Federal Register / Vol. 81, No. 21 / Tuesday, February 2, 2016 / Notices 5447 

governmental jurisdictions. Most 

hospitals and most other providers and 

suppliers are small entities, either by 

nonprofit status or by having revenues 

of $7.0 million to $35.5 million in any 

one year. Individuals and states are not 

included in the definition of a small 

entity. CMS is not preparing an analysis 

for the RFA because it has determined, 

and the Secretary certifies, that this 

document will not have a significant 

economic impact on a substantial 

number of small entities. 

In addition, section 1102(b) of the Act 

requires us to prepare a regulatory 

impact analysis if an action 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, CMS defines a small rural 

hospital as a hospital that is located 

outside of a Metropolitan Statistical 

Area for Medicare payment purposes 

and has fewer than 100 beds. CMS is not 

preparing an analysis for section 1102(b) 

of the Act because it has determined, 

and the Secretary certifies, that this 

document will not have a significant 

impact on the operations of a substantial 

number of small rural hospitals. 

Section 202 of the Unfunded 

Mandates Reform Act of 1995 also 

requires that agencies assess anticipated 

costs and benefits before issuing any 

regulatory action whose mandates 

require spending in any one year of 

$100 million in 1995 dollars, updated 

annually for inflation. In 2015, that 

threshold is approximately $144 

million. This document will have no 

consequential effect on 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 regulatory action (and 

subsequent final action) that imposes 

substantial direct requirement costs on 

state and local governments, preempts 

state law, or otherwise has Federalism 

implications. Because this document 

does not impose any costs on state or 

local governments, the requirements of 

Executive Order 13132 are not 

applicable. 

In accordance with the provisions of 

Executive Order 12866, the Office of 

Management and Budget reviewed this 

document. 

Authority: Sections 1102 and 1871 of the 

Social Security Act (42 U.S.C. 1302 and 

1395hh) and 44 U.S.C. Chapter 35. 

Dated: December 7, 2015. 

Andrew M. Slavitt, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

[FR Doc. 2016–01835 Filed 1–29–16; 4:15 pm] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–3323–N] 

Request for Information: Certification 

Frequency and Requirements for the 

Reporting of Quality Measures Under 

CMS Programs; Extension of Comment 

Period 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Request for information; 

extension of comment period. 

SUMMARY: This document extends the 

comment period for the December 31, 

2015 request for information entitled 

‘‘Request for Information: Certification 

Frequency and Requirements for the 

Reporting of Quality Measures Under 

CMS Programs’’ (80 FR 81824) (referred 

to in this document as December 31 

RFI). The comment period for the 

December 31 RFI, which would have 

ended on February 1, 2016, is extended 

for 15 days. 

DATES: The comment period is extended 

to February 16, 2016. To be assured 

consideration, written or electronic 

comments on the December 31 RFI must 

be received at one of the addresses 

provided below no later than February 

16, 2016. 

ADDRESSES: In commenting on the 

December 31 RFI, please refer either to 

file code CMS–3323–NC and comment 

as indicated in that document (80 FR 

81824) or file code CMS–3323–N and 

comment as provided in this document. 

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–3323–N, P.O. Box 8013, 

Baltimore, MD 21244–8013. 

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–3323–N, 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. 

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. Comments received 

timely will also be available for public 

inspection as they are received, 

generally beginning approximately 3 

weeks after publication of a document, 

at the headquarters of the Centers for 

Medicare & Medicaid Services, 7500 

Security Boulevard, Baltimore, 

Maryland 21244, Monday through 


wgreen on DSK2VPTVN1PROD with NOTICES
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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