP Exp. Including DSH.
This column contains the amount of the States’ projected FY 2014 total computable (TC) medical assistance expenditures including DSH expenditures.
Column F .......... FY 2014 TC DSH Expenditures.
This column contains the amount of the States’ projected FY 2014 total computable DSH expenditures.
Column G ......... FY 2014 TC MAP Exp. Net of DSH.


### 11439 Federal Register / Vol. 79, No. 40 / Friday, February 28, 2014 / Notices

K EY TO 

### ADDENDUM 1—P RELIMINARY 

### DSH A LLOTMENTS FOR 

### FY 2014.—Continued

Column Description

This column contains the amount of the States’ projected FY 2014 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 percent 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 2013 Allotment or 12 percent limit.This column contains the greater of the State’s prior FY (FY 2013) DSH allotment or the amount of the 12 percent limit, determined as the maximum of the amount in Column C or Column H

Column J .......... FY 2014 DSH Allotment. This column contains the States’ preliminary FY 2014 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 addendum.


### 11440 Federal Register / Vol. 79, No. 40 / Friday, February 28, 2014 / NoticesADDENDUM1—PRELIMINARYDSH ALLOTMENTS FORFISCALYEAR2014STATEFY 2014FMAPs(percent)Prior FY (2013)DSH allotmentsPrior FY (2013)DSH allotment(Col C)×100%+ pct increasein CPIU:FY 2014 TC MAPExp. includingDSH4FY 2014 TCDSHExpenditures4FY 2014 TCMAPEXP. net ofDSH Col E¥F‘‘12% Amount’’=Col G×.12(1¥.12/Col B)’’(in FS)Greater of ColH or Col C(12% Limit, FY2013 allotment)FY 2014 DSHallotment MINCol I, Col D101.5%A BCDEFG HIJALABAMA ......................................................... 68.12 $323,093,267 $327,939,666 $5,837,507,000 $517,367,000 $5,320,140,000 $774,927,876 $774,927,876 $327,939,666ARIZONA .......................................................... 67.23 106,384,369 107,980,135 8,763,763,000 156,364,000 8,607,399,000 1,257,306,757 1,257,306,757 107,980,135CALIFORNIA .................................................... 50.00 1,151,840,630 1,169,118,239 72,253,198,000 935,479,000 71,317,719,000 11,260,692,474 11,260,692,474 1,169,118,239COLORADO ..................................................... 50.00 97,190,657 98,648,517 5,510,334,000 195,772,000 5,314,562,000 839,141,368 839,141,368 98,648,517CONNECTICUT ................................................ 50.00 210,141,962 213,294,091 6,585,550,000 228,325,000 6,357,225,000 1,003,772,368 1,003,772,368 213,294,091DISTRICT OF COLUMBIA ............................... 70.00 64,355,975 65,321,315 2,345,594,000 44,744,000 2,300,850,000 333,226,552 333,226,552 65,321,315FLORIDA .......................................................... 58.79 210,141,962 213,294,091 21,065,753,000 361,462,000 20,704,291,000 3,121,706,180 3,121,706,180 213,294,091GEORGIA ......................................................... 65.93 282,378,262 286,613,936 8,929,625,000 435,776,000 8,493,849,000 1,246,058,516 1,246,058,516 286,613,936ILLINOIS ........................................................... 50.00 225,902,609 229,291,148 16,174,722,000 428,796,000 15,745,926,000 2,486,198,842 2,486,198,842 229,291,148INDIANA ........................................................... 66.92 224,589,223 227,958,061 8,960,665,0000 8,960,665,000 1,310,228,045 1,310,228,045 227,958,061KANSAS ........................................................... 56.91 43,341,780 43,991,907 2,825,757,000 74,228,000 2,751,529,000 418,408,859 418,408,859 43,991,907KENTUCKY ...................................................... 69.83 152,352,923 154,638,217 6,276,300,000 152,353,000 6,123,947,000 887,363,415 887,363,415 154,638,217LOUISIANA1.....................................................na na na na na na na na 731,960,000MAINE ............................................................... 61.55 110,324,530 111,979,398 2,491,965,000 37,000,000 2,454,965,000 365,940,898 365,940,898 111,979,398MARYLAND ...................................................... 50.00 80,116,623 81,318,372 8,676,095,000 85,128,000 8,590,967,000 1,356,468,474 1,356,468,474 81,318,372MASSACHUSETTS .......................................... 50.00 320,466,492 325,273,489 14,210,660,0000 14,210,660,000 2,243,788,421 2,243,788,421 325,273,489MICHIGAN ........................................................ 66.32 278,438,100 282,614,672 13,523,842,000 364,144,000 13,159,698,000 1,928,021,733 1,928,021,733 282,614,672MISSISSIPPI ..................................................... 73.05 160,233,246 162,636,745 5,094,327,000 321,190,000 4,773,137,000 685,361,490 685,361,490 162,636,745MISSOURI ........................................................ 62.03 497,773,773 505,240,380 9,279,932,000 684,657,000 8,595,275,000 1,278,828,483 1,278,828,483 505,240,380NEVADA ........................................................... 63.10 48,595,328 49,324,258 2,092,603,000 77,014,000 2,015,589,000 298,670,057 298,670,057 49,324,258NEW HAMPSHIRE ........................................... 50.00 168,217,088 170,740,344 1,340,075,000 124,810,000 1,215,265,000 191,883,947 191,883,947 170,740,344NEW JERSEY .................................................. 50.00 676,394,441 686,540,358 13,682,358,000 1,207,107,000 12,475,251,000 1,969,776,474 1,969,776,474 686,540,358NEW YORK ...................................................... 50.00 1,687,702,633 1,713,018,172 67,240,475,000 3,373,800,000 63,866,675,000 10,084,211,842 10,084,211,842 1,713,018,172NORTH CAROLINA .......................................... 65.78 309,959,394 314,608,785 13,134,561,000 478,361,000 12,656,200,0001,857,623,286 1,857,623,286 314,608,785OHIO ................................................................. 63.02 426,850,861 433,253,624 19,534,779,0000 19,534,779,000 2,895,527,493 2,895,527,493 433,253,624PENNSYLVANIA .............................................. 53.52 589,710,881 598,556,544 21,451,173,000 732,037,000 20,719,136,000 3,204,879,071 3,204,879,071 598,556,544RHODE ISLAND ............................................... 50.11 68,296,138 69,320,580 2,302,742,000 137,098,000 2,165,644,000341,706,914 341,706,914 69,320,580SOUTH CAROLINA .......................................... 70.57 344,107,463 349,269,075 5,582,305,000 474,540,000 5,107,765,000 738,511,134 738,511,134 349,269,075TENNESSEE2.................................................. 65.29 na na na na na na na 0TEXAS .............................................................. 58.69 1,004,741,257 1,019,812,376 37,675,429,000 2,991,551,000 34,683,878,000 5,231,775,883 5,231,775,883 1,019,812,376VERMONT5....................................................... 56.76 23,640,971 23,995,586 1,536,190,000 37,449,000 1,498,741,000 228,065,789 228,065,789 23,995,586VIRGINIA .......................................................... 50.00 92,050,138 93,430,890 8,287,311,000 243,321,000 8,043,990,000 1,270,103,684 1,270,103,684 93,430,890WASHINGTON ................................................. 50.00 194,381,315 197,297,035 7,949,059,000 456,511,000 7,492,548,000 1,183,033,895 1,183,033,895 197,297,035WEST VIRGINIA ............................................... 71.09 70,922,912 71,986,756 3,534,234,000 70,185,000 3,464,049,000500,103,388 500,103,388 71,986,756TOTAL ....................................................... .................. 10,244,637,203 10,398,306,761 424,148,883,000 15,426,569,000 408,722,314,000 62,783,822,812 62,783,822,812 11,130,266,762**LOW DSH STATES**ALASKA ............................................................ 50.00 21,402,636 21,723,676 1,583,467,000 20,638,000 1,562,829,000 246,762,473.68 246,762,474 21,723,676ARKANSAS ...................................................... 70.10 45,325,292 46,005,171 4,549,145,000 43,820,000 4,505,325,000 652,302,821 652,302,821 46,005,171DELAWARE ...................................................... 55.31 9,512,282 9,654,966 1,620,151,000 16,804,000 1,603,347,000245,710,799 245,710,799 9,654,966HAWAII3........................................................... 51.85 10,240,000 10,393,600 1,940,694,000 0 1,940,694,000 303,011,243.86 303,011,244 10,393,600IDAHO ............................................................... 71.64 17,271,044 17,530,110 1,867,605,000 23,451,000 1,844,154,000 265,825,337.14 265,825,337 17,530,110IOWA ................................................................ 57.93 41,378,149 41,998,821 3,852,612,000 53,536,000 3,799,076,000 574,997,969 574,997,969 41,998,821MINNESOTA ..................................................... 50.00 78,476,334 79,653,479 10,571,446,000 154,792,000 10,416,654,000 1,644,734,842 1,644,734,842 79,653,479MONTANA ........................................................ 66.33 11,926,371 12,105,267 1,078,653,000 18,023,000 1,060,630,000 155,387,273 155,387,273 12,105,267NEBRASKA ...................................................... 54.74 29,733,219 30,179,217 2,060,181,000 41,391,000 2,018,790,000 310,272,058 310,272,058 30,179,217NEW MEXICO .................................................. 69.20 21,402,636 21,723,676 3,598,324,000 21,380,000 3,576,944,000519,282,220 519,282,220 21,723,676NORTH DAKOTA ............................................. 50.00 10,036,360 10,186,905 844,103,000 1,600,000 842,503,000 133,026,789 133,026,789 10,186,905OKLAHOMA ...................................................... 64.02 38,049,129 38,619,866 5,219,568,000 58,140,000 5,161,428,000 762,248,260 762,248,260 38,619,866OREGON .......................................................... 63.14 47,561,414 48,274,835 6,163,918,000 71,176,000 6,092,742,000 902,688,455 902,688,455 48,274,835SOUTH DAKOTA ............................................. 53.54 11,604,719 11,778,790 843,570,000 1,476,000 842,094,000 130,242,791 130,242,791 11,778,790UTAH ................................................................ 70.34 20,612,808 20,922,000 2,089,446,000 29,583,000 2,059,863,000 298,026,939 298,026,939 20,922,000WISCONSIN ..................................................... 59.06 99,326,563 100,816,461 7,532,985,000 159,936,000 7,373,049,000 1,110,375,539 1,110,375,539 100,816,461


### 11441 Federal Register / Vol. 79, No. 40 / Friday, February 28, 2014 / NoticesWYOMING ........................................................ 50.00 237,807 241,374 568,307,000 463,000 567,844,000 89,659,57989,659,579 241,374TOTAL LOW DSH STATES ...................... .................. 514,096,763 521,808,214 55,984,175,000 716,209,000 55,267,966,000 8,344,555,389 8,344,555,389 521,808,214TOTAL ................................................ .................. 10,758,733,966 10,920,114,975 480,133,058,000 16,142,778,000 463,990,280,000 71,128,378,201 71,128,378,201 11,652,074,9761Louisiana’s FY 2014 DSH allotment is determined under the provisions of section 1923(f)(3)(C) and (D) of the Act.2Tennessee’s DSH allotment for FY 2014, determined under section 1923(f)(6)(A) of the Act, is 0.3Begining FY 2013, under section 1923(f)(6)(B)(II) of the Act, Hawaii’s DSH allotment for a fiscal year is determined as for low-DSH states. This means Hawaii’s DSH alloment for a fiscal year is determined as forall States, by increasing the previous fiscal year allotment by the percentage increase in the CPIU for the previous fiscal year.4Expenditures based on the amounts reported by States on the Form CMS–37.5FMAP for Vermont for FY 2014 determined in accordance with section 1905(z)(1)(A) of the Act.


### 11442 Federal Register / Vol. 79, No. 40 / Friday, February 28, 2014 / Notices

K EY TO 

### ADDENDUM 2—P RELIMINARY 

### IMD DSH L IMITS FOR 

### FY 2014

Column Description

**The preliminary FY 2014 IMD DSH Limits for the Non-Low DSH States are presented in the top section of this addendum and the pre**

 

** liminary FY 2014 IMD DSH Limits for the Low-DSH States are presented in the bottom section of the addendum.**

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 2014 Federal Share DSH Allotment. This column contains the states’ preliminary FY 2014 DSH allotments from Column J Addendum 1.

Column G ......... FY 2014 FMAP. Column H ......... FY 2014 DSH Allotments in Total Computable, Col. F/G. This column contains states’ FY 2014 total computable DSH allotment (determined as Column F/Column G). Column I ........... Applicable Percentage Applied to FY 2014 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 2014 TC IMD DSH Limit. Lesser of Col. I or C. This column contains the total computable FY 2014 TC IMD DSH Limit equal to the lesser of the amount in Column I

or Column C. Column K .......... FY 2014 IMD DSH Limit in Federal Share, Col. G x J. This column contains the FY 2014 Federal Share IMD DSH limit determined by converting the total computable FY 2014 IMD

DSH Limit from Column J into a federal share amount by multiplying it by the FY 2014 FMAP in Column G.


### 11443 Federal Register / Vol. 79, No. 40 / Friday, February 28, 2014 / NoticesADDENDUM2—PRELIMINARYIMD DSH LIMIT FORFISCALYEAR2014StateInpatient hospitalservices FY 95DSH totalcomputableIMD andmental healthservices FY 95DSH totalcomputableTotal inpatient &IMD & mentalhealth FY 95 DSHtotal computablecol B + CApplicablepercentcol C/DFY 2014allotment in FSFY 2014FMAPs(percent)FY 2014allotments inTCcol F/GApplicablepercentageapplied to FY2014allotments iinTCcol E×Col HFY 2014 TCIMD limit(lesser of col Ior Col C)FY 2014 IMDlimit in FScol G×JA BCDEFGHIJKALABAMA ........................................... $413,006,229 $4,451,770 $417,457,999 1.07 $327,939,666 68.12 $481,414,659 $5,133,804 $4,451,770 $3,032,546ARIZONA ............................................ 93,916,100 28,474,900 122,391,000 23.27 107,980,135 67.23 160,613,022 37,367,451 28,474,900 19,143,675CALIFORNIA ...................................... 2,189,879,543 1,555,919 2,191,435,462 0.07 1,169,118,239 50.00 2,338,236,478 1,660,148 1,555,919 777,960COLORADO ....................................... 173,900,441 594,776 174,495,217 0.34 98,648,517 50.00 197,297,034 672,497 594,776 297,388CONNECTICUT .................................. 303,359,275 105,573,725 408,933,000 25.82 213,294,091 50.00 426,588,182 110,131,741 105,573,725 52,786,863DISTRICT OF COLUMBIA ................. 39,532,234 6,545,136 46,077,370 14.20 65,321,315 70.00 93,316,164 13,255,248 6,545,136 4,581,595FLORIDA ............................................ 184,468,014 149,714,986 334,183,000 33.00 213,294,091 58.79 362,806,755 119,726,229 119,726,229 70,387,050GEORGIA ........................................... 407,343,557 0 407,343,557 0.00 286,613,936 65.93 434,724,611 0 0 0ILLINOIS ............................................. 315,868,508 89,408,276 405,276,784 22.06 229,291,148 50.00 458,582,296 101,168,027 89,408,276 44,704,138INDIANA ............................................. 79,960,783 153,566,302 233,527,085 33.00 227,958,061 66.92 340,642,649 112,412,074 112,412,074 75,226,160KANSAS ............................................. 11,587,208 76,663,508 88,250,716 33.00 43,991,907 56.91 77,300,838 25,509,277 25,509,277 14,517,329KENTUCKY ........................................ 158,804,908 37,443,073 196,247,981 19.08 154,638,217 69.83 221,449,545 42,251,398 37,443,073 26,146,498LOUISIANA ......................................... 1,078,512,169 132,917,149 1,211,429,318 10.97 731,960,000 60.98 1,200,327,976 131,699,118 131,699,118 80,310,122MAINE ................................................. 99,957,958 60,958,342 160,916,300 33.00 111,979,398 61.55 181,932,409 60,037,695 60,037,695 36,953,201MARYLAND ........................................ 22,226,467 120,873,531 143,099,998 33.00 81,318,372 50.00 162,636,744 53,670,126 53,670,126 26,835,063MASSACHUSETTS ............................ 469,653,946 105,635,054 575,289,000 18.36 325,273,489 50.00 650,546,978 119,453,988 105,635,054 52,817,527MICHIGAN .......................................... 133,258,800 304,765,552 438,024,352 33.00 282,614,672 66.32 426,137,925 140,625,515 140,625,515 93,262,842MISSISSIPPI ....................................... 182,608,033 0 182,608,033 0.00 162,636,745 73.05 222,637,570 0 0 0MISSOURI .......................................... 521,946,524 207,234,618 729,181,142 28.42 505,240,380 62.03 814,509,721 231,485,157 207,234,618 128,547,634NEVADA ............................................. 73,560,000 0 73,560,000 0.00 49,324,258 63.10 78,168,396 0 0 0NEW HAMPSHIRE ............................. 92,675,916 94,753,948 187,429,864 33.00 170,740,344 50.00 341,480,688 112,688,627 94,753,948 47,376,974NEW JERSEY .................................... 736,742,539 357,370,461 1,094,113,000 32.66 686,540,358 50.00 1,373,080,716 448,489,771 357,370,461 178,685,231NEW YORK ........................................ 2,418,869,368 605,000,000 3,023,869,368 20.01 1,713,018,172 50.00 3,426,036,344685,463,469 605,000,000 302,500,000NORTH CAROLINA ............................ 193,201,966 236,072,627 429,274,593 33.00 314,608,785 65.78 478,274,225 157,830,494 157,830,494 103,820,899OHIO ................................................... 535,731,956 93,432,758 629,164,714 14.85 433,253,624 63.02 687,485,916 102,093,623 93,432,758 58,881,324PENNSYLVANIA ................................ 388,207,319 579,199,682 967,407,001 33.00 598,556,544 53.52 1,118,379,193 369,065,134 369,065,134 197,523,660RHODE ISLAND ................................. 108,503,167 2,397,833 110,901,000 2.16 69,320,580 50.11 138,336,819 2,991,033 2,397,833 1,201,554SOUTH CAROLINA ............................ 366,681,364 72,076,341 438,757,705 16.43 349,269,075 70.57 494,925,712 81,303,266 72,076,341 50,864,274TENNESSEE * ....................................0 0 0 0.00 0 65.29 0 0 0 0TEXAS ................................................ 1,220,515,401 292,513,592 1,513,028,993 19.33 1,019,812,376 58.69 1,737,625,449 335,934,780 292,513,592 171,676,227VERMONT ** ....................................... 19,979,252 9,071,297 29,050,549 31.23 23,995,586 56.76 42,275,521 13,200,914 9,071,297 5,148,868VIRGINIA ............................................ 129,313,480 7,770,268 137,083,748 5.67 93,430,890 50.00 186,861,780 10,591,818 7,770,268 3,885,134WASHINGTON ................................... 171,725,815 163,836,435 335,562,250 33.00 197,297,035 50.00 394,594,070 130,216,043 130,216,043 65,108,022WEST VIRGINIA ................................. 66,962,606 18,887,045 85,849,651 22.00 71,986,756 71.09 101,261,438 22,277,660 18,887,045 13,426,800TOTAL ......................................... 13,402,460,846 4,118,758,904 17,521,219,750 .................. 11,130,266,762 .................. 19,837,936,852 3,778,134,755 3,440,982,495 1,930,546,450**LOW DSH STATES**ALASKA ..............................................2,506,827 17,611,765 20,118,592 33.00 21,723,676 50.00 43,447,352 14,337,626 14,337,626 7,168,813ARKANSAS ........................................2,422,649 819,351 3,242,000 25.27 46,005,171 70.10 65,627,919 16,586,151 819,351 574,365DELAWARE ........................................0 7,069,000 7,069,000 33.00 9,654,966 55.31 17,456,095 5,760,511 5,760,511 3,186,139HAWAII ...............................................0 0 0 0.00 10,393,600 51.85 20,045,516 0 0 0IDAHO .................................................2,081,429 0 2,081,429 0.00 17,530,110 71.64 24,469,724 0 0 0IOWA .................................................. 12,011,250 0 12,011,250 0.00 41,998,821 57.93 72,499,259 0 0 0MINNESOTA ....................................... 24,240,000 5,257,214 29,497,214 17.82 79,653,479 50.00 159,306,958 28,392,877 5,257,214 2,628,607MONTANA ..........................................237,048 0 237,048 0.00 12,105,267 66.33 18,250,063 0 0 0NEBRASKA ........................................6,449,102 1,811,337 8,260,439 21.93 30,179,217 54.74 55,131,927 12,089,248 1,811,337 991,526NEW MEXICO ....................................6,490,015 254,786 6,744,801 3.78 21,723,676 69.20 31,392,595 1,185,861 254,786 176,312NORTH DAKOTA ...............................214,523 988,478 1,203,001 33.00 10,186,905 50.00 20,373,810 6,723,357 988,478 494,239OKLAHOMA ........................................ 20,019,969 3,273,248 23,293,217 14.05 38,619,866 64.02 60,324,689 8,477,046 3,273,248 2,095,533OREGON ............................................ 11,437,908 19,975,092 31,413,000 33.00 48,274,835 63.14 76,456,818 25,230,75019,975,092 12,612,273SOUTH DAKOTA ...............................321,120 751,299 1,072,419 33.00 11,778,790 53.54 21,999,981 7,259,994 751,299 402,245UTAH ..................................................3,621,116 934,586 4,555,702 20.51 20,922,000 70.34 29,744,100 6,101,896 934,586 657,388WISCONSIN .......................................6,609,524 4,492,011 11,101,535 33.00 100,816,461 59.06 170,701,763 56,331,582 4,492,011 2,652,982


### 11444 Federal Register / Vol. 79, No. 40 / Friday, February 28, 2014 / NoticesADDENDUM2—PRELIMINARYIMD DSH LIMIT FORFISCALYEAR2014—ContinuedStateInpatient hospitalservices FY 95DSH totalcomputableIMD andmental healthservices FY 95DSH totalcomputableTotal inpatient &IMD & mentalhealth FY 95 DSHtotal computablecol B + CApplicablepercentcol C/DFY 2014allotment in FSFY 2014FMAPs(percent)FY 2014allotments inTCcol F/GApplicablepercentageapplied to FY2014allotments iinTCcol E×Col HFY 2014 TCIMD limit(lesser of col Ior Col C)FY 2014 IMDlimit in FScol G×JA BCDEFGHIJKWYOMING ..........................................0 0 0 0.00 241,374 50.00 482,748 0 0 0TOTAL LOW DSH STATES ........ 98,662,480 63,238,167 161,900,647 .................. 521,808,214 .................. 887,711,318 188,476,899 58,655,539 33,640,422TOTAL .................................. 13,501,123,326 4,181,997,071 17,683,120,397 .................. 11,652,074,976 .................. 20,724,648,170 3,966,611,654 3,499,638,034 1,964,186,872FOOTNOTES:* Tennessee’s DSH allotment for FY 2014, determined under section 1923(f)(6)(A) of the Act, is $0.** Vermont’s FMAP for FY 2014 determined in accordance with section 1905(z)(1)(A) of the Act.


### 11445 Federal Register / Vol. 79, No. 40 / Friday, February 28, 2014 / Notices

[FR Doc. 2014–04032 Filed 2–27–14; 8:45 am]

**BILLING CODE 4120–01–P**

**DEPARTMENT OF HEALTH AND**

**HUMAN SERVICES**

**Administration for Children and**

**Families**

**Proposed Information Collection Activity; Comment Request** 

Title: Head Start Family and Child Experiences Survey (FACES).

OMB No.: 0970–0151. Description: The Office of Planning, Research and Evaluation (OPRE),

Administration for Children and Families (ACF), U.S. Department of Health and Human Services (HHS), is proposing to collect data for the Head Start Family and Child Experiences Survey (FACES). Featuring a new ‘‘Core Plus’’ study design, FACES will provide data on a set of key indicators, including information for performance measures. This design also allows for more rapid and frequent data reporting (Core study) and serves as a vehicle for studying more complex issues and topics in greater detail and with increased efficiency (Plus studies).

The FACES Core study will assess the

school readiness skills of Head Start children, survey their parents, and ask

their Head Start teachers to rate

children’s social and emotional skills. In addition, FACES will include observations in Head Start classrooms, and program director, center director, and teacher surveys. FACES Plus studies include additional survey content of policy or programmatic interest, and may include additional programs or respondents beyond those participating in the Core FACES study.

Previous notices provided the opportunity for public comment on the proposed Head Start program recruitment and center selection process (FR V.78, pg. 75569 12/12/2013; FR V.79, pg. 8461 02/12/2014). This notice describes the planned data collection activities for the FACES Core study and Plus studies. Direct child assessments, parent surveys, and teacher child reports for the Core study are included in this clearance package. Additionally, we describe instruments to support the Core study at the program and

classroom levels and the Plus studies anticipated for future submission. Since these instruments will be informed by initial findings of FACES and emerging policy needs, they cannot be fully specified at this time. However, we describe the respondents and data collection methods, estimated respondent burden, and how the

information will be used to the extent possible at this time. Subsequently, when fully developed in a manner consistent with the description provided in this 60-day notice and prior to use, we will submit these materials for a 30-day public comment period under the Paperwork Reduction Act.

Methods for Core data collection start

with site visits in fall 2014 to 60 Head Start programs to directly assess the school readiness skills of 2,400 children sampled to participate in FACES. Parents of sampled children will complete surveys on the Web or by telephone about their children and family background. Head Start teachers will rate each sampled child (approximately 10 children perclassroom) using the Web or paper-andpencil forms. These activities will occur a second time in spring 2015. Additionally, the program sample size will increase to 180 programs in the spring to collect program- and

classroom-level data. The methods of data collection for this phase will feature site visitors conducting observations of the types and quality of classroom activities. Head Start program directors, center directors, and teachers will complete surveys about themselves

and the services and instruction at Head Start. The program- and classroom-level

data collection will occur a second time in spring 2017.

Plus study data collection will parallel the Core design in many ways, including recruitment and data collection procedures, to add new respondents, include new populations, or expand on the information gathered in the Core study. Additional early care

and education administrators or providers (such as Education Coordinators or Family Service Staff) may be sampled. Plus studies may

involve data collection in additional programs, such as programs serving different populations or programs implementing specific interventions.

Data collection for these Plus studies may include child assessments, parent surveys, teacher child reports, and staff surveys. Plus studies may also feature topical modules to gather information in greater depth on particular topics (for example, parent engagement or program functioning). The methods of data

collection will involve new methodologies such as qualitative interviews and supplemental surveys with expanded content.

The purpose of the Core data collection is to support the 2007

reauthorization of the Head Start program (P.L. 110–134), which calls for periodic assessments of Head Start’s quality and effectiveness. Plus data collection will further support understanding Head Start functioning for a broader set of programs or in more depth for particular topics.

Annual Burden Estimates

Respondents: Head Start children, parents of Head Start children, and Head Start teachers, directors, and other early care and education program staff.

Instrument Total number of respondents Annual
number of respondents Number of

responses per

respondent Average
burden hour

per response Estimated
annual burden
hours

**Core Study**

Head Start core child assessment ....................................... 2,400 800 2 0.75 1,200 Head Start core parent survey ............................................ 2,400 800 2 0.25 400 Head Start fall parent supplemental survey ........................ 2,400 800 1 0.08 64 Head Start spring parent supplemental survey ................... 2,400 800 1 0.08 64 Head Start core teacher child report ................................... 240 80 20 0.17 272 Head Start core teacher survey ........................................... 720 240 2 0.50 240 Head Start core program director survey ............................ 180 60 2 0.25 30 Head Start core center director survey ............................... 360 120 2 0.25 60

**Plus Studies**

Head Start parent qualitative interview ................................ 400 133 2 1.00 267 Head Start staff qualitative interview ................................... 300 100 2 1.00 200 Head Start child assessment for plus study ........................ 1,350 450 2 0.75 675