3250 Federal Register / Vol. 60, No. 9 / Friday, January 13, 1995 / Notices

petitioner’s environmental assessment

without further announcement in the

Federal Register. If, based on its review,

the agency finds that an environmental

impact statement is not required and

this petition results in a regulation, the

notice of availability of the agency’s

finding of no significant impact and the

evidence supporting that finding will be

published with the regulation in the

Federal Register in accordance with 21

CFR 25.40(c).

Dated: January 6, 1995.

Alan M. Rulis,

Acting Director, Office of Premarket

Approval, Center for Food Safety and Applied

Nutrition.

[FR Doc. 95–897 Filed 1–13–95; 8:45 am]

BILLING CODE 4160–01–F

Health Care Financing Administration

[MB–089–N]

RIN 0938–AG61

Medicaid Program; Limitations on

Aggregate Payments to

Disproportionate Share Hospitals:

Federal Fiscal Year 1995

AGENCY: Health Care Financing

Administration (HCFA), HHS.

ACTION: Notice.

SUMMARY: This notice announces the

preliminary Federal fiscal year (FFY)

1995 national target and individual

State allotments for Medicaid payment

adjustments made to hospitals that serve

a disproportionate number of Medicaid

recipients and low-income patients with

special needs. We are publishing this

notice in accordance with the

provisions of section 1923(f)(1)(C) of the

Social Security Act (the Act) and

implementing regulations at 42 CFR

447.297 through 447.299. The

preliminary FFY 1995 State DSH

allotments published in this notice will

be superseded by final FFY 1995 DSH

allotments to be published in the

Federal Register by April 1, 1995.

EFFECTIVE DATE: The preliminary DSH

payment adjustment expenditure limits

included in this notice apply to

Medicaid DSH payment adjustments

that are applicable to FFY 1995.

FOR FURTHER INFORMATION CONTACT:

Richard Strauss, (410) 966–2019.

SUPPLEMENTARY INFORMATION:

I. Background

Section 1923(f) of the Social Security

Act (the Act) and implementing

Medicaid regulations at 42 CFR 447.297

through 447.299 require us to estimate

and publish in the Federal Register the

national target and each State’s

allotment for disproportionate hospital

share (DSH) payments for each Federal

fiscal year (FFY). DSH payments are

payment adjustments made to

Medicaid-participating hospitals that

serve a large number of Medicaid

recipients and other low-income

individuals with special needs.

Preliminary amounts must be published

by October 1 of each FFY and final

amounts by April 1 of each FFY.

The implementing regulations

provide that the national aggregate DSH

limit for a FFY is a target rather than an

absolute cap when determining the

amount that can be allocated for DSH

payments. The national DSH target is 12

percent of the total amount of medical

assistance expenditures (excluding total

administrative costs) that are projected

to be made under approved Medicaid

State plans during the FFY. (Note:

Whenever the phrases ‘‘total medical

assistance expenditures’’ or ‘‘total

administrative costs’’ are used in this

notice, they mean both the State and

Federal share of expenditures or costs.)

In addition to the national DSH target,

there is a specific State DSH limit for

each State for each FFY. The State DSH

limit is a specified amount of DSH

payment adjustments applicable to a

FFY above which FFP will not be

available. This is called the ‘‘State DSH

allotment’’.

Each State’s DSH allotment for FFY

1995 is calculated by first determining

whether the State is a ‘‘high-DSH State,’’

or a ‘‘low-DSH State.’’ This is

determined by using the State’s ‘‘base

allotment.’’ A State’s base allotment is

the greater of: (1) The total amount of

the State’s actual and projected DSH

payment adjustments made under the

State’s approved State plan applicable

to FFY 1992, as adjusted by HCFA; or

(2) $1,000,000.

A State whose base allotment exceeds

12 percent of the State’s total medical

assistance expenditures (excluding

administrative costs) projected to be

made in FFY 1995 is referred to as a

‘‘high-DSH State.’’ The FFY 1995 State

DSH allotment for a high-DSH State is

limited to the State’s base allotment.

A State whose base allotment is equal

to or less than 12 percent of the State’s

total medical assistance expenditures

(excluding administrative costs)

projected to be made in FFY 1995 is

referred to as a ‘‘low-DSH State.’’ The

FFY 1995 State DSH allotment for a

low-DSH State is equal to the State’s

DSH allotment for FFY 1994 increased

by growth amounts and supplemental

amounts, if any. However, the FFY 1995

DSH allotment for a low-DSH State

cannot exceed 12 percent of the State’s

total medical assistance expenditures

for FFY 1995 (excluding administrative

costs).

The growth amount for FFY 1995 is

equal to the projected percentage

increase (the growth factor) in a lowDSH State’s total Medicaid program

expenditures between FFY 1994 and

FFY 1995 multiplied by the State’s final

DSH allotment for 1994. Because the

national DSH limit is considered a

target, a low-DSH State whose program

grows from one year to the next can

receive a growth amount that would not

be permitted if the national limit was

viewed as an absolute cap.

There is no growth factor and no

growth amount for any low-DSH State

whose Medicaid program does not grow

(that is, stayed the same or declined)

between fiscal years FFY 1994 and FFY

1995. Furthermore, because a low-DSH

State’s FFY 1995 DSH allotment cannot

exceed 12 percent of the State’s total

medical assistance expenditures, it is

possible for its FFY 1995 DSH allotment

to be lower than its FFY 1994 DSH

allotment. This situation occurs when

the State experiences a decrease in its

program expenditures between years

and its prior FFY DSH allotment is

greater than 12 percent of the total

projected medical assistance

expenditures for the current FFY. This

situation did not occur for FFY 1995.

Consequently, there are no States with

preliminary FFY 1995 State DSH

allotments that are lower than the final

FFY 1994 State DSH allotments.

There is no supplemental amount

available for redistribution for FFY

1995. The supplemental amount, if any,

is equal to a low-DSH State’s

proportional share of a pool of funds

(the redistribution pool). The

redistribution pool is equal to the

national 12-percent DSH target reduced

by the total of the base allotments for

high-DSH States, the total of the State

DSH allotments for the previous FFY for

low-DSH States, and the total of the

low-DSH State growth amounts. Since

the sum of these amounts is above the

projected FFY 1995 national 12 percent

DSH target, there is no redistribution

pool and, therefore, no supplemental

amounts for FFY 1995.

As prescribed in the law and

regulations, no State’s DSH allotment

will be below a minimum of $1 million.

As an exception to the above

requirements, under section

1923(f)(1)(A)(i)(II) of the Act and

regulations at 42 CFR 447.296(b)(5) and

447.298(f), a State may make DSH

payments for a FFY in accordance with

the minimum payment adjustments

required by Medicare methodology

described in section 1923(c)(1) of the
Federal Register / Vol. 60, No. 9 / Friday, January 13, 1995 / Notices 3251

Act. Nebraska’s preliminary State DSH

allotment has been determined in

accordance with this exception.

We are publishing in this notice the

preliminary FFY 1995 national DSH

target and State DSH allotments based

on the best available data we have at

this time from the States as adjusted by

HCFA. This data is taken from each

State’s August 1994 Form HCFA–37 and

is adjusted as necessary. The final FFY

1995 DSH allotments will be published

in the Federal Register by April 1, 1995.

II. Calculations of the Preliminary FFY

1995 DSH Limits

The total of the preliminary State DSH

allotments for FFY 1995 is equal to the

sum of the base allotments for all highDSH States, the FFY 1994 State DSH

allotments for all low-DSH States, and

the growth amounts for all low-DSH

States. A State-by-State breakdown is

presented in section III of this notice.

We classified States as high-DSH or

low-DSH States. If a State’s base

allotment exceeded 12 percent of its

total unadjusted medical assistance

expenditures (excluding administrative

costs) projected to be made under the

State’s approved plan in FFY 1995, we

classified that State as a ‘‘high-DSH’’

State. If a State’s base allotment was 12

percent or less of its total unadjusted

medical assistance expenditures

projected to be made under the State’s

approved State plan under title XIX of

the Act in FFY 1995, we classified that

State as a ‘‘low-DSH’’ State. There are 34

low-DSH States and 16 high-DSH States

for FFY 1995 as a result of this

classification.

Using the most recent data from the

August 1994 budget projections (Form

HCFA–37), we estimate the States’ FFY

1995 national total medical assistance

expenditures to be $155,059,961,000.

Thus, the overall preliminary national

FFY 1995 DSH expenditure target is

approximately $18.6 billion (12 percent

of $155.1 billion).

In addition, in the preliminary FFY

1995 State DSH allotments we provide

a total of $752,609,000 ($417,509,000

Federal share) in growth amounts for

the 34 low-DSH States. The growth

factor percentage for each of the lowDSH States was determined by

calculating the Medicaid program

growth percentage for each low-DSH

State between FFY 1994 and FFY 1995.

To compute this percentage, we first

ascertained each low-DSH State’s

estimate of total FFY 1994 medical

assistance and administrative

expenditures as reported on the State’s

Medicaid Budget Report (Form HCFA–

37) submitted in August 1994. Next, we

compared those estimates to each lowDSH State’s total estimated unadjusted

FFY 1995 medical assistance and

administrative expenditures as reported

to HCFA on the State’s August 1994

Form HCFA–37 submission.

The growth factor percentage was

multiplied by the low-DSH State’s final

FFY 1994 DSH allotment amount to

establish the State’s preliminary growth

amount for FFY 1995.

Since the sum of the total of the base

allotments for high-DSH States, the total

of the State DSH allotments for the

previous FFY for low-DSH States, and

the growth for low-DSH States

($19,242,708,000) is greater than the

preliminary FFY 1995 national target

($18,607,195,000), there is no

preliminary FFY 1995 redistribution

pool.

The low-DSH State’s growth amount

was then added to the low-DSH State’s

final FFY 1994 DSH allotment amount

to establish the preliminary total lowDSH State DSH allotment for FFY 1995.

If a State’s growth amount, when added

to its final FFY 1994 DSH allotment

amount, exceeds 12 percent of its FFY

1995 estimated medical assistance

expenditures, the State only receives a

partial growth amount which, when

added to its final FFY 1994 allotment,

limits its total State DSH allotment for

FFY 1995 to 12 percent of its estimated

FFY 1995 medical assistance

expenditures. For this reason, seven of

the low-DSH States received partial

growth amounts.

As we explained above, in accordance

with the minimum payment

adjustments required by Medicare

methodology, Nebraska’s preliminary

FFY 1995 State DSH allotment is $11

million.

In summary, the total of all

preliminary State DSH allotments for

FFY 1995 is $19,242,708,000

($10,978,517,000 Federal share). This

total is composed of the prior FFY’s

final State DSH allotments

($18,490,099,000) plus growth amounts

for all low-DSH States ($752,609,000)

plus supplemental amounts for lowDSH States ($0). The total of all

preliminary FFY 1995 State DSH

allotments is 12.6 percent of the total

medical assistance expenditures

(excluding administrative costs)

projected to be made by these States in

FFY 1995. The total of all preliminary

DSH allotments for FFY 1995 is

$635,513,000 over the FFY 1995

preliminary national target amount of

$18,607,195,000.

Each State should monitor and make

any necessary adjustments to its DSH

spending during FFY 1995 to ensure

that its actual FFY 1995 DSH payment

adjustment expenditures do not exceed

its final State DSH allotment for FFY

1995 which will be published by April

1, 1995. As the ongoing reconciliation

between actual FFY 1995 DSH payment

adjustment expenditures and the final

FFY 1995 DSH allotments takes place,

each State should amend its plans as

may be necessary to make any

adjustments to its FFY 1995 DSH

payment adjustment expenditure

patterns so that the State will not exceed

its final FFY 1995 DSH allotment.

The FFY 1995 reconciliation of DSH

allotments to actual expenditures will

take place on an ongoing basis as States

file expenditure reports with HCFA for

DSH payment adjustment expenditures

applicable to FFY 1995. In addition,

additional DSH payment adjustment

expenditures made in succeeding FFYs

that are applicable to FFY 1995 will

continue to be reconciled back to each

State’s final FFY 1995 DSH allotment as

additional expenditure reports are

submitted to ensure that the final FFY

1995 DSH allotment is not exceeded.

Any DSH payment adjustment

expenditures in excess of the final DSH

allotment will be disallowed.

Any DSH expenditures that are

disallowed will be subject to the normal

Medicaid disallowance procedures.

III. Preliminary FFY 1995 DSH

Allotments Under Public Law 102–234

KEY TO CHART

Column Description

Column A ........... = Name of State.

Column B ........... = Final FFY 1994 DSH Allotments For All States. For a high-DSH State, this is the State’s base allotment which is the

greater of the State’s FFY 1992 allowable DSH payment adjustment expenditures applicable to FFY 1992, or

$1,000,000. For a low-DSH State, this is equal to the final DSH allotment for FFY 1994 which was published in the

Federal Register on May 2, 1994.
3252 Federal Register / Vol. 60, No. 9 / Friday, January 13, 1995 / Notices

KEY TO CHART—Continued

Column Description

Column C ........... = Growth Amounts For Low-DSH States. This is an increase in a low-DSH State’s final FFY 1994 DSH allotment to the

extent that the State’s Medicaid program grew between FFY 1994 and FFY 1995.

Column D ........... = Preliminary FFY 1995 State DSH Allotments. For high DSH States this is equal to the base allotment from column B.

For low-DSH States, this is equal to the final State DSH allotments for FFY 1994 from column B plus the growth

amounts from column C and the supplemental amounts, if any, from column D.

Column E ........... = High or Low DSH State Designation. ‘‘High’’ indicates the State is a high-DSH State and a ‘‘Low’’ indicates the State is

a low-DSH State.

PRELIMINARY FEDERAL FISCAL YEAR 1995 DISPROPORTIONATE SHARE HOSPITAL ALLOTMENTS UNDER PUBLIC LAW 102–

234 AMOUNTS ARE STATE AND FEDERAL SHARES

[Dollars are in thousands(000)]

State

Final FFY 94

DSH allotments

for all states

Growth amounts for low

DSH states (1)

Preliminary FFY

95 state DSH allotments

High or

low DSH

state designation

A B C D E

AL ................................................................................................. $417,458 NOT APPLICABLE ........... $417,458 HIGH.

AK ................................................................................................ $19,589 $1,273 ............................... $20,862 LOW.

AR ................................................................................................ $3,039 $203 .................................. $3,242 LOW.

CA ................................................................................................ $2,191,451 NOT APPLICABLE ........... $2,191,451 HIGH.

CO ................................................................................................ $302,014 NOT APPLICABLE ........... $302,013 HIGH.

CT ................................................................................................ $408,933 NOT APPLICABLE ........... $408,933 HIGH.

DE ................................................................................................ $5,924 $1,063 ............................... $6,986 LOW.

DC ................................................................................................ $41,039 NOT APPLICABLE ........... $41,039 LOW.

FL ................................................................................................. $286,478 $76,223 ............................. $362,701 LOW.

GA ................................................................................................ $382,344 $34,880 ............................. $417,224 LOW.

HI .................................................................................................. $64,078 $3,887 ............................... $67,965 LOW.

ID .................................................................................................. $1,985 $126 .................................. $2,111 LOW.

IL .................................................................................................. $394,993 $69,434 ............................. $464,427 LOW.

IN .................................................................................................. $336,799 $31,516 ............................. $368,315 LOW.

IA .................................................................................................. $5,497 $689 .................................. $6,186 LOW.

KS ................................................................................................ $188,935 NOT APPLICABLE ........... $188,935 HIGH.

KY ................................................................................................ $264,289 NOT APPLICABLE ........... $264,289 HIGH.

LA ................................................................................................. $1,217,636 NOT APPLICABLE ........... $1,217,636 HIGH.

ME ................................................................................................ $165,317 NOT APPLICABLE ........... $165,317 HIGH.

MD ................................................................................................ $129,543 $15,000 ............................. $144,543 LOW.

MA ................................................................................................ $567,128 $19,052 ............................. $586,180 LOW.

MI ................................................................................................. $617,700 $67,497 ............................. $685,197 LOW.

MN ................................................................................................ $55,394 $5,225 ............................... $60,618 LOW.

MS ................................................................................................ $158,464 $16,481 ............................. $174,946 LOW.

MO ............................................................................................... $731,894 NOT APPLICABLE ........... $731,894 HIGH.

MT ................................................................................................ $1,300 $78 .................................... $1,378 LOW.

NE(2) ............................................................................................ $11,000 NOT APPLICABLE ........... $11,000 LOW.

NV ................................................................................................ $73,560 NOT APPLICABLE ........... $73,560 HIGH.

NH ................................................................................................ $392,006 NOT APPLICABLE ........... $392,006 HIGH.

NJ ................................................................................................. $1,094,113 NOT APPLICABLE ........... $1,094,113 HIGH.

NM ................................................................................................ $15,757 $1,743 ............................... $17,501 LOW.

NY ................................................................................................ $2,831,864 $206,729 ........................... $3,038,594 LOW.

NC ................................................................................................ $389,266 $49,413 ............................. $438,679 LOW.

ND ................................................................................................ $1,155 $38 .................................... $1,193 LOW.

OH ................................................................................................ $566,925 $73,044 ............................. $639,969 LOW.

OK ................................................................................................ $23,568 $529 .................................. $24,097 LOW.

OR ................................................................................................ $25,058 $5,537 ............................... $30,594 LOW.

PA ................................................................................................ $967,407 NOT APPLICABLE ........... $967,407 HIGH.

RI .................................................................................................. $94,432 $7,705 ............................... $102,137 LOW.

SC ................................................................................................ $439,759 NOT APPLICABLE ........... $439,759 HIGH.

SD ................................................................................................ $1,302 $137 .................................. $1,439 LOW.

TN ................................................................................................ $430,611 NOT APPLICABLE ........... $430,611 HIGH.

TX ................................................................................................. $1,513,029 NOT APPLICABLE ........... $1,513,029 HIGH.

UT ................................................................................................ $5,514 $651 .................................. $6,165 LOW.

VT ................................................................................................. $26,662 $1,351 ............................... $28,013 LOW.

VA ................................................................................................ $185,746 $26,038 ............................. $211,785 LOW.

WA ............................................................................................... $307,993 $33,210 ............................. $341,202 LOW.

WV ............................................................................................... $121,883 $1,710 ............................... $123,592 LOW.

WI ................................................................................................. $10,881 $1,978 ............................... $12,859 LOW.

WY ............................................................................................... $1,389 $170 .................................. $1,559 LOW.

TOTAL ............................................................................... $18,490,099 $752,609 ........................... $19,242,708 ,
Federal Register / Vol. 60, No. 9 / Friday, January 13, 1995 / Notices 3253

PRELIMINARY FEDERAL FISCAL YEAR 1995 DISPROPORTIONATE SHARE HOSPITAL ALLOTMENTS UNDER PUBLIC LAW 102–

234 AMOUNTS ARE STATE AND FEDERAL SHARES—CONTINUED

[Dollars are in thousands(000)]

State

Final FFY 94

DSH allotments

for all states

Growth amounts for low

DSH states (1)

Preliminary FFY

95 state DSH allotments

High or

low DSH

state designation

A B C D E

NOTES:.

(1) There was 1 low DSH State which had negative growth and 7 low DSH States which got partial growth up to 12% of FFY 95 Map.

(2) Allotment based upon minimum payment adjustment amount.

IV. Regulatory Impact Statement

We generally prepare a regulatory

flexibility analysis that is consistent

with the Regulatory Flexibility Act

(RFA) (5 U.S.C. 601 through 612), unless

the Administrator certifies that a notice

would not have a significant economic

impact on a substantial number of small

entities. For purposes of a RFA, States

and individuals are not considered

small entities. However, providers are

considered small entities. Additionally,

section 1102(b) of the Act requires the

Secretary to prepare a regulatory impact

analysis if a notice may have a

significant impact on the operations of

a substantial number of small rural

hospitals. Such an 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 Metropolitan

Statistical Area and has fewer than 50

beds.

This notice does not contain rules;

rather, it reflects the DSH allotments for

each State as determined in accordance

with §§ 447.297 through 447.299.

We have discussed the method of

calculating the preliminary FFY 1995

national aggregate DSH target and the

preliminary FFY 1995 individual State

DSH allotments in the previous sections

of this preamble. These calculations

should have a positive impact on

payments to DSHs. Allotments will not

be reduced for high-DSH States since we

are now interpreting the 12-percent

limit as a target. Low-DSH States will

get their base allotments plus their

growth amounts.

In accordance with the provisions of

Executive Order 12866, this notice was

reviewed by the Office of Management

and Budget.

(Catalog of Federal Assistance Program No.

93.778, Medical Assistance Program)

Dated: October 28, 1994.

Bruce C. Vladeck,

Administrator, Health Care Financing

Administration.

Dated: November 16, 1994.

Donna E. Shalala,

Secretary.

[FR Doc. 95–850 Filed 1–12–95; 8:45 am]

BILLING CODE 4120–01–P

Social Security Administration

Agency Forms Submitted to the Office

of Management and Budget for

Clearance

Normally on Fridays, the Social

Security Administration publishes a list

of information collection packages that

have been submitted to the Office of

Management and Budget (OMB) for

clearance in compliance with Public

Law 96–511, The Paperwork Reduction

Act. The following clearance packages

have been submitted to OMB since the

last list was published in the Federal

Register on Friday, November 25, 1994.

(Call Reports Clearance Officer on (410) 965–

4142 for copies of package.)

1. Supplemental Security Income

Notice of Interim Assistance

Reimbursement (TWO FORMS)—0960–

NEW. Forms SSA–8125 and SSA–L8125

will collect interim assistance

reimbursement (IAR) information from

States which provide such

reimbursement. Form SSA–8125 will be

used in most cases. The use of form

SSA–L8125 will be limited to situations

where a person is collecting

Supplemental Security Income

payments because of disability due to

drug abuse or alcoholism. The

respondents will be States who provide

IAR.

Number of Respondents: 140,000.

Frequency of Response: 1.

Average Burden Per Response: 10

minutes.

Estimated Annual Burden: 23,333

hours.

2. Pre-1957 Military Service Federal

Benefit Questionnaire—0960–0120. The

information on form SSA–2512 is used

by the Social Security Administration to

establish whether the wage earner’s

military service may be used to

determine entitlement to or the amount

of any Social Security benefit payable.

The respondents are claimants who are

applying for Social Security benefits on

a record where the wage earner has pre1957 military service.

Number of Respondents: 56,000.

Frequency of Response: 1.

Average Burden Per Response: 10

minutes.

Estimated Annual Burden: 9,333

hours.

3. Reconsideration Report for

Disability Cessation—0960–0350. The

information on form SSA–782 is used

by the Social Security Administration to

obtain additional information and

evidence to support requests for

reconsideration. The respondents are

claimants under Title II and Title XVI of

the Social Security Act who file a

request for reconsideration of disability

benefits.

Number of Respondents: 11,550.

Frequency of Response: 1.

Average Burden Per Response: 30

minutes.

Estimated Annual Burden: 5,775

hours.

OMB Desk Officer: Laura Oliven.

Written comments and

recommendations regarding these

information collections should be sent

directly to the appropriate OMB Desk

Officer designated above at the

following address: Office of

Management and Budget, OIRA, New

Executive Office Building, Room 10230,

Washington, D.C. 20503.

Dated: January 9, 1995.

Charlotte Whitenight,

Reports Clearance Officer, Social Security

Administration.

[FR Doc. 95–924 Filed 1–12–95; 8:45 am]

BILLING CODE 4190–29–P–M