21314 Federal Register / Vol. 75, No. 78 / Friday, April 23, 2010 / Notices 

form for those reporting on program 

income; short form for all others) will be 

used for financial reporting. 

Federal Cash Transaction Reports are 

due every calendar quarter to the 

Division of Payment Management, 

Payment Management Branch. Failure 

to submit timely reports may cause a 

disruption in timely payments to your 

organization. 

Grantees are responsible and 

accountable for accurate reporting of the 

Progress Reports and FSRs which are 

generally due [semi-annually/annually]. 

FSRs (SF–269) are due 90 days after 

each budget period and the final SF–269 

must be verified from the grantee 

records on how the value was derived. 

Failure to submit required reports 

within the time allowed may result in 

suspension or termination of an active 

agreement, withholding of additional 

awards for the project, or other 

enforcement actions such as 

withholding of payments or converting 

to the reimbursement method of 

payment. Continued failure to submit 

required reports may result in one or 

both of the following: (1) The 

imposition of special award provisions; 

and (2) the non-funding or non-award of 

other eligible projects or activities. This 

applies whether the delinquency is 

attributable to the failure of the 

organization or the individual 

responsible for preparation of the 

reports. 

Telecommunication for the hearing 

impaired is available at: TTY (301) 443– 

6394. 

VII. Agency Contact(s) 

Grants (Business) 

Mr. Roscoe Brunson, Grants 

Management Specialist, 801 Thompson 

Ave., Reyes Bldg., Suite 360, Rockville, 

MD 20852. Telephone: (301) 443–5204. 

E-mail: Roscoe.Brunson@ihs.gov. 

Program (Programmatic/Technical) 

Ms. Nancy Bill, Program Manager, IPP 

Program, HIS, 801 Thompson Ave, Suite 

120, OEHE–DEHS TWB 610, Rockville, 

MD 20852. Phone: (301) 443–0105. 

Nancy.Bill@ihs.gov. 

VIII. Other Information—Allowable 

and Non-Allowable Items 

The following will be considered 

allowable equipment purchases— 

Equipment/Construction: 

(1) Costs of breath testing devices are 

allowable, provided the device appears 

on the National Highway Traffic Safety 

Administration (NHTSA) Conforming 

Products List (CPL) for this type of 

equipment. 

(2) Police traffic radar—cost is 

allowable subject to the following: 

• Devices must appear on the NHTSA 

Conforming Products List (CPL) when 

published in the Federal Register. 

• Operators must be trained using the 

NHTSA radar operators training 

program or an approved equivalent. 

• The police agency must implement 

a comprehensive radar operator and one 

to three year equipment certification 

program with periodic recertification 

once every one to three years. 

(3) Costs for child restraint devices are 

allowable. Child safety seat restraint 

devices must be a ‘‘5 star rating’’ in 

accordance with the National Highway 

Traffic Safety Administration Federal 

Safety Standards (no after market 

devices) and strict performance 

standards (Federal Motor Vehicle Safety 

Standards, FMVSS 213,225). 

(4) Cost for limited construction or 

home safety devices installation that is 

aligned with the program’s objectives or 

targets specific outcome in reducing 

unintentional fall prevention projects 

are acceptable. 

(5) Media campaign when combined 

with enforcement, policy, or incentive 

programs (print, radio and video). 

The following costs are deemed 

unallowable costs—Equipment/ 

Facilities: 

(1) Police officer equipment— 

uniforms, weapons, handguns, 

shotguns, mace, batons, riot helmets, 

bulletproof vests, and ammunition. 

(2) Portable scales—including costs 

associated with transportation and use 

of portable scales. Costs for large 

computer systems are not allowable. 

(Automatic Data Processing, Main 

Frame, LAN). 

(3) Costs for commercial lease or 

purchase of vehicle or motorcycles. 

(4) Costs of equipment maintenance 

or repairs of vehicles. 

(5) Costs for speed measuring 

devices—except for enforcement 

purposes and related project evaluation 

are not allowable i.e. speed trailers. 

(6) Projects related to water, sanitation 

and waste management. 

(7) Projects that include design and 

planning of construction of facilities. 

(8) Projects not utilizing effective 

strategies based on evidence or best 

practice. 

(9) Projects with an education only 

activities. 

(10) Animal control programs. 

(11) Tribal employee defensive 

driving course. 

IHS IPP is the lead Federal agency in 

the development and implementation of 

AI/AN IPP. IHS is directed to develop, 

implement, and evaluate IPP that would 

be successful in reducing American 

Indian and Alaskan Native morbidity 

and mortality related to injuries. The 

purpose of the IHS CA funding is to 

promote the capacity of Tribes and 

Tribal/urban/non-profit Indian 

organizations to build and sustain 

evidence-based IPP. The Public Health 

Service (PHS) strongly encourages all 

contracts to provide a smoke-free 

workplace and promote the non-use of 

all tobacco products. Public Law 103– 

227, the Pro-Children Act of 1994, 

prohibits smoking in certain facilities 

(or in some cases, any portion of the 

facility) in which regular or routine 

education, library, day care, health care 

of early childhood development services 

are provided to children. This is 

consistent with the IHS mission to 

protect and advance the physical and 

mental health of the AI/AN people. 

Dated: April 19, 2010. 

Yvette Roubideaux, 

Director, Indian Health Service. 

[FR Doc. 2010–9502 Filed 4–22–10; 8:45 am] 

BILLING CODE 4165–16–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–2300–N] 

RIN 0938–AP66 

Medicaid Program; Final FY 2008, 

Revised Preliminary FY 2009, and 

Preliminary FY 2010 Disproportionate 

Share Hospital Allotments and Final FY 

2008, Revised Preliminary FY 2009, 

and Preliminary FY 2010 

Disproportionate Share Hospital 

Institutions for Mental Disease 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) 2008 and the 

preliminary Federal share DSH 

allotments for FY 2010. This notice also 

announces the final FY 2008 and the 

preliminary FY 2010 limitations on 

aggregate DSH payments that States may 

make to institutions for mental disease 

and other mental health facilities. This 

notice also announces the revised 

preliminary Federal share DSH 

allotments for FY 2009 and the revised 

preliminary FY limitations on aggregate 

DSH payments that States may make to 

institutions for mental disease and other 

mental health facilities to reflect the 

provisions of the American 

Reinvestment and Recovery Act of 2009 

(the Recovery Act), enacted on February 

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Federal Register / Vol. 75, No. 78 / Friday, April 23, 2010 / Notices 21315 

17, 2009. This notice also includes 

background information describing the 

methodology for determining the 

amounts of States’ FY DSH allotments. 

DATES: Effective Date: This notice is 

effective June 22, 2010. The final 

allotments and limitations set forth in 

this notice are effective for the fiscal 

year’s specified. 

FOR FURTHER INFORMATION CONTACT: 

Richard Strauss, (410) 786–2019. 

SUPPLEMENTARY INFORMATION: 

I. Background 

A. Disproportionate Share Hospital 

Allotments for Federal FY 2003 

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). 

Most States’ actual FY 2002 

allotments were determined in 

accordance with the provisions of 

section 1923(f)(4) of the Act which 

allowed for a special DSH calculation 

rule for FY 2001 and FY 2002. However, 

as indicated previously, the calculation 

of States’ FY 2003 allotments was not 

based on the actual FY 2002 DSH 

allotments; rather, section 1923(f)(3) of 

the Act requires that the States’ FY 2003 

allotments be determined using the 

amount of the States’ FY 2002 

allotments specified in the chart in 

section 1923(f)(2) of the Act. The 

exception to this is the calculation of 

the FY 2003 DSH allotments for certain 

‘‘Low-DSH States’’ (defined in section 

1923(f)(5) of the Act). Under the LowDSH State provision, there is a special 

calculation methodology for the LowDSH States only. Under this 

methodology, the FY 2003 allotments 

were determined by using (that is, 

increasing) States’ actual FY 2002 DSH 

allotments (not their FY 2002 allotments 

specified in the chart in section 

1923(f)(2) of the Act) by the percentage 

change in the CPI–U for the previous 

fiscal year. 

B. DSH Allotments for FY 2004 

Section 1001(a) of the Medicare 

Prescription Drug, Improvement, and 

Modernization Act of 2003 (MMA) (Pub. 

L. 108–173, enacted on December 8, 

2003) amended section 1923(f)(3) of the 

Act to provide for a ‘‘Special, Temporary 

Increase In Allotments On A One-Time, 

Non-Cumulative 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 so determined were not subject 

to the 12 percent limit. 

C. DSH Allotments for Non-Low DSH 

States for FY 2005, and FYs Thereafter 

Under the methodology contained in 

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

amended by section 1001(a)(2) of the 

MMA, the non-Low-DSH States’ DSH 

allotments for FY 2005 and subsequent 

FYs continue at the same level as the 

States’ DSH allotments for FY 2004 until 

a ‘‘fiscal year specified’’ occurs. The 

fiscal year specified is the first FY for 

which the Secretary estimates that a 

State’s DSH allotment equals (or no 

longer exceeds) the DSH allotment as 

would have been determined under the 

statute in effect before the enactment of 

the MMA. We determine whether the 

fiscal year specified has occurred under 

a special parallel process. Specifically, 

under this parallel process, a ‘‘parallel’’ 

DSH allotment is determined for FYs 

after 2003 by increasing the State’s DSH 

allotment for the previous FY by the 

percentage change in the CPI–U for the 

prior FY, subject to the 12 percent limit. 

This is the methodology as would 

otherwise have been applied under 

section 1923(f)(3)(A) of the Act 

notwithstanding the application of the 

provisions of MMA. The fiscal year 

specified, is the FY in which the 

parallel DSH allotment calculated under 

this special parallel process finally 

equals or exceeds the FY 2004 DSH 

allotment, as determined under the 

MMA provisions. Once the fiscal year 

specified occurs for a State, that State’s 

FY DSH allotment will be calculated by 

increasing the State’s previous actual FY 

DSH allotment (which would be equal 

to the FY 2004 DSH allotment) by the 

percentage change in the CPI–U for the 

previous FY, subject to the 12 percent 

limit. The following example illustrates 

how the FY DSH allotment would be 

calculated for FYs after FY 2004. 

Example—In this example, we are 

determining the parallel FY 2009 DSH 

allotment. A State’s actual FY 2003 DSH 

allotment is $100 million. Under the 

MMA, this State’s actual FY 2004 DSH 

allotment would be $116 million ($100 

million increased by 16 percent). The 

State’s DSH allotment for FY 2005 and 

subsequent FYs would continue at the 

$116 million FY 2004 DSH allotment for 

FYs following FY 2004 until the fiscal 

year specified occurs. Under the 

separate parallel process, we determine 

whether the fiscal year specified has 

occurred by calculating the State’s DSH 

allotments in accordance with the 

statute in effect before the enactment of 

the MMA. Under this special process, 

we continue to determine the State’s 

parallel DSH allotment for each FY by 

increasing the State’s parallel DSH 

allotment for the previous FY (as also 

determined under the special parallel 

process) by the percentage change in the 

CPI–U for the previous FY, and subject 

to the 12 percent limit. Assume for 

purposes of this example that, in 

accordance with this special parallel 

process, the State’s parallel FY 2008 

DSH allotment was determined to be 

$115 million and the percentage change 

in the CPI–U for FY 2008 (the previous 

FY) relevant for the calculation of the 

FY 2009 DSH allotment was 4.4 percent. 

That is, the percentage change for the 

CPI–U for FY 2008, the year before FY 

2009, was 4.4 percent. Therefore, the 

State’s special parallel process FY 2009 

DSH allotment amount would be 

calculated by increasing the special 

parallel process FY 2008 DSH allotment 

amount of $115 million by 4.4 percent; 

this results in a parallel process DSH 

allotment process amount for FY 2009 

of $120.06 million. Since $120.06 

million is greater than $116 million (the 

actual FY 2004 DSH allotment 

calculated under the MMA), we would 

determine that FY 2009 is the fiscal year 

specified (the first year that the FY 2004 

allotment equals or no longer exceeds 

the parallel process allotment). Since FY 

2009 is the fiscal year specified, we 

would then determine the State’s FY 

2009 allotment by increasing the State’s 

actual FY 2008 DSH allotment ($116 

million) by the percentage change in the 

CPI–U for FY 2008 (4.4 percent). 

Therefore, the State’s FY 2009 DSH 

allotment would be $121.104 million 

($116 million increased by 4.4 percent); 

for purposes of the calculation in this 

example, the application of the 12 

percent limit has no effect. Furthermore, 

for FY 2009 and thereafter, the State’s 

DSH allotment would be calculated 

under the provisions of section 

1923(f)(3)(A) of the Act by increasing 

the State’s previous FY’s DSH allotment 

by the percentage change in the CPI–U 

for the previous FY, subject to the 12 

percent limit. 

However, as amended by section 

1001(b)(4) of the MMA, section 

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21316 Federal Register / Vol. 75, No. 78 / Friday, April 23, 2010 / Notices 

1923(f)(5)(B) of the Act also contains 

criteria for determining whether a State 

is a Low-DSH State, beginning with FY 

2004. This provision is described in 

section I.D. 

D. DSH Allotments for Low-DSH States 

for FY 2004 and FYs Thereafter 

Section 1001(b)(1) of the MMA 

amended section 1923(f)(5) of the Act 

regarding the calculation of the FY DSH 

allotments for ‘‘Low-DSH’’ States for FY 

2004 and subsequent fiscal years. 

Specifically, under section 1923(f)(5)(B) 

of the Act, as amended by section 

1001(b)(4) of the MMA, a State is 

considered a Low-DSH State for FY 

2004 if its total DSH payments under its 

State plan for FY 2000 (including 

Federal and State shares) as reported to 

CMS as of August 31, 2003, are greater 

than 0 percent and less than 3 percent 

of the State’s total FY 2000 expenditures 

under its State plan for medical 

assistance. For States that meet the new 

Low-DSH criteria, their FY 2004 DSH 

allotments are calculated by increasing 

their FY 2003 DSH allotments by 16 

percent. Therefore, for FY 2004, LowDSH States’ FY DSH allotments are 

calculated in the same way as the DSH 

allotments for regular States, which 

under section 1923(f)(3) of the Act, get 

the special temporary increase for FY 

2004. 

Furthermore, for States meeting the 

MMA’s Low-DSH definition, the DSH 

allotments for FYs 2005 through 2008 

will continue to be determined by 

increasing the previous FY’s DSH 

allotment by 16 percent. The Low-DSH 

States’ DSH allotments for FYs 2004 

through 2008 are not subject to the 12 

percent limit. The Low-DSH States’ DSH 

allotments for FYs 2009 and subsequent 

FYs are calculated by increasing those 

States’ DSH allotments for the prior FY 

by the percentage change in the CPI–U 

for that prior fiscal year. For FYs 2009 

and thereafter, the DSH allotments so 

determined would be subject to the 12 

percent limit. 

E. Institutions for Mental Diseases DSH 

Limits for FYs 1998 and Thereafter 

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. 

Each State’s IMD limit on DSH 

payments to IMDs and other mental 

health facilities was calculated by first 

determining the State’s total computable 

DSH expenditures attributable to the FY 

1995 DSH allotment for mental health 

facilities and inpatient hospitals. This 

calculation was based on the total 

computable DSH expenditures reported 

by the State on the Form CMS–64 as 

mental health DSH and inpatient 

hospital as of January 1, 1997. We then 

calculate an ‘‘applicable percentage.’’ 

The applicable percentage for FY 1998 

through FY 2000 (1995 IMD DSH 

percentage) is calculated by dividing the 

total computable amount of IMD and 

mental health DSH expenditures 

applicable to the State’s FY 1995 DSH 

allotment by the total computable 

amount of all DSH expenditures (mental 

health facility plus inpatient hospital) 

applicable to the FY 1995 DSH 

allotment. For FY 2001 and thereafter, 

the applicable percentage is defined as 

the lesser of the applicable percentage 

as calculated above (for FYs 1998 

through 2001) or 50 percent for FY 

2001; 40 percent for FY 2002; and 33 

percent for each subsequent fiscal year. 

The applicable percentage is then 

applied to each State’s total computable 

FY DSH allotment for the current fiscal 

year. The State’s total computable FY 

DSH allotment is calculated by dividing 

the State’s Federal share DSH allotment 

for the FY by the State’s Federal medical 

assistance percentage (FMAP) for that 

fiscal year. 

In the final step of the calculation of 

the IMD DSH Limit, the State’s total 

computable IMD DSH limit for the FY 

is set at the lesser of the product of a 

State’s current FY total computable DSH 

allotment and the applicable percentage 

for that FY, or the State’s FY 1995 total 

computable IMD and other mental 

health facility DSH expenditures 

applicable to the State’s FY 1995 DSH 

allotment as reported on the Form 

CMS–64. 

The MMA legislation did not amend 

the Medicaid statute with respect to the 

calculation of the IMD DSH limit. 

F. Publication in the Federal Register 

of Preliminary and Final Notice for DSH 

Allotments and IMD DSH Limits 

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 such preliminary FY DSH 

allotment. For example, in determining 

the preliminary FY 2009 DSH allotment, 

we would apply the CPI–U percentage 

increase for FY 2008 that was available 

just before the beginning of FY 2009 on 

October 1, 2008. 

The DSH allotments and IMD DSH 

limits determined using these estimates 

and CPI–U percentage increases 

available before the beginning of the FY 

are referred to as ‘‘preliminary.’’ Only 

after we receive States’ reports of the 

actual medical assistance expenditures 

through the quarterly expenditure report 

(Form CMS–64), and the final historic 

CPI–U percentage increases for the prior 

FY, which occurs after the end of the 

FY, are the ‘‘final’’ DSH Allotments and 

IMD DSH limits determined. 

The notice published in the Federal 

Register on December 28, 2007 (72 FR 

73831), included the announcement of 

the preliminary FY 2008 DSH 

allotments (based on estimates), and the 

preliminary FY 2008 IMD DSH limits 

(since they were based on the 

preliminary DSH allotments for FY 

2008). The notice published in the 

Federal Register on December 19, 2008 

(73 FR 77704) and the correction notice 

published in the Federal Register on 

January 26, 2009 (74 FR 4439) 

announced the final FY 2007 DSH 

allotments and the final FY 2007 IMD 

DSH limits (since they were based on 

the actual expenditures for years), and 

the preliminary FY 2009 DSH 

allotments (based on estimates and 

CPI–U percentage increases for FY 2008 

available prior to the beginning of FY 

2009), and the preliminary FY 2009 IMD 

DSH limits (since they were based on 

the preliminary DSH allotments for FY 

2009). 

This notice announces the final FY 

2008 DSH allotments and the final FY 

2008 IMD DSH limits (since these are 

now based on the actual expenditures 

for that FY), the preliminary FY 2010 

DSH allotments (based on expenditure 

estimates), and the preliminary IMD 

DSH limits for FY 2010 (since they are 

based on the preliminary DSH 

allotments for FY 2010). This notice 

does not include the final FY 2009 DSH 

allotments or the final FY 2009 IMD 

DSH limits, since the actual 

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Federal Register / Vol. 75, No. 78 / Friday, April 23, 2010 / Notices 21317 

expenditures for FY 2009 are not 

available at this time. 

However, this notice also announces 

revised preliminary FY 2009 DSH 

Allotments and revised preliminary FY 

2009 IMD DSH limits determined in 

accordance with the provisions of 

section 5002 of the American Recovery 

and Reinvestment Act of 2009 (the 

Recovery Act, Pub. L. 111–5) enacted on 

February 17, 2009, and the final historic 

CPI–U percentage increase for FY 2008. 

This DSH provision of the Recovery Act 

is described in section H below. 

G. DSH Allotment Provisions for Certain 

States 

1. DSH Allotments for the State of 

Tennessee 

Section 1923(f)(6)(A) of the Act, as 

amended by section 404 of Public Law 

109–432 (enacted on December 20, 

2006), section 204 of Public Law 110– 

173 (enacted on December 29, 2007), 

section 202 of Public Law 110–275 

(enacted on July 15, 2008), and most 

recently section 616 of Public Law 111– 

3 (enacted on February 4, 2009) 

provides for the determination of a DSH 

allotment for the State of Tennessee for 

each of FYs 2007 through FY 2011, and 

for a period in FY 2012. In accordance 

with this provision, Tennessee’s DSH 

allotment for each of these FYs is the 

greater of $280 million and the FY 2007 

Federal medical assistance percentage of 

the DSH payment adjustments reflected 

in the State’s TennCare Demonstration 

Project for the demonstration year 

ending in 2006. In accordance with this 

provision, the State’s Federal share DSH 

allotment for each of FYs 2007 through 

FY 2011 is $305,451,928. Furthermore, 

Tennessee’s DSH allotment for the 

period October 1, 2011 through 

December 31, 2011 (the first quarter of 

FY 2012) is one-fourth of this amount; 

that is, $76,362,982. Section 

1923(f)(6)(A)(ii) of the Act further limits 

the amount of Federal funds that are 

available for DSH payments that 

Tennessee may make in each FY to 30 

percent of the DSH allotment. In this 

regard, the limit on the DSH payments 

that the State of Tennessee may make is 

effectively $91,635,578 (30 percent of 

$305,451,928) for each FY 2007 through 

FY 2011, and $22,908,895 (30 percent of 

$76,362,982) for the period October 1, 

2011 through December 31, 2011. 

2. DSH Allotments for the State of 

Hawaii 

Section 1923(f)(6)(B) of the Act, as 

amended by section 404 of Public Law 

109–432, section 204 of Public Law 

110–173, section 202 of Public Law 

110–275, and most recently section 616 

of Public Law 111–3 (enacted on 

February 4, 2009) provides for a DSH 

allotment for the State of Hawaii for 

each of FYs 2007 through FY 2011, and 

for a period in FY 2012. In accordance 

with this provision, Hawaii’s DSH 

allotment for FY 2007 through FY 2011 

is $10 million. Furthermore, Hawaii’s 

DSH allotment for the period October 1, 

2011 through December 31, 2011 (the 

first quarter of FY 2012) is $2.5 million. 

H. DSH Allotments for FY 2009 and FY 

2010 Under the Recovery Act 

Section 5002 of the Recovery Act 

added a new section 1923(f)(3)(E) of the 

Act; this new section provides for a 

temporary increase in States’ DSH 

allotments for FY 2009 and FY 2010. 

1. Revised Preliminary DSH Allotments 

for FY 2009 

As indicated above, States’ 

preliminary FY 2009 DSH allotments 

were previously published in the 

Federal Register on January 26, 2009. 

However, section 5002 of the Recovery 

Act enacted after the publication of the 

preliminary FY 2009 DSH allotments 

provided for an increase in States’ DSH 

allotments from what were previously 

determined and published in the 

Federal Register on January 26, 2009. 

The Recovery Act 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, requires that in general States’ DSH 

allotments for FY 2009 be equal to 102.5 

percent of the FY 2009 allotments that 

would otherwise have been determined; 

this provision does not apply to certain 

States as discussed in section G. above. 

As described in section F above, we 

typically publish States’ preliminary 

DSH allotments based on expenditure 

estimates and CPI–U percentage 

increases available before the FY for 

which the preliminary DSH allotment is 

being determined. The preliminary DSH 

allotments are subsequently finalized 

after the FY is over and when the 

applicable inputs for determining the 

DSH allotments (that is, the applicable 

expenditures and the CPI–U percentage 

increase for the previous FY) are final. 

Due to the Recovery Act temporary 

increase for FY 2009, in this notice, we 

are announcing a revision to the 

preliminary FY 2009 DSH allotments 

previously published to reflect updated 

States’ expenditures, and more 

significantly, to reflect an updated and 

increased CPI–U percentage increase. As 

described above, States’ DSH allotments 

are determined by increasing the 

previous FY allotment by the applicable 

CPI–U percentage increase. In 

particular, when we previously 

calculated the preliminary FY 2009 

allotments, the applicable CPI–U 

percentage increase for FY 2008 (used 

for determining the FY 2009 DSH 

allotment) which was available before 

the beginning of FY 2009 was 4.0 

percent. However, subsequent to our 

initial determination of the preliminary 

FY 2009 DSH allotments, the historical 

applicable CPI–U percentage increase 

for FY 2008 became available; that 

actual CPI–U increase for FY 2008 is 4.4 

percent. In order to ensure that the full 

increase in DSH allotments for FY 2009 

is available to States during FY 2009, we 

revised the preliminary FY 2009 DSH 

allotments prior to the end of FY 2009 

to reflect both the updated increase in 

the applicable CPI–U percentage 

increase for FY 2008 and the 2.5 percent 

increase in States’ FY 2009 DSH 

allotments as required under the 

Recovery Act. 

We note that section 5001 of the 

Recovery Act provided for the Federal 

medical assistance percentage (FMAP) 

for each State to be increased during the 

‘‘Recession Adjustment Period’’ 

specified in such section. As referenced 

in this notice and in the included 

charts, the FMAP is a factor in the 

methodology for determining States’ 

fiscal year DSH allotments and IMD 

DSH limits. However, section 5001(e) of 

the Recovery Act specifically precludes 

the use of the Recovery Act increased 

FMAP with respect to the determination 

of DSH payments. Therefore, the regular 

FMAP is used in the calculation of the 

fiscal year DSH allotments and the IMD 

DSH limits. 

2. Preliminary DSH Allotments for FY 

2010 

Sections 1923(f)(3)(E)(i)(II) and (ii) of 

the Act, as amended by Section 5002 of 

the Recovery Act, provide that the FY 

2010 DSH allotment for a State is 

determined as the higher of: 

• 102.5 percent of the DSH allotment 

for FY 2009, as determined under the 

Recovery Act provision, or 

• The FY 2010 DSH allotment as 

would otherwise be calculated without 

the application of the Recovery Act 

provision (using the preliminary 

applicable percentage increase in the 

CPI–U for FY 2009 (the preceding fiscal 

year) that was available at the beginning 

of FY 2010). 

In accordance with the Recovery Act 

provision, we have determined the 

preliminary FY 2010 DSH allotments for 

most States as 102.5 percent of the DSH 

allotments for FY 2009, as determined 

under the Recovery Act. The exception 

is that this provision does not apply for 

the States described in section G above. 

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3. Determination of FY DSH Allotments 

for FYs After FY 2010 

Under section 1923(f)(3)(E)(i)(III) of 

the Act, as amended by the Recovery 

Act, for FYs after FY 2010, the States’ 

DSH allotments are determined as 

previously calculated under the statute 

before the enactment of the Recovery 

Act. 

4. Effect of the Recovery Act DSH 

Provision on Calculation of the States’ 

IMD DSH Limits for FY 2009 and FY 

2010 

Section E above described the 

determination of States’ IMD DSH limits 

for FYs beginning FY 1998 and after, as 

determined under section 1923(h) of the 

Act. Section 5002 of the Recovery Act 

did not amend section 1923(h) of the 

Act. Accordingly, States’ IMD DSH 

limits for FY 2009 and FY 2010, the FYs 

for which the Recovery Act provisions 

are applicable, are determined as under 

the existing provisions. As described in 

section E above, States’ DSH allotments 

are an element of the determination of 

the IMD DSH limit; therefore, the DSH 

allotments for FY 2009 and FY 2010, as 

determined under the Recovery Act 

provisions, would be used in calculating 

States’ FY 2009 and FY 2010 IMD DSH 

limits in the same way as the DSH 

allotments were applied under section 

1923(h) of the Act regardless of the 

Recovery Act provision. 

II. Provisions of the Notice 

A. Calculation of the Final FY 2008 

Federal Share State DSH Allotments, 

the Revised Preliminary FY 2009 State 

DSH Allotments, and the Preliminary 

FY 2010 Federal Share State DSH 

Allotments 

1. Final FY 2008 Federal Share State 

DSH Allotments 

Chart 1 of the Addendum to this 

notice provides the States’ ‘‘final’’ FY 

2008 DSH allotments. The final FY 2008 

DSH allotments for each State were 

computed in accordance with the 

provisions of the Medicaid statute as 

amended by the MMA. As required by 

the provisions of the MMA, the final FY 

2004 DSH allotments for the ‘‘Low-DSH’’ 

States and all the other States were 

calculated by increasing the FY 2003 

DSH allotments by 16 percent. In the 

March 26, 2004 notice published in the 

Federal Register (69 FR 15850), we 

explained the definition and 

determination of the ‘‘Low-DSH’’ States 

under the MMA provisions. However, 

for following FYs, the DSH allotments 

are determined under a process which 

incorporates the ‘‘parallel process’’ 

described in the above section I.C of this 

notice. Under that parallel process, 

States’ final FY 2008 DSH allotments 

were determined using the States’ actual 

FY 2008 expenditures as reported by 

States (on Form CMS–64). 

2. Revised Calculation of the States’ 

Preliminary FY 2009 Federal Share 

State DSH Allotments 

Chart 2 of the Addendum to this 

notice provides the States’ revised 

‘‘preliminary’’ FY 2009 DSH allotments 

as discussed above in section I.H.1 of 

this notice. 

As discussed in section I.C and I.F of 

this notice, the preliminary FY 2009 

DSH allotments were previously 

published in the Federal Register on 

January 26, 2009. As described above 

and in the previous Federal Register 

notice 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 

have been determining whether the 

fiscal year specified (as defined in 

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

occurred. Under section 1923(f)(3)(D) of 

the Act, 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; under 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 under section 

1923(f)(3)(C)(i) of the Act (under which 

the States’ FY 2003 DSH allotments 

were increased by 16 percent). In other 

words, 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. 

We are reiterating the parallel process 

provision because for all non-Low DSH 

States (except Louisiana), we have 

determined that FY 2009 is the fiscal 

year specified. Therefore, as indicated 

in section 1923(f)(3)(C)(ii) of the Act, the 

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 2 illustrates 

the revised preliminary FY 2009 DSH 

allotments. For the non-Low DSH States 

for which the FY 2009 is the fiscal year 

specified, the FY 2010 and subsequent 

FY DSH allotments will be 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 allotment is calculated using the 

same methodology as for the non-Low 

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. 

The preliminary FY 2009 allotments 

were initially determined using the 

States’ August 2008 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 2009. As discussed in 

section I.H.1 above, based on the 

updated CPI–U percentage increase for 

FY 2008 (from 4.0 percent to 4.4 

percent), and the enactment of section 

5002 of the Recovery Act (which 

provides that States’ FY 2009 DSH 

allotments are equal to 102.5 percent of 

such allotments as would otherwise be 

determined for such FY), we are 

revising the preliminary FY 2009 DSH 

allotments in this notice from what was 

previously published in the Federal 

Register correction notice on January 

26, 2009. 

States’ final FY 2009 DSH allotments 

will be published in the Federal 

Register following receipt of the States’ 

four quarterly Medicaid expenditure 

reports (Form CMS–64) for FY 2009 

following the end of FY 2009. 

3. Calculation of the Preliminary FY 

2010 Federal Share State DSH 

Allotments 

Chart 3 of the Addendum to this 

notice provides the preliminary FY 2010 

DSH allotments determined in 

accordance with the Recovery Act 

provisions discussed above in section 

I.H.2 of this notice. States’ final FY 2010 

DSH allotments will be published in the 

Federal Register following receipt of the 

States’ four quarterly Medicaid 

expenditure reports (Form CMS–64) for 

FY 2010 following the end of FY 2010. 

B. Calculation of the Final FY 2008, 

Revised Preliminary FY 2009, and 

Preliminary FY 2010 IMD DSH Limits 

As discussed in section I.E. and I.H.4 

above of this notice, 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 

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Federal Register / Vol. 75, No. 78 / Friday, April 23, 2010 / Notices 21319 

IMD or DSH payments that exceed such 

IMD limits. In this notice, we are 

publishing the final FY 2008 IMD DSH 

Limit, the revised preliminary FY 2009 

IMD DSH Limit, and the preliminary FY 

2010 IMD DSH Limit determined in 

accordance with the provisions 

discussed above, and for FY 2009 and 

FY 2010, reflecting the DSH allotments 

for such FYs determined under the 

provisions of section 5002 of the 

Recovery Act. 

Charts 4, 5, and 6 of the Addendum 

to this notice detail each State’s final 

IMD DSH Limit for FY 2008, revised 

preliminary IMD DSH Limit for FY 

2009, and the preliminary IMD DSH 

Limit for FY 2010, respectively, 

determined in accordance with section 

1923(h) of the Act. 

III. Collection of Information 

Requirements 

This document does not impose 

information collection and 

recordkeeping requirements. 

Consequently, it need not be reviewed 

by the Office of Management and 

Budget under the authority of the 

Paperwork Reduction Act of 1995 (44 

U.S.C. 35). 

IV. Regulatory Impact Statement 

We have examined the impact of this 

rule as required by Executive Order 

12866 (September 1993, Regulatory 

Planning and Review), the Regulatory 

Flexibility Act (RFA) (September 19, 

1980, Pub. L. 96–354), section 1102(b) of 

the Social Security Act, the Unfunded 

Mandates Reform Act of 1995 (Pub. L. 

104–4), and Executive Order 13132. 

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 reach 

the economic threshold and thus is 

considered a major rule. 

There are no changes between the 

preliminary and final FY 2008 DSH 

allotments and FY 2008 IMD DSH 

limits. This is because FY 2008 was not 

determined to be the fiscal year 

specified for any State. That is, only 

substantive changes related to the 

CPI–U or the States’ Medicaid 

expenditures that would affect the 

determination of the fiscal year 

specified would have resulted in a 

change between the preliminary and 

final DSH allotments and IMD limits for 

FY 2008. 

The revised preliminary FY 2009 DSH 

allotments published in this notice are 

about $308 million greater than the 

preliminary FY 2009 DSH allotments 

published in the Federal Register 

correction notice on January 26, 2009 

(74 FR 4439). As discussed previously, 

this occurred because of the application 

of a higher CPI–U (4.4 percent in the 

revised preliminary determination 

compared to 4.0 percent in the original 

preliminary determination) and the 

application of the Recovery Act increase 

to States’ DSH allotments for FY 2009. 

The revised preliminary FY 2009 IMD 

DSH Limits being published in this 

notice are about $22 million greater than 

the preliminary FY 2009 IMD DSH 

limits published in the Federal Register 

notice on December 19, 2008 (73 FR 

77704). This 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 original 

preliminary FY 2009 DSH allotments 

were increased in the revised 

preliminary FY 2009 DSH allotments, 

the IMD DSH limits for some States 

were also increased. 

The preliminary FY 2010 DSH 

allotments being published in this 

notice are about $277 million greater 

than the revised preliminary FY 2009 

DSH allotments being published in this 

notice and about $585 million greater 

than the preliminary FY 2009 DSH 

allotments published in the Federal 

Register correction notice on January 

26, 2009 (74 FR 4439). These increases 

are a direct result of the application of 

the Recovery Act provisions which in 

this case resulted in the FY 2010 DSH 

allotments being determined as 2.5 

percent greater than the FY 2009 DSH 

allotments as determined under the 

Recovery Act. 

The preliminary FY 2010 IMD DSH 

Limits being published in this notice are 

about $21 million greater than the 

revised preliminary FY 2009 IMD DSH 

Limits being published in this notice, 

and about $43 million greater than the 

preliminary FY 2009 IMD DSH limits 

published in the Federal Register notice 

on December 19, 2008 (73 FR 77704). 

This 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 2010 DSH allotments 

were increased as compared to the 

preliminary FY 2009 DSH allotments, 

the associated FY 2010 IMD DSH limits 

for some States were also increased. 

The RFA requires agencies to analyze 

options for regulatory relief of small 

businesses. 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 $6.5 million to $31.5 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 we have 

determined, and the Secretary certifies, 

that this notice will not have 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 we have determined 

and the Secretary certifies that this 

notice will not have a significant impact 

on the operations of a substantial 

number of small rural hospitals. 

The Medicaid statute (including as 

most recently amended by the Recovery 

Act) specifies the methodology for 

determining the amounts of States’ DSH 

allotments and IMD DSH limits; and as 

described previously, results in 

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. 

That threshold level is currently 

approximately $133 million. This notice 

will have no consequential effect on 

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21320 Federal Register / Vol. 75, No. 78 / Friday, April 23, 2010 / Notices 

State, local, or tribal governments 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. 

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 

increase 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 such FY DSH 

allotments from FY 2008 to FY 2009. 

TABLE—ACCOUNTING STATEMENT: 

CLASSIFICATION OF ESTIMATED EXPENDITURES, FROM THE FY 20XX 

TO FY 2010 

[In millions] 

Category Transfers 

Annualized Monetized 

Transfers.

$33,713. 

TABLE—ACCOUNTING STATEMENT: 

CLASSIFICATION OF ESTIMATED EXPENDITURES, FROM THE FY 20XX 

TO FY 2010—Continued 

[In millions] 

Category Transfers 

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. 

Addendum 

This addendum contains the charts 1 

through 4 (preceded by associated keys) 

that are referred to in the preamble of 

this notice. 

KEY TO CHART 1—FINAL DSH ALLOTMENTS FOR FY 2008 

[Key to the Chart of the Final FY 2008 DSH Allotments. The final FY 2008 DSH Allotments for the regular States are presented in the top section 

of this chart and the final FY 2008 DSH Allotments for the Low-DSH States are presented in the bottom section of the chart] 

Column Description 

For Non-Low-DSH States 

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

Column B ............... Final FY 2004 DSH Allotments—This column contains the final Federal share FY 2004 DSH Allotments. 

Column C ............... FY 2008 DSH Allotments—This column contains the final Federal share FY 2008 DSH Allotments. 

For Low-DSH States 

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

Column B ............... Prior FY DSH Allotments (FY 2007)—This column contains the final FY 2007 DSH Allotments. 

Column C ............... FY 2008 DSH Allotments—This column contains the final Federal share FY 2008 DSH Allotments = Column B multiplied 

by 1.16. 

Key to Chart 2. Preliminary DSH 

Allotments for FY 2009. 

KEY TO CHART 2—REVISED PRELIMINARY DSH ALLOTMENTS FOR FY 2009 

[The Revised Preliminary FY 2009 DSH Allotments for the NON–Low DSH States are presented in the top section of this chart, and the Revised 

Preliminary FY 2009 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 2. 

Columns C–L .... For all States, the entries in Columns C through K present the determination of the revised preliminary FY 2009 DSH allotments as would be calculated without the application of section 5002 of ARRA. For all States, the entries in Column L 

present the calculation of the revised preliminary FY 2009 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 2, 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 2. 

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

Column D ......... FY 2008 DSH Allotments For States Meeting Test. This column contains the States’ prior FY 2008 DSH Allotments.

Column E .......... FY 2008 Allotments × (1 + Percentage Increase in CPI–U): 1.044. This column contains the amount in Column D increased 

by 1 plus the percentage increase in the CPI–U for the prior FY (4.4 percent). 

Column F .......... FY 2009 TC MAP Including DSH. This column contains the amount of the States’ projected FY 2009 total computable medical assistance expenditures including DSH expenditures. 

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Federal Register / Vol. 75, No. 78 / Friday, April 23, 2010 / Notices 21321 

KEY TO CHART 2—REVISED PRELIMINARY DSH ALLOTMENTS FOR FY 2009—Continued 

[The Revised Preliminary FY 2009 DSH Allotments for the NON–Low DSH States are presented in the top section of this chart, and the Revised 

Preliminary FY 2009 DSH Allotments for the Low-DSH States are presented in the bottom section of this chart] 

Column Description 

Column G ......... FY 2009 TC DSH Expenditures. This column contains the amount of the States’ projected FY 2009 total computable DSH expenditures. 

Column H ......... FY 2009 TC MAP Exp. Net of DSH. This column contains the amount of the States’ projected FY 2009 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 2008 Allotment or 12% Limit. This column contains the greater of the State’s prior FY (FY 2008) 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 2009 DSH Allotment. This column contains the States’ FY 2009 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. 

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, and calculated as the amount in Column K multiplied by 102.5 percent. 

Key to Chart 3. Preliminary DSH 

Allotments for FY 2010. 

KEY TO CHART 3—PRELIMINARY DSH ALLOTMENTS FOR FY 2010 

[The Preliminary FY 2010 DSH Allotments for the NON–Low DSH States are presented in the top section of this chart, and the Preliminary 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 3. 

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

as would be calculated without the application of section 5002 of ARRA. For all States, the entries in Columns L through 

N present the calculation of the preliminary 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 3, 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 3. 

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

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

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

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 Including DSH. This column contains the amount of the States’ projected FY 2010 total computable 

medical assistance expenditures including DSH expenditures. 

Column G ............... FY 2010 TC DSH Expenditures. This column contains the amount of the States’ projected FY 2010 total computable DSH 

expenditures. 

Column H ............... FY 2010 TC MAP Exp. Net of DSH. This column contains the amount of the States’ projected 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 revised preliminary DSH allotment as 

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

Column N ............... FY 2010 DSH Allotment. This column contains the preliminary FY 2010 DSH allotment determined as the higher of the 

amount in Column K (the preliminary 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. 

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21322 Federal Register / Vol. 75, No. 78 / Friday, April 23, 2010 / Notices 

KEY TO CHART 4—FINAL IMD DSH LIMT FOR FY 2008 

[Key to the Chart of the Final FY 2008 IMD Limitations—The Final FY 2008 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)(II) of the Act, for FYs after FY 2002, the applicable percentage can be no greater than 33 percent. 

Column F ............... FY 2008 Allotment In FS. This column contains the States’ final FY 2008 DSH allotments. 

Column G ............... FY 2008 FMAP. This column contains the States’ FY 2008 FMAPs. 

Column H ............... FY 2008 DSH Allotments in TC. Col. F/G. This column contains the FY 2008 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 2008 total computable DSH allotment (calculated 

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

Column J ................ FY 2008 IMD DSH Limit Total Computable. Lesser of Col. C or I. The column contains the lesser of the amount in Column 

C or Column I. 

Column K ............... FY 2008 IMD DSH Limit in Federal Share, Col. G x J. This column contains the total computable IMD DSH Limit from Col. 

J and converts that amount into a Federal share (calculated as Col. G x Col. J). 

KEY TO CHART 5—REVISED PRELIMINARY IMD DSH LIMIT UNDER ARRA FOR FY 2009 

[Key to the Chart of the Revised FY 2009 IMD Limitations—The revised preliminary FY 2009 IMD DSH Limits for the Non-Low DSH States are 

presented in the top section of this chart and the revised preliminary FY 2009 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)(II) of the Act, for FYs after FY 2002, the applicable Percentage can be no greater than 33 percent. 

Column F ............... FY 2009 Federal Share DSH Allotment. This column contains the States’ preliminary FY 2009 DSH allotments. 

Column G ............... FY 2009 FMAP. This columns contains the States’ FY 2009 FMAPs. 

Column H ............... FY 2009 DSH Allotments in Total Computable Col. F/G. This column contains States’ FY 2009 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 2009 total computable DSH allotment (calculated 

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

Column J ................ FY 2009 IMD DSH Limit Total Computable. Lesser of Col. C or I. The column contains the lesser of the lesser of Column I 

or C. 

Column K ............... FY 2009 IMD DSH Limit in Federal Share, Col. G × J. This column contains the total computable IMD DSH Limit from Col. 

J and converts that amount into a Federal share (calculated as the amount in Column G multiplied by the amount in 

Column J). 

KEY TO CHART 6—PRELIMINARY IMD DSH LIMIT UNDER ARRA FOR FY 2010 

[Key to the Chart of the FY 2010 IMD Limitations.—The preliminary FY 2010 IMD DSH Limits for the Non-Low DSH States are presented in the 

top section of this chart and the preliminary FY 2010 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. 

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Federal Register / Vol. 75, No. 78 / Friday, April 23, 2010 / Notices 21323 

KEY TO CHART 6—PRELIMINARY IMD DSH LIMIT UNDER ARRA FOR FY 2010—Continued 

[Key to the Chart of the FY 2010 IMD Limitations.—The preliminary FY 2010 IMD DSH Limits for the Non-Low DSH States are presented in the 

top section of this chart and the preliminary FY 2010 IMD DSH Limits for the Low-DSH States are presented in the bottom section of the chart] 

Column Description 

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)(II) Of the Act, for FYs after FY 2002, the applicable Percentage can be no greater than 33 percent. 

Column F ............... FY 2010 Federal Share DSH Allotment. This column contains the States’ preliminary FY 2010 DSH allotments. 

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

Column H ............... FY 2010 DSH Allotments in Total Computable Col. F/G. This column contains States’ FY 2010 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 2010 IMD DSH Limit Total Computable. Lesser of Col. C or I. The column contains the lesser of the lesser of Column I 

or C. 

Column K ............... FY 2010 IMD DSH Limit in Federal Share, Col. G x J. This column contains the total computable IMD DSH Limit from Col. 

J and converts that amount into a Federal share (calculated as the amount in Column G multiplied by the amount in 

Column J). 

BILLING CODE 4120–01–P 

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(Catalog of Federal Domestic Assistance 

Program No. 93.778, Medical Assistance 

Program) 

Dated: December 17, 2009. 

Charlene Frizerra, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

Dated: February 22, 2010. 

Kathleen Sebelius, 

Secretary. 

[FR Doc. 2010–8502 Filed 4–22–10; 8:45 am] 

BILLING CODE 4120–01–C 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–2309–N] 

RIN 0938–AP90 

Medicaid Program; State Allotments 

for Payment of Medicare Part B 

Premiums for Qualifying Individuals: 

Federal Fiscal Year 2009 and Federal 

Fiscal Year 2010 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice sets forth final 

allotments available to States to pay the 

Medicare Part B premiums for 

Qualifying Individuals (QIs) for the 

Federal fiscal year (FY) 2009 and the 

preliminary QI allotments for FY 2010. 

The amounts of these QI allotments 

were determined in accordance with the 

methodology set forth in regulations, as 

amended in the Federal Register 

published on November 24, 2008, and 

reflect funding for the QI program made 

available under recent legislation. 

DATES: Effective dates: The final QI 

allotments for payment of Medicare Part 

B premiums for FY 2009 are effective 

October 1, 2008. The preliminary QI 

allotments for FY 2010 are effective 

October 1, 2009. 

FOR FURTHER INFORMATION CONTACT: 

Richard Strauss, (410) 786–2019. 

SUPPLEMENTARY INFORMATION: 

I. Background 

A. History of the QI Program 

Section 1902 of the Social Security 

Act (the Act) sets forth the requirements 

for State plans for medical assistance. 

Before August 5, 1997, section 

1902(a)(10)(E) of the Act specified that 

State Medicaid plans must provide for 

some or all types of Medicare costsharing for three eligibility groups of 

low-income Medicare beneficiaries. 

These three groups included qualified 

Medicare beneficiaries (QMBs), 

specified low-income Medicare 


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