5448 Federal Register / Vol. 81, No. 21 / Tuesday, February 2, 2016 / Notices 

Friday of each week from 8:30 a.m. to 

4 p.m. To schedule an appointment to 

view public comments, phone 1–800– 

743–3951. 

FOR FURTHER INFORMATION CONTACT: Lisa 

Marie Gomez, (410) 786–1175. 

SUPPLEMENTARY INFORMATION: On 

December 31, 2015, we published a 

request for information in the Federal 

Register (80 FR 81824) entitled, 

‘‘Request for Information: Certification 

Frequency and Requirements for the 

Reporting of Quality Measures Under 

CMS Programs’’ (referred to in this 

document as ‘‘the December 31 RFI’’). 

That request for information seek public 

comment regarding several items related 

to the certification of health information 

technology (IT), including electronic 

health records (EHR) products used for 

reporting to certain CMS quality 

reporting programs such as, but not 

limited to, the Hospital Inpatient 

Quality Reporting (IQR) Program and 

the Physician Quality Reporting System 

(PQRS). In addition, it requested 

feedback on how often to require 

recertification, the number of clinical 

quality measures (CQMs) a certified 

Health IT Module should be required to 

certify to, and testing of certified Health 

IT Module(s). 

We have received inquiries from 

stakeholders regarding the 30-day 

comment period to submit comments 

regarding the December 31 RFI. The 

stakeholders stated that they need 

additional time to respond to the 

questions posed in the December 31 

RFI. Since we requested the public’s 

comments on several options, we 

believe that it is important to allow 

ample time for the public to prepare 

their comments. Therefore, we have 

decided to extend the comment period 

for an additional 15 days. This 

document announces the extension of 

the public comment period to February 

16, 2016. 

Dated: January 28, 2016. 

Andrew M. Slavitt, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

[FR Doc. 2016–01937 Filed 2–1–16; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–2398–N] 

RIN 0983–ZB24 

Medicaid Program; Final FY 2013 and 

Preliminary FY 2015 Disproportionate 

Share Hospital Allotments, and Final 

FY 2013 and Preliminary FY 2015 

Institutions for Mental Diseases 

Disproportionate Share Hospital Limits 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice announces the 

final federal share disproportionate 

share hospital (DSH) allotments for 

federal fiscal year (FY) 2013 and the 

preliminary federal share DSH 

allotments for FY 2015. This notice also 

announces the final FY 2013 and the 

preliminary FY 2015 limitations on 

aggregate DSH payments that states may 

make to institutions for mental disease 

and other mental health facilities. In 

addition, this notice includes 

background information describing the 

methodology for determining the 

amounts of states’ FY DSH allotments. 

DATES: This notice is effective March 3, 

2016. The final allotments and 

limitations set forth in this notice are 

effective for the fiscal years specified. 

FOR FURTHER INFORMATION CONTACT: 

Stuart Goldstein, (410) 786–0694 and 

Richard Cuno, (410) 786–1111. 

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 most recently 

delayed and modified by the Medicare 

Access and CHIP Reauthorization Act of 

2015 (MACRA) (Pub. L. 114–10), 

enacted on April 16, 2015. The 

reductions of states’ fiscal year DSH 

allotments under section 1923(f)(7) of 

the Act that were applicable to FY 2017 

were repealed, and are instead 

scheduled to begin in FY 2018 at 

modified levels. MACRA also extended 

DSH allotment reductions through 2025. 

Because there is no reduction to DSH 

allotments for FY 2015 under section 

1923(f)(7) of the Act, this notice 

contains only the state-specific 

preliminary FY 2015 DSH allotments, as 

calculated under the statute without 

application of the reductions that would 

have otherwise been imposed. 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 2015 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 


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Federal Register / Vol. 81, No. 21 / Tuesday, February 2, 2016 / Notices 5449 

(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 

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 Final FY 2013 

Federal Share State DSH Allotments 

and the Preliminary FY 2015 Federal 

Share State DSH Allotments 

1. Final FY 2013 Federal Share State 

DSH Allotments 

Addendum 1 to this notice provides 

the states’ final FY 2013 DSH allotments 

determined in accordance with section 

1923(f)(3) of the Act. As described in the 

background section of this notice, in 

general, the DSH allotment for a FY is 

calculated by increasing the FY DSH 

allotment for the preceding FY by the 

CPI–U increase for the previous fiscal 

year. For purposes of calculating the 

states’ final FY 2013 DSH allotments, 

the preceding final fiscal year DSH 

allotments (for FY 2012) were published 

in the July 26, 2013 Federal Register (78 

FR 45217). For purposes of calculating 

the states’ final FY 2013 DSH allotments 

we are using the actual Medicaid 

expenditures for FY 2013. Finally, for 

purposes of calculating the states’ final 

FY 2013 DSH allotments, the applicable 

historical percentage change in the CPI– 

U for the previous FY (FY 2012) was 2.4 

percent; we note that this is the same as 

the estimated 2.4 percentage change in 

the CPI–U for FY 2012 that was 

available and used in the calculation of 

the preliminary FY 2013 DSH 

allotments which were published in the 

July 26, 2013 Federal Register (78 FR 

45217). 

2. Calculation of the Preliminary FY 

2015 Federal Share State DSH 

Allotments 

Addendum 2 to this notice provides 

the preliminary FY 2015 DSH 

allotments determined in accordance 

with section 1923(f)(3) of the Act. The 

preliminary FY 2015 DSH allotments 

contained in this notice were 

determined based on the most recent 

available estimates from states of their 

FY 2015 total computable Medicaid 

expenditures. Also, the preliminary FY 

2015 allotments contained in this notice 

were determined by increasing the 

preliminary FY 2014 DSH allotments as 

contained in the notice published in the 

February 28, 2014 Federal Register (79 

FR 11436) by 1.6 percent, representing 

the most recent available estimate of the 

percentage increase in the CPI–U for FY 

2014 (the previous FY to FY 2015). 

We will publish states’ final FY 2015 

DSH allotments in future notices based 

on the states’ four quarterly Medicaid 

expenditure reports (Form CMS–64) for 

FY 2015 available following the end of 

FY 2015 and the actual change in the 

CPI–U for FY 2014. 

B. Calculation of the Final FY 2013 and 

Preliminary FY 2015 IMD DSH Limits 

Section 1923(h) of the Act specifies 

the methodology to be used to establish 

the limits on the amount of DSH 

payments that a state can make to IMDs 

and other mental health facilities. FFP 

is not available for IMD or DSH 

payments that exceed the IMD limits. In 

this notice, we are publishing the final 

FY 2013 and the preliminary FY 2015 

IMD DSH Limits determined in 

accordance with the provisions 

discussed above. 

Addendums 3 and 4 to this notice 

detail each state’s final FY 2013 and 

preliminary FY 2015 IMD DSH Limit, 

respectively, determined in accordance 

with section 1923(h) of the Act. 

III. Collection of Information 

Requirements 

This notice does not impose any new 

or revised information collection or 

recordkeeping requirements. The 

requirements and burden associated 

with form CMS–37 (OMB control 

number 0938–1265) and form CMS–64 

(OMB control number 0938–1265) are 

unaffected by this notice. As it pertains 

to the content of this notice, CMS–37 

and CMS–64 are not subject to formal 

Office of Management and Budget 

review under the authority of the 

Paperwork Reduction Act of 1995 (44 

U.S.C. 3501 et seq.). 

IV. Regulatory Impact Statement 

We have examined the impact of this 

notice as required by Executive Order 

12866 on Regulatory Planning and 

Review (September 1993), the 

Regulatory Flexibility Act (RFA) 

(September 19, 1980, Pub. L. 96–354), 

section 1102(b) of the Act, section 202 

of the Unfunded Mandates Reform Act 

of 1995 (March 22, 1995; Pub. L. 104– 

4), Executive Order 13132 on 

Federalism (August 4, 1999) and the 

Congressional Review Act (5 U.S.C. 

804(2)). 

Executive Order 12866 directs 

agencies to assess all costs and benefits 

of available regulatory alternatives and, 

if regulation is necessary, to select 

regulatory approaches that maximize 

net benefits (including potential 

economic, environmental, public health 

and safety effects, distributive impacts, 

and equity). A regulatory impact 

analysis (RIA) must be prepared for 

major rules with economically 

significant effects ($100 million or more 

in any 1 year). This notice reaches the 

$100 million economic threshold and 

thus is considered a major rule under 

the Congressional Review Act. 

The final FY 2013 DSH allotments 

being published in this notice are equal 


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5450 Federal Register / Vol. 81, No. 21 / Tuesday, February 2, 2016 / Notices 

to the preliminary FY 2013 DSH 

allotments published in the July 26, 

2013 Federal Register (78 FR 45217). 

This is due to the actual percentage 

change in the CPI–U for FY 2012 used 

in the calculation of the final FY 2013 

allotments (2.4 percent) being equal to 

the estimated percentage change in the 

CPI–U for FY 2012 used in the 

calculation of the preliminary FY 2013 

allotments (2.4 percent). The final FY 

2013 IMD DSH limits being published 

in this notice are also equal to the 

preliminary FY 2013 IMD DSH limits 

published in the July 26, 2013 Federal 

Register (78 FR 45217). Since the final 

FY 2013 DSH allotments were equal to 

the preliminary FY 2013 DSH 

allotments, the associated FY 2013 IMD 

DSH limits also remained the same. 

The preliminary FY 2015 DSH 

allotments being published in this 

notice are about $240 million more than 

the preliminary FY 2014 DSH 

allotments published in the February 

28, 2014 Federal Register (79 FR 

11436). The increase in the DSH 

allotments is due to the application of 

the statutory formula for calculating 

DSH allotments under which the prior 

fiscal year allotments are increased by 

the percentage increase in the CPI–U for 

the prior fiscal year. The preliminary FY 

2015 IMD DSH limits being published 

in this notice are about $14 million 

more than the preliminary FY 2014 IMD 

DSH limits published in the February 

28, 2014 Federal Register (79 FR 

11436). 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 2015 DSH allotments 

are greater than the preliminary FY 2014 

DSH allotments, the associated 

preliminary FY 2015 IMD DSH limits 

for some states also increased. 

The RFA requires agencies to analyze 

options for regulatory relief of small 

businesses, if a rule has a significant 

impact on a substantial number of small 

entities. For purposes of the RFA, small 

entities include small businesses, 

nonprofit organizations, and small 

governmental jurisdictions. Most 

hospitals and most other providers and 

suppliers are small entities, either by 

nonprofit status or by having revenues 

of less than $7.5 million to $38.5 

million in any 1 year. Individuals and 

states are not included in the definition 

of a small entity. We are not preparing 

an analysis for the RFA because the 

Secretary has determined that this 

notice will not have significant 

economic impact on a substantial 

number of small entities. Specifically, 

any impact on providers is due to the 

effect of the various controlling statutes; 

providers are not impacted as a result of 

the independent regulatory action in 

publishing this notice. The purpose of 

the notice is to announce the latest 

distributions as required by the statute. 

In addition, section 1102(b) of the Act 

requires us to prepare a regulatory 

impact analysis if a rule may have a 

significant impact on the operations of 

a substantial number of small rural 

hospitals. This analysis must conform to 

the provisions of section 604 of the 

RFA. For purposes of section 1102(b) of 

the Act, we define a small rural hospital 

as a hospital that is located outside of 

a Core-Based Statistical Area for 

Medicaid payment regulations and has 

fewer than 100 beds. We are not 

preparing analysis for section 1102(b) of 

the Act because the Secretary has 

determined that this notice will not 

have a significant impact on the 

operations of a substantial number of 

small rural hospitals. 

The Medicaid statute specifies the 

methodology for determining the 

amounts of states’ DSH allotments and 

IMD DSH limits; and as described 

previously, the application of the 

methodology specified in statute results 

in the decreases or increases in states’ 

DSH allotments and IMD DSH limits for 

the applicable FYs. The statute 

applicable to these allotments and limits 

does not apply to the determination of 

the amounts of DSH payments made to 

specific DSH hospitals; rather, these 

allotments and limits represent an 

overall limit on the total of such DSH 

payments. In this regard, we do not 

believe that this notice will have a 

significant economic impact on a 

substantial number of small entities. 

Section 202 of the Unfunded 

Mandates Reform Act of 1995 also 

requires that agencies assess anticipated 

costs and benefits before issuing any 

rule whose mandates require spending 

in any 1 year of $100 million in 1995 

dollars, updated annually for inflation. 

In 2015, that is approximately $144 

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 issues 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 

The methodologies for determining 

the states’ fiscal year DSH allotments 

and IMD DSH Limits, as reflected in this 

notice, were established in accordance 

with the methodologies and formula for 

determining states’ allotments as 

specified in the statute. 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 2014 to FY 2015. 

TABLE 1—ACCOUNTING STATEMENT: 

CLASSIFICATION OF ESTIMATED EXPENDITURES, FROM THE FY 2014 TO

FY 2015 

[In millions] 

Category Transfers 

Annualized Monetized 

Transfers.

$240. 

From Whom To 

Whom? 

Federal Government 

to States. 

Congressional Review Act 

This proposed regulation is subject to 

the Congressional Review Act 

provisions of the Small Business 

Regulatory Enforcement Fairness Act of 

1996 (5 U.S.C. 801 et seq.) and has been 

transmitted to the Congress and the 

Comptroller General for review. 

In accordance with the provisions of 

Executive Order 12866, this notice was 

reviewed by the Office of Management 

and Budget. 

Dated: December 3, 2015. 

Andrew M. Slavitt, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

Dated: January 20, 2016. 

Sylvia M. Burwell, 

Secretary, Department of Health and Human 

Services. 


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KEY TO ADDENDUM 1—FINAL DSH ALLOTMENTS FOR FY 2013 

[The Final FY 2013 DSH Allotments for the NON-Low DSH States are presented in the top section of this addendum, and the Final FY 2013 

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

Column Description 

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

Column B .......... FY 2013 FMAPs. 

This column contains the States’ FY 2013 Federal Medical Assistance Percentages. 

Column C ......... Prior FY (2012) DSH Allotments 

This column contains the States’ prior FY 2012 DSH Allotments. 

Column D ......... Prior FY (2012) DSH Allotments (Col C) × (100 percent + Percentage Increase in CPIU): 102.4 percent. 

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

(102.4 percent). 

Column E .......... FY 2013 TC MAP Exp. Including DSH. 

This column contains the amount of the States’ FY 2013 total computable (TC) medical assistance expenditures including 

DSH expenditures. 

Column F .......... FY 2013 TC DSH Expenditures. 

This column contains the amount of the States’ FY 2013 total computable DSH expenditures. 

Column G ......... FY 2013 TC MAP Exp. Net of DSH. 

This column contains the amount of the States’ FY 2013 total computable medical assistance expenditures net of DSH expenditures, calculated as the amount in Column E minus the amount in Column F. 

Column H ......... 12 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 2012 Allotment or 12 percent Limit. 

This column contains the greater of the State’s prior FY (FY 2012) 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 2013 DSH Allotment. 

This column contains the States’ final FY 2013 DSH allotments, determined as the minimum of the amount in Column I or 

Column D. 

For states with ‘‘na’’ in Columns I or D, refer to the footnotes in the addendum. 


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ADDENDUM 1—FINAL DSH ALLOTMENTS FOR FY 2013 

State FY 2013 FMAPs (percent) Prior FY (2012) DSH allotments 

Prior FY (2012) 

DSH allotment 

(Col C) × 100% + 

Pct increase in 

CPIU: 102.4% 

FY 2013 TC MAP 

Exp. including 

DSH 

FY 2013 TC DSH 

expenditures 

FY 2013 TC MAP 

EXP. net of DSH 

Col E–F 

‘‘12% Amount’’ = 

Col G × .12/(1– 

.12/Col B)* 

(in FS) 

Greater of Col H 

or Col C (12% 

limit, FY 2012 

Allotment) 

FY 2013 DSH 

allotment 

MIN Col I, Col D 

A B C D E F G H I J 

ALABAMA ......................... 68.53 $315,520,769 $323,093,267 $4,999,646,843 $470,923,104 $4,528,723,739 $658,807,935 $658,807,935 $323,093,267 ARIZONA .......................... 65.68 103,890,985 106,384,369 8,437,380,837 173,082,813 8,264,298,024 1,213,410,792 1,213,410,792 106,384,369 CALIFORNIA .................... 50.00 1,124,844,365 1,151,840,630 61,425,894,719 2,119,710,409 59,306,184,310 9,364,134,365 9,364,134,365 1,151,840,630 COLORADO ..................... 50.00 94,912,751 97,190,657 5,048,193,724 194,191,858 4,854,001,866 766,421,347 766,421,347 97,190,657 CONNECTICUT ................ 50.00 205,216,760 210,141,962 6,415,388,481 272,860,246 6,142,528,235 969,872,879 969,872,879 210,141,962 DISTRICT OF COLUMBIA 70.00 62,847,632 64,355,975 2,275,681,171 56,387,767 2,219,293,404 321,414,907 321,414,907 64,355,975 FLORIDA .......................... 58.08 205,216,760 210,141,962 18,411,438,180 335,009,637 18,076,428,543 2,734,059,817 2,734,059,817 210,141,962 GEORGIA ......................... 65.56 275,760,021 282,378,262 8,887,641,041 429,964,548 8,457,676,493 1,242,312,033 1,242,312,033 282,378,262 ILLINOIS ........................... 50.00 220,608,017 225,902,609 15,493,580,784 447,072,185 15,046,508,599 2,375,764,516 2,375,764,516 225,902,609 INDIANA ........................... 67.16 219,325,413 224,589,223 7,930,553,510 337,536,579 7,593,016,931 1,109,384,374 1,109,384,374 224,589,223 KANSAS ........................... 56.51 42,325,957 43,341,780 2,544,769,057 76,622,785 2,468,146,272 376,027,713 376,027,713 43,341,780 KENTUCKY ...................... 70.55 148,782,151 152,352,923 5,726,056,802 216,263,666 5,509,793,136 796,685,033 796,685,033 152,352,923 LOUISIANA/1 .................... na na na na na na na na 731,960,000 MAINE ............................... 62.57 107,738,799 110,324,530 2,826,874,563 37,489,437 2,789,385,126 414,155,018 414,155,018 110,324,530 MARYLAND ...................... 50.00 78,238,890 80,116,623 7,688,146,740 134,340,816 7,553,805,924 1,192,706,199 1,192,706,199 80,116,623 MASSACHUSETTS .......... 50.00 312,955,559 320,466,492 12,999,170,453 0 12,999,170,453 2,052,500,598 2,052,500,598 320,466,492 MICHIGAN ........................ 66.39 271,912,207 278,438,100 12,308,409,960 387,951,247 11,920,458,713 1,746,054,614 1,746,054,614 278,438,100 MISSISSIPPI ..................... 73.43 156,477,779 160,233,246 4,708,563,005 217,999,554 4,490,563,451 644,132,328 644,132,328 160,233,246 MISSOURI ........................ 61.37 486,107,200 497,773,773 8,863,322,084 703,393,659 8,159,928,425 1,217,196,210 1,217,196,210 497,773,773 NEVADA ........................... 59.74 47,456,375 48,595,328 1,797,228,664 81,373,600 1,715,855,064 257,658,605 257,658,605 48,595,328 NEW HAMPSHIRE ........... 50.00 164,274,500 168,217,088 1,188,634,372 40,923,914 1,147,710,458 181,217,441 181,217,441 168,217,088 NEW JERSEY .................. 50.00 660,541,446 676,394,441 10,480,866,440 1,298,115,161 9,182,751,279 1,449,908,097 1,449,908,097 676,394,441 NEW YORK ...................... 50.00 1,648,147,103 1,687,702,633 52,489,778,879 3,423,365,423 49,066,413,456 7,747,328,440 7,747,328,440 1,687,702,633 NORTH CAROLINA .......... 65.51 302,694,721 309,959,394 11,721,921,735 617,376,633 11,104,545,102 1,631,378,246 1,631,378,246 309,959,394 OHIO ................................. 63.58 416,846,544 426,850,861 16,628,494,101 649,120,744 15,979,373,357 2,363,633,714 2,363,633,714 426,850,861 PENNSYLVANIA .............. 54.28 575,889,532 589,710,881 20,922,389,122 847,055,684 20,075,333,438 3,092,778,900 3,092,778,900 589,710,881 RHODE ISLAND ............... 51.26 66,695,447 68,296,138 1,909,141,351 129,846,057 1,779,295,294 278,777,412 278,777,412 68,296,138 SOUTH CAROLINA .......... 70.43 336,042,444 344,107,463 4,690,094,944 457,173,209 4,232,921,735 612,270,432 612,270,432 344,107,463 TENNESSEE/2 ................. na na na na na na na na 53,100,000 TEXAS .............................. 59.30 981,192,634 1,004,741,257 27,752,018,303 226,747,941 27,525,270,362 4,141,011,076 4,141,011,076 1,004,741,257 VERMONT ........................ 56.04 23,086,886 23,640,971 1,452,095,084 37,448,781 1,414,646,303 216,013,021 216,013,021 23,640,971 VIRGINIA .......................... 50.00 89,892,713 92,050,138 7,218,485,856 186,468,433 7,032,017,423 1,110,318,540 1,110,318,540 92,050,138 WASHINGTON ................. 50.00 189,825,503 194,381,315 7,805,501,929 366,733,930 7,438,767,999 1,174,542,316 1,174,542,316 194,381,315 WEST VIRGINIA ............... 72.04 69,260,656 70,922,912 3,007,417,198 75,434,137 2,931,983,061 422,158,680 422,158,680 70,922,912 

Total ........................... 0.00 10,004,528,519 10,244,637,203 366,054,779,932 15,047,983,957 351,006,795,975 53,874,035,598 53,874,035,598 11,029,697,203 

LOW DSH STATES 

ALASKA ............................ 50.00 20,901,012 21,402,636 1,340,719,400 21,706,474 1,319,012,926 208,265,198.84 208,265,199 21,402,636 ARKANSAS ...................... 70.17 44,262,980 45,325,292 4,156,350,929 61,000,000 4,095,350,929 592,822,640 592,822,640 45,325,292 DELAWARE ...................... 55.67 9,289,338 9,512,282 1,557,544,100 10,874,669 1,546,669,431 236,601,110 236,601,110 9,512,282 HAWAII ............................. 51.86 10,000,000 10,240,000 1,586,220,307 24,971,280 1,561,249,027 243,752,256.52 243,752,257 10,240,000 IDAHO ............................... 71.00 16,866,254 17,271,044 1,641,925,393 23,708,980 1,618,216,413 233,681,421.00 233,681,421 17,271,044 IOWA ................................ 59.59 40,408,349 41,378,149 3,622,873,642 54,606,370 3,568,267,272 536,162,337 536,162,337 41,378,149 MINNESOTA ..................... 50.00 76,637,045 78,476,334 8,781,239,289 46,287,099 8,734,952,190 1,379,202,977 1,379,202,977 78,476,334 MONTANA ........................ 66.00 11,646,847 11,926,371 996,801,715 17,703,206 979,098,509 143,601,115 143,601,115 11,926,371 NEBRASKA ...................... 55.76 29,036,347 29,733,219 1,790,372,947 45,313,162 1,745,059,785 266,831,445 266,831,445 29,733,219 NEW MEXICO .................. 69.07 20,901,012 21,402,636 3,280,561,202 25,164,146 3,255,397,056 472,788,382 472,788,382 21,402,636 NORTH DAKOTA ............. 52.27 9,801,133 10,036,360 775,035,726 1,265,931 773,769,795 120,521,323 120,521,323 10,036,360 OKLAHOMA ...................... 64.00 37,157,353 38,049,129 4,481,944,280 41,759,650 4,440,184,630 655,781,115 655,781,115 38,049,129 OREGON .......................... 62.44 46,446,693 47,561,414 5,070,815,864 76,536,235 4,994,279,629 741,894,100 741,894,100 47,561,414 SOUTH DAKOTA ............. 56.19 11,332,733 11,604,719 758,090,042 1,441,151 756,648,891 115,454,450 115,454,450 11,604,719 UTAH ................................ 69.61 20,129,695 20,612,808 2,087,187,059 28,794,708 2,058,392,351 298,457,958 298,457,958 20,612,808 WISCONSIN ..................... 59.74 96,998,597 99,326,563 7,034,898,860 581,325 7,034,317,535 1,056,296,932 1,056,296,932 99,326,563 WYOMING ........................ 50.00 232,233 237,807 546,576,901 463,560 546,113,341 86,228,422 86,228,422 237,807 


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Federal Register / Vol. 81, No. 21 / Tuesday, February 2, 2016 / Notices 5453 

Total Low DSH States 0.00 502,047,621 514,096,764 49,509,157,656 482,177,946 49,026,979,710 7,388,343,182 7,388,343,182 514,096,763 

Total .................... 0.00 10,506,576,140 10,758,733,967 415,563,937,588 15,530,161,903 400,033,775,685 61,262,378,780 61,262,378,780 11,543,793,966 

1FY 2013 DSH allotment for Louisiana determined under the provisions of section 1903(f)(3)(C) and (D) of the Act. 2Tennessee’s DSH allotments are determined under section 1923(f)(6)(A)(v)(II) of the Act. Under this provision, Tennessee’s DSH payments for FY 2013 are limited to $53,100,000. 3Beginning FY 2013, under section 1923(f)(6)(B)(II) of the Act, Hawaii’s DSH allotments are determined as for low-DSH states. This means its allotments are determined as for all States, by increasing the previous 

fiscal year allotment by the CPIU for the previous fiscal year. 


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5454 Federal Register / Vol. 81, No. 21 / Tuesday, February 2, 2016 / Notices 

KEY TO ADDENDUM 2—PRELIMINARY DSH ALLOTMENTS FOR FY 2015 

[The Preliminary FY 2015 DSH Allotments for the NON-Low DSH States are presented in the top section of this addendum, and the Preliminary 

FY 2015 DSH Allotments for the Low-DSH States are presented in the bottom section of this addendum] 

Column Description 

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

Column B .......... FY 2015 FMAPs. 

This column contains the States’ FY 2015 Federal Medical Assistance Percentages. 

Column C ......... Prior FY (2014) DSH Allotments. 

This column contains the States’ prior FY 2014 DSH Allotments 

Column D ......... Prior FY (2014) DSH Allotments (Col C) × (100 percent + Percentage Increase in CPIU): 101.6 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 (101.6 percent). 

Column E .......... FY 2015 TC MAP Exp. Including DSH. 

This column contains the amount of the States’ projected FY 2015 total computable (TC) medical assistance expenditures including DSH expenditures. 

Column F .......... FY 2015 TC DSH Expenditures. 

This column contains the amount of the States’ projected FY 2015 total computable DSH expenditures. 

Column G ......... FY 2015 TC MAP Exp. Net of DSH. 

This column contains the amount of the States’ projected FY 2015 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 2014 Allotment or 12 percent Limit. 

This column contains the greater of the State’s prior FY (FY 2014) 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 2015 DSH Allotment. 

This column contains the States’ preliminary FY 2015 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. 


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Federal Register / Vol. 81, No. 21 / Tuesday, February 2, 2016 / Notices 5455 

ADDENDUM 2—PRELIMINARY DSH ALLOTMENTS FOR FY 2015 

State FY 2015 FMAPs (percent) Prior FY (2014) DSH allotments 

Prior FY (2014) 

DSH Allotment 

(Col C) × 100% + 

Pct increase in 

CPIU: 101.6% 

FY 2015 TC MAP 

Exp. Including 

DSH 4

FY 2015 TC DSH 

Expenditures 4

FY 2015 TC MAP 

EXP. Net Of DSH 

Col E–F 

‘‘12% Amount’’ = 

Col G × .12/(1– 

.12/Col B)* (in FS) 

Greater of Col H 

or Col C (12% 

Limit, FY 2014 

allotment) 

FY 2015 DSH 

Allotment Min Col 

I, Col D 

A B C D E F G H I J 

ALABAMA ......................... 68.99 $327,939,666 $333,186,701 $5,727,646,000 $507,528,000 $5,220,118,000 $758,313,966 $758,313,966 $333,186,701 ARIZONA .......................... 68.46 107,980,135 109,707,817 11,262,757,000 167,012,000 11,095,745,000 1,614,483,959 1,614,483,959 109,707,817 CALIFORNIA .................... 50.00 1,169,118,239 1,187,824,131 96,031,140,000 597,609,000 95,433,531,000 15,068,452,263 15,068,452,263 1,187,824,131 COLORADO ..................... 51.01 98,648,517 100,226,893 6,927,502,000 204,899,000 6,722,603,000 1,054,867,918 1,054,867,918 100,226,893 CONNECTICUT ................ 50.00 213,294,091 216,706,796 7,094,230,000 125,646,000 6,968,584,000 1,100,302,737 1,100,302,737 216,706,796 DISTRICT OF COLUMBIA 70.00 65,321,315 66,366,456 2,630,681,000 37,174,000 2,593,507,000 375,611,359 375,611,359 66,366,456 FLORIDA .......................... 59.72 213,294,091 216,706,796 22,430,097,000 362,102,000 22,067,995,000 3,314,083,809 3,314,083,809 216,706,796 GEORGIA ......................... 66.94 286,613,936 291,199,759 9,915,707,000 434,725,000 9,480,982,000 1,386,218,278 1,386,218,278 291,199,759 ILLINOIS ........................... 50.76 229,291,148 232,959,806 19,753,482,000 456,614,000 19,296,868,000 3,032,535,665 3,032,535,665 232,959,806 INDIANA ........................... 66.52 227,958,061 231,605,390 10,719,730,000 474,987,000 10,244,743,000 1,499,956,649 1,499,956,649 231,605,390 KANSAS ........................... 56.63 43,991,907 44,695,778 3,161,490,000 74,228,000 3,087,262,000 470,082,851 470,082,851 44,695,778 KENTUCKY ...................... 69.94 154,638,217 157,112,428 8,903,447,000 241,000,000 8,662,447,000 1,254,784,004 1,254,784,004 157,112,428 LOUISIANA1 ..................... 62.05 731,960,000 743,671,360 7,995,712,000 551,048,000 7,444,664,000 1,107,551,811 1,107,551,811 743,671,360 MAINE ............................... 61.88 111,979,398 113,771,068 2,565,931,000 38,566,000 2,527,365,000 376,247,024 376,247,024 113,771,068 MARYLAND ...................... 50.00 81,318,372 82,619,466 11,133,665,000 92,859,000 11,040,806,000 1,743,285,158 1,743,285,158 82,619,466 MASSACHUSETTS .......... 50.00 325,273,489 330,477,865 16,287,567,000 0 16,287,567,000 2,571,721,105 2,571,721,105 330,477,865 MICHIGAN ........................ 65.54 282,614,672 287,136,507 16,050,268,000 322,351,000 15,727,917,000 2,310,364,618 2,310,364,618 287,136,507 MISSISSIPPI ..................... 73.58 162,636,745 165,238,933 5,362,441,000 228,204,000 5,134,237,000 736,168,545 736,168,545 165,238,933 MISSOURI ........................ 63.45 505,240,380 513,324,226 9,641,725,000 713,722,000 8,928,003,000 1,321,240,327 1,321,240,327 513,324,226 NEVADA ........................... 64.36 49,324,258 50,113,446 2,848,030,000 78,128,000 2,769,902,000 408,565,835 408,565,835 50,113,446 NEW HAMPSHIRE ........... 50.00 170,740,344 173,472,190 1,816,048,000 76,097,000 1,739,951,000 274,729,105 274,729,105 173,472,190 NEW JERSEY .................. 50.00 686,540,358 697,525,004 14,214,233,000 1,213,776,000 13,000,457,000 2,052,703,737 2,052,703,737 697,525,004 NEW YORK ...................... 50.00 1,713,018,172 1,740,426,463 68,512,267,000 5,326,800,000 63,185,467,000 9,976,652,684 9,976,652,684 1,740,426,463 NORTH CAROLINA .......... 65.88 314,608,785 319,642,526 12,482,232,000 411,389,000 12,070,843,000 1,771,107,209 1,771,107,209 319,642,526 OHIO ................................. 62.64 433,253,624 440,185,682 21,305,059,000 0 21,305,059,000 3,162,438,142 3,162,438,142 440,185,682 PENNSYLVANIA .............. 51.82 598,556,544 608,133,449 24,679,963,000 787,072,000 23,892,891,000 3,731,179,141 3,731,179,141 608,133,449 RHODE ISLAND ............... 50.00 69,320,580 70,429,709 3,117,756,000 142,487,000 2,975,269,000 469,779,316 469,779,316 70,429,709 SOUTH CAROLINA .......... 70.64 349,269,075 354,857,380 5,636,583,000 494,437,000 5,142,146,000 743,331,228 743,331,228 354,857,380 TENNESSEE2 .................. na na na na na na na na 53,100,000 TEXAS .............................. 58.05 1,019,812,376 1,036,129,374 35,894,535,000 2,630,047,000 33,264,488,000 5,031,931,019 5,031,931,019 1,036,129,374 VERMONT 5 ...................... 56.21 23,995,586 24,379,515 1,577,599,000 37,449,000 1,540,150,000 234,983,483 234,983,483 24,379,515 VIRGINIA .......................... 50.00 93,430,890 94,925,784 8,689,637,000 193,862,000 8,495,775,000 1,341,438,158 1,341,438,158 94,925,784 WASHINGTON ................. 50.03 197,297,035 200,453,788 12,536,442,000 405,243,000 12,131,199,000 1,915,089,832 1,915,089,832 200,453,788 WEST VIRGINIA ............... 71.35 71,986,756 73,138,544 3,631,855,000 71,987,000 3,559,868,000 513,556,694 513,556,694 73,138,544 

Total ........................... .............................. 11,130,266,762 11,308,351,030 490,537,457,000 17,499,048,000 473,038,409,000 72,723,757,629 72,723,757,629 11,361,451,030 

LOW DSH STATES 

ALASKA ............................ 50.00 21,723,676 22,071,255 1,661,590,000 21,894,000 1,639,696,000 258,899,368.42 258,899,368 22,071,255 ARKANSAS ...................... 70.88 46,005,171 46,741,254 6,070,657,000 65,820,000 6,004,837,000 867,437,867 867,437,867 46,741,254 DELAWARE ...................... 53.63 9,654,966 9,809,445 1,549,168,000 24,248,000 1,524,920,000 235,738,053 235,738,053 9,809,445 HAWAII 3 ........................... 52.23 10,393,600 10,559,898 1,951,834,000 0 1,951,834,000 304,084,384.25 304,084,384 10,559,898 IDAHO ............................... 71.75 17,530,110 17,810,592 2,009,716,000 24,470,000 1,985,246,000 286,074,779.25 286,074,779 17,810,592 IOWA ................................ 55.54 41,998,821 42,670,802 4,714,183,000 34,688,000 4,679,495,000 716,304,508 716,304,508 42,670,802 MINNESOTA ..................... 50.00 79,653,479 80,927,935 11,849,443,000 154,792,000 11,694,651,000 1,846,523,842 1,846,523,842 80,927,935 MONTANA ........................ 65.90 12,105,267 12,298,951 1,030,146,000 1,896,000 1,028,250,000 150,860,872 150,860,872 12,298,951 NEBRASKA ...................... 53.27 30,179,217 30,662,084 2,053,612,000 42,720,000 2,010,892,000 311,471,433 311,471,433 30,662,084 NEW MEXICO .................. 69.65 21,723,676 22,071,255 4,758,998,000 31,196,000 4,727,802,000 685,428,779 685,428,779 22,071,255 NORTH DAKOTA ............. 50.00 10,186,905 10,349,895 1,155,141,000 1,735,000 1,153,406,000 182,116,737 182,116,737 10,349,895 OKLAHOMA ...................... 62.30 38,619,866 39,237,784 5,404,554,000 58,140,000 5,346,414,000 794,628,053 794,628,053 39,237,784 OREGON .......................... 64.06 48,274,835 49,047,232 8,294,293,000 81,136,000 8,213,157,000 1,212,757,981 1,212,757,981 49,047,232 SOUTH DAKOTA ............. 51.64 11,778,790 11,967,251 857,827,000 1,613,000 856,214,000 133,849,317 133,849,317 11,967,251 UTAH ................................ 70.56 20,922,000 21,256,752 2,276,646,000 31,390,000 2,245,256,000 324,641,933 324,641,933 21,256,752 WISCONSIN ..................... 58.27 100,816,461 102,429,524 8,016,231,000 166,265,000 7,849,966,000 1,186,300,027 1,186,300,027 102,429,524 WYOMING ........................ 50.00 241,374 245,236 596,915,000 476,000 596,439,000 94,174,579 94,174,579 245,236 


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5456 Federal Register / Vol. 81, No. 21 / Tuesday, February 2, 2016 / Notices 

ADDENDUM 2—PRELIMINARY DSH ALLOTMENTS FOR FY 2015—Continued 

State FY 2015 FMAPs (percent) Prior FY (2014) DSH allotments 

Prior FY (2014) 

DSH Allotment 

(Col C) × 100% + 

Pct increase in 

CPIU: 101.6% 

FY 2015 TC MAP 

Exp. Including 

DSH 4

FY 2015 TC DSH 

Expenditures 4

FY 2015 TC MAP 

EXP. Net Of DSH 

Col E–F 

‘‘12% Amount’’ = 

Col G × .12/(1– 

.12/Col B)* (in FS) 

Greater of Col H 

or Col C (12% 

Limit, FY 2014 

allotment) 

FY 2015 DSH 

Allotment Min Col 

I, Col D 

A B C D E F G H I J 

Total Low DSH States .............................. 521,808,214 530,157,145 64,250,954,000 742,479,000 63,508,475,000 9,591,292,512 9,591,292,512 530,157,145 

Total .................... .............................. 11,652,074,976 11,838,508,176 554,788,411,000 18,241,527,000 536,546,884,000 82,315,050,141 82,315,050,141 11,891,608,175 

1 Louisiana’s FY 2015 DSH allotment is determined under the provisions of section 1923(f)(3)(C) and (D) of the Act. 2Tennessee’s DSH allotment for FY 2015 determined under section 1923(f)(6)(A)(vi) of the Act 3Beginning 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 allotment for a fiscal year is determined as for 

all 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 2015 determined in accordance with section 1905(z)(1)(A) of the Act. 


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Federal Register / Vol. 81, No. 21 / Tuesday, February 2, 2016 / Notices 5457 

KEY TO ADDENDUM 3—FINAL IMD DSH LIMITS FOR FY 2013 

[The final FY 2013 IMD DSH Limits for the Non-Low DSH States are presented in the top section of this addendum and the preliminary FY 2013 

IMD DSH Limits for the Low-DSH States are presented in the bottom section of the addendum] 

Column Description 

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

Column B .......... Inpatient Hospital Services FY 95 DSH Total Computable 

This column contains the States’ total computable FY 1995 inpatient hospital DSH expenditures as reported on the Form 

CMS–64. 

Column C ......... IMD and Mental Health Services FY 95 DSH Total 

Computable. This column contains the total computable FY 1995 mental health facility DSH expenditures as reported on the 

Form CMS–64 as of January 1, 1997. 

Column D ......... Total Inpatient Hospital & IMD & Mental Health FY 95 DSH Total 

Computable, Col. B + C. This column contains the total computation of all inpatient hospital DSH expenditures and mental 

health facility DSH expenditures for FY 1995 as reported on the Form CMS–64 as of January 1, 1997 (representing the 

sum of Column B and Column C). 

Column E .......... Applicable Percentage, Col. C/D. 

This column contains the ‘‘applicable percentage’’ representing the total Computable FY 1995 mental health facility DSH expenditures divided by total computable all inpatient hospital and mental health facility DSH expenditures for FY 1995 (the 

amount in Column C divided by the amount in Column D) Per section 1923(h)(2)(A)(ii)(III) of the Act, for FYs after FY 2002, 

the applicable percentage can be no greater than 33 percent. 

Column F .......... FY 2013 Federal Share DSH Allotment 

This column contains the states’ FY 2013 DSH allotments from Column J Addendum 1. 

Column G ......... FY 2013 FMAP. 

Column H ......... FY 2013 DSH Allotments in Total Computable, Col. F/G. 

This column contains states’ FY 2013 total computable DSH allotment (determined as Column F/Column G). 

Column I ........... Applicable Percentage Applied to FY 2013 Allotments in TC, Col E × Col H. 

This column contains the applicable percentage of FY 2012 total computable DSH allotment (calculated as the percentage in 

Column E multiplied by the amount in Column H). 

Column J .......... FY 2013 TC IMD DSH Limit. Lesser of Col. 

I or C. This column contains the total computable FY 2013 TC IMD DSH Limit equal to the lesser of the amount in Column I 

or Column C. 

Column K .......... FY 2013 IMD DSH Limit in Federal Share, Col. G × J. 

This column contains the FY 2013 Federal Share IMD DSH limit determined by converting the total computable FY 2013 IMD 

DSH Limit from Column J into a federal share amount by multiplying it by the FY 2013 FMAP in Column G. 


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5458 Federal Register / Vol. 81, No. 21 / Tuesday, February 2, 2016 / Notices 

ADDENDUM 3—FINAL IMD DSH LIMITS FOR FY 2013 

State 

Inpatient 

Hospital 

services FY 

95 DSH 

Total 

computable 

IMD And 

mental 

health 

services FY 

95 DSH 

Total 

computable 

Total inpatient 

& IMD & 

mental health 

FY 95 DSH 

total 

computable 

Col B + C 

Applicable 

percent 

Col C/D 

(percent) 

FY 2013 

Allotment 

In FS 

FY 2013 

FMAPs 

(percent) 

FY 2013 

Allotments 

in TC 

Col F/G 

Applicable 

percentage 

applied to 

FY 2013 

allotments 

in TC 

Col E × Col H 

FY 2013 

TC IMD Limit 

(Lesser Of 

Col I or Col C) 

FY 2013 

IMD Limit 

In FS 

Col G × J 

MMA 

LOW 

DSH 

Status 

A B C D E F G H I J K L 

ALABAMA ........................... $413,006,229 $4,451,770 $417,457,999 1.07 $323,093,267 68.53 471,462,523 $5,027,674 $4,451,770 $3,050,798 N/A ARIZONA ............................ 93,916,100 28,474,900 122,391,000 23.27 106,384,369 65.68 161,973,765 37,684,035 28,474,900 18,702,314 N/A CALIFORNIA ...................... 2,189,879,543 1,555,919 2,191,435,462 0.07 1,151,840,630 50.00 2,303,681,260 1,635,614 1,555,919 777,960 N/A COLORADO ....................... 173,900,441 594,776 174,495,217 0.34 97,190,657 50.00 194,381,314 662,559 594,776 297,388 N/A CONNECTICUT .................. 303,359,275 105,573,725 408,933,000 25.82 210,141,962 50.00 420,283,924 108,504,179 105,573,725 52,786,863 N/A DISTRICT OF COLUMBIA 39,532,234 6,545,136 46,077,370 14.20 64,355,975 70.00 91,937,107 13,059,358 6,545,136 4,581,595 N/A FLORIDA ............................ 184,468,014 149,714,986 334,183,000 33.00 210,141,962 58.08 361,814,673 119,398,842 119,398,842 69,346,847 N/A GEORGIA ........................... 407,343,557 0 407,343,557 0.00 282,378,262 65.56 430,717,300 0 0 0 N/A ILLINOIS ............................. 315,868,508 89,408,276 405,276,784 22.06 225,902,609 50.00 451,805,218 99,672,933 89,408,276 44,704,138 N/A INDIANA ............................. 79,960,783 153,566,302 233,527,085 33.00 224,589,223 67.16 334,409,206 110,355,038 110,355,038 74,114,444 N/A KANSAS ............................. 11,587,208 76,663,508 88,250,716 33.00 43,341,780 56.51 76,697,540 25,310,188 25,310,188 14,302,787 N/A KENTUCKY ........................ 158,804,908 37,443,073 196,247,981 19.08 152,352,923 70.55 215,950,281 41,202,167 37,443,073 26,416,088 N/A LOUISIANA ......................... 1,078,512,169 132,917,149 1,211,429,318 10.97 731,960,000 65.51 1,117,325,599 122,592,157 122,592,157 80,310,122 N/A MAINE ................................. 99,957,958 60,958,342 160,916,300 33.00 110,324,530 62.57 176,321,768 58,186,183 58,186,183 36,407,095 N/A MARYLAND ........................ 22,226,467 120,873,531 143,099,998 33.00 80,116,623 50.00 160,233,246 52,876,971 52,876,971 26,438,486 N/A MASSACHUSETTS ............ 469,653,946 105,635,054 575,289,000 18.36 320,466,492 50.00 640,932,984 117,688,658 105,635,054 52,817,527 N/A MICHIGAN .......................... 133,258,800 304,765,552 438,024,352 33.00 278,438,100 66.39 419,397,650 138,401,225 138,401,225 91,884,573 N/A MISSISSIPPI ....................... 182,608,033 0 182,608,033 0.00 160,233,246 73.43 218,212,238 0 0 0 N/A MISSOURI .......................... 521,946,524 207,234,618 729,181,142 28.42 497,773,773 61.37 811,102,775 230,516,896 207,234,618 127,179,885 N/A NEVADA ............................. 73,560,000 0 73,560,000 0.00 48,595,328 59.74 81,344,707 0 0 0 N/A NEW HAMPSHIRE ............. 92,675,916 94,753,948 187,429,864 33.00 168,217,088 50.00 336,434,176 111,023,278 94,753,948 47,376,974 N/A NEW JERSEY .................... 736,742,539 357,370,461 1,094,113,000 32.66 676,394,441 50.00 1,352,788,882 441,861,843 357,370,461 178,685,231 N/A NEW YORK ........................ 2,418,869,368 605,000,000 3,023,869,368 20.01 1,687,702,633 50.00 3,375,405,266 675,333,468 605,000,000 302,500,000 N/A NORTH CAROLINA ............ 193,201,966 236,072,627 429,274,593 33.00 309,959,394 65.51 473,148,212 156,138,910 156,138,910 102,286,600 N/A OHIO ................................... 535,731,956 93,432,758 629,164,714 14.85 426,850,861 63.58 671,360,272 99,698,919 93,432,758 59,404,548 N/A PENNSYLVANIA ................ 388,207,319 579,199,682 967,407,001 33.00 589,710,881 54.28 1,086,423,878 358,519,880 358,519,880 194,604,591 N/A RHODE ISLAND ................. 108,503,167 2,397,833 110,901,000 2.16 68,296,138 51.26 133,234,760 2,880,720 2,397,833 1,229,129 N/A SOUTH CAROLINA ............ 366,681,364 72,076,341 438,757,705 16.43 344,107,463 70.43 488,580,808 80,260,965 72,076,341 50,763,367 N/A TENNESSEE ...................... 0 0 0 0.00 53,100,000 66.13 80,296,386 0 0 0 N/A TEXAS ................................ 1,220,515,401 292,513,592 1,513,028,993 19.33 1,004,741,257 59.30 1,694,336,015 327,565,642 292,513,592 173,460,560 N/A VERMONT .......................... 19,979,252 9,071,297 29,050,549 31.23 23,640,971 56.04 42,185,887 13,172,925 9,071,297 5,083,555 N/A VIRGINIA ............................ 129,313,480 7,770,268 137,083,748 5.67 92,050,138 50.00 184,100,276 10,435,289 7,770,268 3,885,134 N/A WASHINGTON ................... 171,725,815 163,836,435 335,562,250 33.00 194,381,315 50.00 388,762,630 128,291,668 128,291,668 64,145,834 N/A WEST VIRGINIA ................. 66,962,606 18,887,045 85,849,651 22.00 70,922,912 72.04 98,449,350 21,658,997 18,887,045 13,606,227 N/A 

Total ............................. 13,402,460,846 4,118,758,904 17,521,219,750 .............. 11,029,697,203 .............. 19,545,491,877 3,709,617,180 3,410,261,852 1,921,150,660 

LOW DSH STATES 

ALASKA .............................. $2,506,827 $17,611,765 $20,118,592 33.00 $21,402,636 50.00 $42,805,272 $14,125,740 $14,125,740 $7,062,870 LOW 

DSH 

ARKANSAS ........................ 2,422,649 819,351 3,242,000 25.27 45,325,292 70.17 64,593,547 16,324,734 819,351 574,939 LOW 

DSH 

DELAWARE ........................ 0 7,069,000 7,069,000 33.00 9,512,282 55.67 17,086,909 5,638,680 5,638,680 3,139,053 LOW 

DSH 

HAWAII ............................... 0 0 0 0.00 10,240,000 51.86 19,745,469 0 0 0 LOW 

DSH 

IDAHO ................................. 2,081,429 0 2,081,429 0.00 17,271,044 71.00 24,325,414 0 0 0 LOW 

DSH 

IOWA .................................. 12,011,250 0 12,011,250 0.00 41,378,149 59.59 69,438,075 0 0 0 LOW 

DSH 

MINNESOTA ....................... 24,240,000 5,257,214 29,497,214 17.82 78,476,334 50.00 156,952,668 27,973,278 5,257,214 2,628,607 LOW 

DSH 

MONTANA .......................... 237,048 0 237,048 0.00 11,926,371 66.00 18,070,259 0 0 0 LOW 

DSH 

NEBRASKA ........................ 6,449,102 1,811,337 8,260,439 21.93 29,733,219 55.76 53,323,563 11,692,713 1,811,337 1,010,002 LOW 

DSH 

NEW MEXICO .................... 6,490,015 254,786 6,744,801 3.78 21,402,636 69.07 30,986,877 1,170,535 254,786 175,981 LOW 

DSH 

NORTH DAKOTA ............... 214,523 988,478 1,203,001 33.00 10,036,360 52.27 19,200,995 6,336,328 988,478 516,677 LOW 

DSH 

OKLAHOMA ........................ 20,019,969 3,273,248 23,293,217 14.05 38,049,129 64.00 59,451,764 8,354,379 3,273,248 2,094,879 LOW 

DSH 


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Federal Register / Vol. 81, No. 21 / Tuesday, February 2, 2016 / Notices 5459 

OREGON ............................ 11,437,908 19,975,092 31,413,000 33.00 47,561,414 62.44 76,171,387 25,136,558 19,975,092 12,472,447 LOW 

DSH 

SOUTH DAKOTA ............... 321,120 751,299 1,072,419 33.00 11,604,719 56.19 20,652,641 6,815,372 751,299 422,155 LOW 

DSH 

UTAH .................................. 3,621,116 934,586 4,555,702 20.51 20,612,808 69.61 29,611,849 6,074,765 934,586 650,565 LOW 

DSH 

WISCONSIN ....................... 6,609,524 4,492,011 11,101,535 33.00 99,326,563 59.74 166,264,752 54,867,368 4,492,011 2,683,527 LOW 

DSH 

WYOMING .......................... 0 0 0 0.00 237,807 50.00 475,614 0 0 0 LOW 

DSH 

Total Low DSH States 98,662,480 63,238,167 161,900,647 .............. 514,096,763 .............. 869,157,055 184,510,449 58,321,822 33,431,702 Total ............................. 13,501,123,326 4,181,997,071 17,683,120,397 .............. 11,543,793,966 .............. 20,414,648,932 3,894,127,630 3,468,583,674 1,954,582,362 


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5460 Federal Register / Vol. 81, No. 21 / Tuesday, February 2, 2016 / Notices 

KEY TO ADDENDUM 4—PRELIMINARY IMD DSH LIMITS FOR FY 2015 

[The preliminary FY 2015 IMD DSH Limits for the Non-Low DSH States are presented in the top section of this addendum and the preliminary 

FY 2015 IMD DSH Limits for the Low-DSH States are presented in the bottom section of the addendum] 

Column Description 

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

Column B .......... Inpatient Hospital Services FY 95 DSH Total Computable. 

This column contains the States’ total computable FY 1995 inpatient hospital DSH expenditures as reported on the Form 

CMS–64. 

Column C ......... IMD and Mental Health Services FY 95 DSH Total 

Computable. This column contains the total computable FY 1995 mental health facility DSH expenditures as reported on the 

Form CMS–64 as of January 1, 1997. 

Column D ......... Total Inpatient Hospital & IMD & Mental Health FY 95 DSH Total 

Computable, Col. B + C. This column contains the total computation of all inpatient hospital DSH expenditures and mental 

health facility DSH expenditures for FY 1995 as reported on the Form CMS–64 as of January 1, 1997 (representing the 

sum of Column B and Column C). 

Column E .......... Applicable Percentage, Col. C/D. 

This column contains the ‘‘applicable percentage’’ representing the total Computable FY 1995 mental health facility DSH expenditures divided by total computable all inpatient hospital and mental health facility DSH expenditures for FY 1995 (the 

amount in Column C divided by the amount in Column D) Per section 1923(h)(2)(A)(ii)(III) of the Act, for FYs after FY 2002, 

the applicable percentage can be no greater than 33 percent. 

Column F .......... FY 2015 Federal Share DSH Allotment. 

This column contains the states’ preliminary FY 2015 DSH allotments from Column J Addendum 1. 

Column G ......... FY 2015 FMAP. 

Column H ......... FY 2015 DSH Allotments in Total Computable, Col. F/G. 

This column contains states’ FY 2015 total computable DSH allotment (determined as Column F/Column G). 

Column I ........... Applicable Percentage Applied to FY 2015 Allotments in TC, Col E x Col H. 

This column contains the applicable percentage of FY 2014 total computable DSH allotment (calculated as the percentage in 

Column E multiplied by the amount in Column H). 

Column J .......... FY 2015 TC IMD DSH Limit. Lesser of Col. 

I or C. This column contains the total computable FY 2015 TC IMD DSH Limit equal to the lesser of the amount in Column I 

or Column C. 

Column K .......... FY 2015 IMD DSH Limit in Federal Share, Col. G × J. 

This column contains the FY 2015 Federal Share IMD DSH limit determined by converting the total computable FY 2015 IMD 

DSH Limit from Column J into a federal share amount by multiplying it by the FY 2015 FMAP in Column G. 


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Federal Register / Vol. 81, No. 21 / Tuesday, February 2, 2016 / Notices 5461 

ADDENDUM 4—PRELIMINARY IMD DSH LIMITS FOR FY 2015 

State 

Inpatient hospital 

services FY 95 

DSH total computable 

IMD and mental 

health services 

FY 95 DSH total 

computable 

Total inpatient & 

IMD & mental 

health FY 95 DSH 

total computable 

Col B + C 

Applicable 

percent 

Col C/D 

FY 2015 allotment 

in FS 

FY 2015 

FMAPs 

(percent) 

FY 2015 

allotments in TC 

Col. F/G 

Applicable 

percentage 

applied to FY 

2015 

allotments in 

TC Col E × 

Col H 

FY 2015 TC 

IMD Limit 

(Lesser Of Col 

I or Col C) 

FY 2015 TC 

IMD limit in FS 

Col G × J 

MMA 

LOW 

DSH 

Status 

A B C D E F G H I J K L 

ALABAMA ........................... $413,006,229 $4,451,770 $417,457,999 1.07 $333,186,701 68.99 $482,949,269 $5,150,169 $4,451,770 $3,071,276 N/A ARIZONA ............................ 93,916,100 28,474,900 122,391,000 23.27 109,707,817 68.46 160,250,974 37,283,219 28,474,900 19,493,917 N/A CALIFORNIA ...................... 2,189,879,543 1,555,919 2,191,435,462 0.07 1,187,824,131 50.00 2,375,648,262 1,686,710 1,555,919 777,960 N/A COLORADO ....................... 173,900,441 594,776 174,495,217 0.34 100,226,893 51.01 196,484,793 669,729 594,776 303,395 N/A CONNECTICUT .................. 303,359,275 105,573,725 408,933,000 25.82 216,706,796 50.00 433,413,592 111,893,849 105,573,725 52,786,863 N/A DISTRICT OF COLUMBIA 39,532,234 6,545,136 46,077,370 14.20 66,366,456 70.00 94,809,223 13,467,332 6,545,136 4,581,595 N/A FLORIDA ............................ 184,468,014 149,714,986 334,183,000 33.00 216,706,796 59.72 362,871,393 119,747,560 119,747,560 71,513,243 N/A GEORGIA ........................... 407,343,557 0 407,343,557 0.00 291,199,759 66.94 435,016,073 0 0 0 N/A ILLINOIS ............................. 315,868,508 89,408,276 405,276,784 22.06 232,959,806 50.76 458,943,668 101,247,749 89,408,276 45,383,641 N/A INDIANA ............................. 79,960,783 153,566,302 233,527,085 33.00 231,605,390 66.52 348,174,068 114,897,442 114,897,442 76,429,779 N/A KANSAS ............................. 11,587,208 76,663,508 88,250,716 33.00 44,695,778 56.63 78,925,972 26,045,571 26,045,571 14,749,607 N/A KENTUCKY ........................ 158,804,908 37,443,073 196,247,981 19.08 157,112,428 69.94 224,638,873 42,859,905 37,443,073 26,187,685 N/A LOUISIANA ......................... 1,078,512,169 132,917,149 1,211,429,318 10.97 743,671,360 62.05 1,198,503,400 131,498,927 131,498,927 81,595,084 N/A MAINE ................................. 99,957,958 60,958,342 160,916,300 33.00 113,771,068 61.88 183,857,576 60,673,000 60,673,000 37,544,452 N/A MARYLAND ........................ 22,226,467 120,873,531 143,099,998 33.00 82,619,466 50.00 165,238,932 54,528,848 54,528,848 27,264,424 N/A MASSACHUSETTS ............ 469,653,946 105,635,054 575,289,000 18.36 330,477,865 50.00 660,955,730 121,365,252 105,635,054 52,817,527 N/A MICHIGAN .......................... 133,258,800 304,765,552 438,024,352 33.00 287,136,507 65.54 438,108,799 144,575,904 144,575,904 94,755,047 N/A MISSISSIPPI ....................... 182,608,033 0 182,608,033 0.00 165,238,933 73.58 224,570,444 0 0 0 N/A MISSOURI .......................... 521,946,524 207,234,618 729,181,142 28.42 513,324,226 63.45 809,021,633 229,925,432 207,234,618 131,490,365 N/A NEVADA ............................. 73,560,000 0 73,560,000 0.00 50,113,446 64.36 77,864,273 0 0 0 N/A NEW HAMPSHIRE ............. 92,675,916 94,753,948 187,429,864 33.00 173,472,190 50.00 346,944,380 114,491,645 94,753,948 47,376,974 N/A NEW JERSEY .................... 736,742,539 357,370,461 1,094,113,000 32.66 697,525,004 50.00 1,395,050,008 455,665,607 357,370,461 178,685,231 N/A NEW YORK ........................ 2,418,869,368 605,000,000 3,023,869,368 20.01 1,740,426,463 50.00 3,480,852,926 696,430,885 605,000,000 302,500,000 N/A NORTH CAROLINA ............ 193,201,966 236,072,627 429,274,593 33.00 319,642,526 65.88 485,189,019 160,112,376 160,112,376 105,482,034 N/A OHIO ................................... 535,731,956 93,432,758 629,164,714 14.85 440,185,682 62.64 702,722,992 104,356,372 93,432,758 58,526,280 N/A PENNSYLVANIA ................ 388,207,319 579,199,682 967,407,001 33.00 608,133,449 51.82 1,173,549,689 387,271,397 387,271,397 200,684,038 N/A RHODE ISLAND ................. 108,503,167 2,397,833 110,901,000 2.16 70,429,709 50.00 140,859,418 3,045,575 2,397,833 1,198,917 N/A SOUTH CAROLINA ............ 366,681,364 72,076,341 438,757,705 16.43 354,857,380 70.64 502,346,234 82,522,262 72,076,341 50,914,727 N/A TENNESSEE* ..................... 0 0 0 0.00 53,100,000 64.99 81,704,878 0 0 0 N/A TEXAS ................................ 1,220,515,401 292,513,592 1,513,028,993 19.33 1,036,129,374 58.05 1,784,891,256 345,072,669 292,513,592 169,804,140 N/A VERMONT** ....................... 19,979,252 9,071,297 29,050,549 31.23 24,379,515 56.21 43,372,202 13,543,363 9,071,297 5,098,976 N/A VIRGINIA ............................ 129,313,480 7,770,268 137,083,748 5.67 94,925,784 50.00 189,851,568 10,761,287 7,770,268 3,885,134 N/A WASHINGTON ................... 171,725,815 163,836,435 335,562,250 33.00 200,453,788 50.03 400,667,176 132,220,168 132,220,168 66,149,750 N/A WEST VIRGINIA ................. 66,962,606 18,887,045 85,849,651 22.00 73,138,544 71.35 102,506,719 22,551,624 18,887,045 13,475,907 N/A 

Total ............................. 13,402,460,846 4,118,758,904 17,521,219,750 .............. 11,361,451,030 .............. 20,240,755,414 3,845,561,828 3,471,761,983 1,944,527,968 ..............

LOW DSH STATES 

ALASKA .............................. 2,506,827 17,611,765 20,118,592 33.00 22,071,255 50.00 44,142,510 14,567,028 14,567,028 7,283,514 LOW 

DSH 

ARKANSAS ........................ 2,422,649 819,351 3,242,000 25.27 46,741,254 70.88 65,944,207 16,666,086 819,351 580,756 LOW 

DSH 

DELAWARE ........................ 0 7,069,000 7,069,000 33.00 9,809,445 53.63 18,290,966 6,036,019 6,036,019 3,237,117 LOW 

DSH 

HAWAII ............................... 0 0 0 0.00 10,559,898 52.23 20,218,070 0 0 0 LOW 

DSH 

IDAHO ................................. 2,081,429 0 2,081,429 0.00 17,810,592 71.75 24,823,125 0 0 0 LOW 

DSH 

IOWA .................................. 12,011,250 0 12,011,250 0.00 42,670,802 55.54 76,828,956 0 0 0 LOW 

DSH 

MINNESOTA ....................... 24,240,000 5,257,214 29,497,214 17.82 80,927,935 50.00 161,855,870 28,847,163 5,257,214 2,628,607 LOW 

DSH 

MONTANA .......................... 237,048 0 237,048 0.00 12,298,951 65.90 18,663,052 0 0 0 LOW 

DSH 


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5462 Federal Register / Vol. 81, No. 21 / Tuesday, February 2, 2016 / Notices 

ADDENDUM 4—PRELIMINARY IMD DSH LIMITS FOR FY 2015—Continued 

State 

Inpatient hospital 

services FY 95 

DSH total computable 

IMD and mental 

health services 

FY 95 DSH total 

computable 

Total inpatient & 

IMD & mental 

health FY 95 DSH 

total computable 

Col B + C 

Applicable 

percent 

Col C/D 

FY 2015 allotment 

in FS 

FY 2015 

FMAPs 

(percent) 

FY 2015 

allotments in TC 

Col. F/G 

Applicable 

percentage 

applied to FY 

2015 

allotments in 

TC Col E × 

Col H 

FY 2015 TC 

IMD Limit 

(Lesser Of Col 

I or Col C) 

FY 2015 TC 

IMD limit in FS 

Col G × J 

MMA 

LOW 

DSH 

Status 

A B C D E F G H I J K L 

NEBRASKA ........................ 6,449,102 1,811,337 8,260,439 21.93 30,662,084 53.27 57,559,760 12,621,620 1,811,337 964,899 LOW 

DSH 

NEW MEXICO .................... 6,490,015 254,786 6,744,801 3.78 22,071,255 69.65 31,688,808 1,197,050 254,786 177,458 LOW 

DSH 

NORTH DAKOTA ............... 214,523 988,478 1,203,001 33.00 10,349,895 50.00 20,699,790 6,830,931 988,478 494,239 LOW 

DSH 

OKLAHOMA ........................ 20,019,969 3,273,248 23,293,217 14.05 39,237,784 62.30 62,981,997 8,850,460 3,273,248 2,039,234 LOW 

DSH 

OREGON ............................ 11,437,908 19,975,092 31,413,000 33.00 49,047,232 64.06 76,564,521 25,266,292 19,975,092 12,796,044 LOW 

DSH 

SOUTH DAKOTA ............... 321,120 751,299 1,072,419 33.00 11,967,251 51.64 23,174,382 7,647,546 751,299 387,971 LOW 

DSH 

UTAH .................................. 3,621,116 934,586 4,555,702 20.51 21,256,752 70.56 30,125,782 6,180,197 934,586 659,444 LOW 

DSH 

WISCONSIN ....................... 6,609,524 4,492,011 11,101,535 33.00 102,429,524 58.27 175,784,321 58,008,826 4,492,011 2,617,495 LOW 

DSH 

WYOMING .......................... 0 0 0 0.00 245,236 50.00 490,472 0 0 0 LOW 

DSH 

Total Low DSH States 98,662,480 63,238,167 161,900,647 .............. 530,157,145 .............. 909,836,589 192,719,219 59,160,449 33,866,778 ..............

Total ...................... 13,501,123,326 4,181,997,071 17,683,120,397 .............. 11,891,608,175 .............. 21,150,592,003 4,038,281,047 3,530,922,432 1,978,394,746 ..............

* Tennessee’s DSH allotment for FY 2015 determined under section 1923(f)(6)(A)(vi) of the Act. ** Vermont’s FMAP for FY 2015 determined in accordance with section 1905(z)(1)(A) of the Act 


wgreen on DSK2VPTVN1PROD with NOTICES
Federal Register / Vol. 81, No. 21 / Tuesday, February 2, 2016 / Notices 5463 

[FR Doc. 2016–01836 Filed 2–1–16; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–1661–NC] 

Medicare Program; Request for an 

Exception to the Prohibition on 

Expansion of Facility Capacity Under 

the Hospital Ownership and Rural 

Provider Exceptions to the Physician 

Self-Referral Prohibition 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice with request for 

comment. 

SUMMARY: The Social Security Act (the 

Act) prohibits a physician-owned 

hospital from expanding its facility 

capacity, unless the Secretary of the 

Department of Health and Human 

Services (the Secretary) grants the 

hospital’s request for an exception to 

that prohibition after considering input 

on the hospital’s request from 

individuals and entities in the 

community where the hospital is 

located. The Centers for Medicare & 

Medicaid Services (CMS) has received a 

request from a physician-owned 

hospital for an exception to the 

prohibition against expansion of facility 

capacity. This notice solicits comments 

on the request from individuals and 

entities in the community in which the 

physician-owned hospital is located. 

Community input may inform our 

determination regarding whether the 

requesting hospital qualifies for an 

exception to the prohibition against 

expansion of facility capacity. 

DATES: Comment Date: To be assured 

consideration, comments must be 

received at one of the addresses 

provided below, no later than 5 p.m. on 

March 3, 2016. 

ADDRESSES: In commenting, please refer 

to file code CMS–1661–NC. Because of 

staff and resource limitations, we cannot 

accept comments by facsimile (FAX) 

transmission. 

You may submit comments in one of 

four ways (please choose only one of the 

ways listed): 

1. Electronically. You may submit 

electronic comments on this regulation 

to http://www.regulations.gov. Follow 

the ‘‘Submit a comment’’ instructions. 

2. By regular mail. You may mail 

written comments to the following 

address only: Centers for Medicare & 

Medicaid Services, Department of 

Health and Human Services, Attention: 

CMS–1661–NC, P.O. Box 8010, 

Baltimore, MD 21244–8010. 

Please allow sufficient time for mailed 

comments to be received before the 

close of the comment period. 

3. By express or overnight mail. You 

may send written comments to the 

following address only: Centers for 

Medicare & Medicaid Services, 

Department of Health and Human 

Services, Attention: CMS–1661–NC, 

Mail Stop C4–26–05, 7500 Security 

Boulevard, Baltimore, MD 21244–1850. 

4. By hand or courier. Alternatively, 

you may deliver (by hand or courier) 

your written comments only to the 

following addresses: 

a. For delivery in Washington, DC— 

Centers for Medicare & Medicaid 

Services, Department of Health and 

Human Services, Room 445–G, Hubert 

H. Humphrey Building, 200 

Independence Avenue SW., 

Washington, DC 20201. 

(Because access to the interior of the 

Hubert H. Humphrey Building is not 

readily available to persons without 

Federal government identification, 

commenters are encouraged to leave 

their comments in the CMS drop slots 

located in the main lobby of the 

building. A stamp-in clock is available 

for persons wishing to retain a proof of 

filing by stamping in and retaining an 

extra copy of the comments being filed.) 

b. For delivery in Baltimore, MD— 

Centers for Medicare & Medicaid 

Services, Department of Health and 

Human Services, 7500 Security 

Boulevard, Baltimore, MD 21244–1850. 

If you intend to deliver your 

comments to the Baltimore address, call 

telephone number (410) 786–9994 in 

advance to schedule your arrival with 

one of our staff members. 

Comments erroneously mailed to the 

addresses indicated as appropriate for 

hand or courier delivery may be delayed 

and received after the comment period. 

FOR FURTHER INFORMATION CONTACT: 

POH-ExceptionRequests@cms.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

Inspection of Public Comments 

All comments received before the 

close of the comment period are 

available for viewing by the public, 

including any personally identifiable or 

confidential business information that is 

included in a comment. We post all 

comments received before the close of 

the comment period on the following 

Web site as soon as possible after they 

have been received: http://

www.regulations.gov. Follow the search 

instructions on that Web site to view 

public comments. 

We will allow stakeholders 30 days 

from the date of this notice to submit 

written comments. Comments received 

timely will be available for public 

inspection as they are received, 

generally beginning approximately 3 

weeks after publication of this notice, at 

the headquarters of the Centers for 

Medicare & Medicaid Services, 7500 

Security Boulevard, Baltimore, 

Maryland 21244, Monday through 

Friday of each week from 8:30 a.m. to 

4 p.m. To schedule an appointment to 

view public comments, please phone 1– 

800–743–3951. 

I. Background 

Section 1877 of the Social Security 

Act (the Act), also known as the 

physician self-referral law—(1) prohibits 

a physician from making referrals for 

certain ‘‘designated health services’’ 

(DHS) payable by Medicare to an entity 

with which he or she (or an immediate 

family member) has a financial 

relationship (ownership or 

compensation), unless the requirements 

of an applicable exception are satisfied; 

and (2) prohibits the entity from filing 

claims with Medicare (or billing another 

individual, entity, or third party payer) 

for those DHS furnished as a result of a 

prohibited referral. 

Section 1877(d)(2) of the Act provides 

an exception for physician ownership or 

investment interests in rural providers 

(the ‘‘rural provider exception’’). In 

order for an entity to qualify for the 

rural provider exception, the DHS must 

be furnished in a rural area (as defined 

in section 1886(d)(2) of the Act) and 

substantially all the DHS furnished by 

the entity must be furnished to 

individuals residing in a rural area. 

Section 1877(d)(3) of the Act provides 

an exception, known as the hospital 

ownership exception, for physician 

ownership or investment interests held 

in a hospital located outside of Puerto 

Rico, provided that the referring 

physician is authorized to perform 

services at the hospital and the 

ownership or investment interest is in 

the hospital itself (and not merely in a 

subdivision of the hospital). 

Section 6001(a)(3) of the Patient 

Protection and Affordable Care Act 

(Pub. L. 111–148) as amended by the 

Health Care and Education 

Reconciliation Act of 2010 (Pub. L. 111– 

152) (hereafter referred to together as 

‘‘the Affordable Care Act’’) amended the 

rural provider and hospital ownership 

exceptions to the physician self-referral 

prohibition to impose additional 

restrictions on physician ownership and 

investment in hospitals and rural 

providers. Since March 23, 2010, a 

physician-owned hospital that seeks to 


wgreen on DSK2VPTVN1PROD with NOTICES