Federal Register / Vol. 82, No. 212 / Friday, November 3, 2017 / Notices 51259 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–2409–N] 

RIN 0938–ZB43 

Medicaid Program; Final FY 2015 and 

Preliminary FY 2017 Disproportionate 

Share Hospital Allotments, and Final 

FY 2015 and Preliminary FY 2017 

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) 2015 and the 

preliminary federal share DSH 

allotments for FY 2017. This notice also 

announces the final FY 2015 and the 

preliminary FY 2017 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 applicable 

December 4, 2017. The final allotments 

and limitations set forth in this notice 

are applicable 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 DSH 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 from FY 2014 

through FY 2020, 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). Subsequent 

legislation, most recently by the 

Medicare Access and CHIP 

Reauthorization Act of 2015 (Pub. L. 

114–10, enacted on April 16, 2015) 

(MACRA), delayed the start of these 

reductions until FY 2018. The proposed 

rule delineating the methodology for the 

calculation of DSH allotment reductions 

scheduled to begin in FY 2018 was 

published in the July 28, 2017 Federal 

Register (82 FR 35155). 

Because there are no reductions to 

DSH allotments for FY 2015 and FY 

2017 under section 1923(f)(7) of the Act, 

as amended, this notice contains only 

the state-specific final FY 2015 DSH 

allotments and preliminary FY 2017 

DSH allotments, as calculated under the 

statute without application of the 

reductions that would have been 

imposed under the Affordable Care Act 

provisions beginning with FY 2014. 

This notice also provides information 

on the calculation of such FY DSH 

allotments, the calculation of the states’ 

institutions for mental diseases (IMDs) 

DSH limits, and the amounts of states’ 

final FY 2015 IMD DSH limits and 

preliminary FY 2017 IMD DSH limits. 

B. Determination of Fiscal Year DSH 

Allotments 

Generally, in accordance with the 

methodology specified under section 

1923(f)(3) of the Act, a state’s FY DSH 

allotment is calculated by increasing the 

amount of its DSH allotment for the 

preceding FY by the percentage change 

in the CPI–U for the previous FY. Also 

in accordance with section 1923(f)(3) of 

the Act, a state’s DSH allotment for a FY 

is subject to the limitation that an 

increase to a state’s DSH allotment for 

a FY cannot result in the DSH allotment 

exceeding the greater of the state’s DSH 

allotment for the previous FY or 12 

percent of the state’s total medical 

assistance expenditures for the 

allotment year (this is referred to as the 

12 percent limit). 

Furthermore, under section 1923(h) of 

the Act, federal financial participation 

(FFP) for DSH payments to 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 1923(h) 

of the Act. 

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 2015 

Federal Share State DSH Allotments, 

and the Preliminary FY 2017 Federal 

Share State DSH Allotments 

1. Final FY 2015 Federal Share State 

DSH Allotments 

Addendum 1 to this notice provides 

the states’ final FY 2015 DSH allotments 

determined in accordance with section 

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

background section, 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 


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calculating the states’ final FY 2015 

DSH allotments, the preceding final 

fiscal year DSH allotments (for FY 2014) 

were published in the October 26, 2016 

Federal Register (81 FR 74432). For 

purposes of calculating the states’ final 

FY 2015 DSH allotments we are using 

the actual Medicaid expenditures for FY 

2015. Finally, for purposes of 

calculating the states’ final FY 2015 

DSH allotments, the applicable 

historical percentage change in the CPI– 

U for the previous FY (FY 2014) was 1.6 

percent; we note that this is the same as 

the estimated 1.6 percentage change in 

the CPI–U for FY 2014 that was 

available and used in the calculation of 

the preliminary FY 2015 DSH 

allotments which were published in the 

February 2, 2016 Federal Register (81 

FR 5448). 

2. Calculation of the Preliminary FY 

2017 Federal Share State DSH 

Allotments 

Addendum 2 to this notice provides 

the preliminary FY 2017 DSH 

allotments determined in accordance 

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

preliminary FY 2017 DSH allotments 

contained in this notice were 

determined based on the most recent 

available estimates from states of their 

FY 2017 total computable Medicaid 

expenditures. Also, the preliminary FY 

2017 allotments contained in this notice 

were determined by increasing the 

preliminary FY 2016 DSH allotments. 

The actual percentage increase in the 

CPI–U for FY 2016 was 0.9 percent 

(CMS originally published the 

preliminary FY 2016 DSH allotments in 

the October 26, 2016 Federal Register 

(81 FR74432)). 

We will publish states’ final FY 2017 

DSH allotments in a future notice based 

on the states’ four quarterly Medicaid 

expenditure reports (Form CMS–64) for 

FY 2017 available following the end of 

FY 2017 utilizing the actual change in 

the CPI–U for FY 2016. 

B. Calculation of the Final FY 2015 and 

Preliminary FY 2017 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 DSH payments to 

IMDs or other mental health facilities 

that exceed the IMD DSH limits. In this 

notice, we are publishing the final FY 

2015 and the preliminary FY 2017 IMD 

DSH limits determined in accordance 

with the provisions discussed above. 

Addendums 3 and 4 to this notice 

detail each state’s final FY 2015 and 

preliminary FY 2017 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 or burden. 

While discussed in section I.B. of this 

notice and in Addendums 3 and 4, the 

requirements and burden associated 

with Form CMS–37 (OMB control 

number 0938–0101) and Form CMS–64 

(OMB control number 0938–0067) are 

unaffected by this notice. Consequently, 

this notice, CMS–37, and CMS–64 are 

not subject to Office of Management and 

Budget review under the authority of 

the Paperwork Reduction Act of 1995 

(44 U.S.C. 3501 et seq.) associated with 

the publication of this notice. 

IV. Regulatory Impact Analysis 

We have examined the impact of this 

notice as required by Executive Order 

12866 on Regulatory Planning and 

Review (September 1993), the 

Regulatory Flexibility Act (RFA) 

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

section 1102(b) of the Act, section 202 

of the Unfunded Mandates Reform Act 

of 1995 (Pub. L. 104–4, enacted on 

March 22, 1995) (UMRA ‘95), Executive 

Order 13132 on Federalism (August 4, 

1999) and the Congressional Review Act 

(5 U.S.C. 804(2)), and Executive Order 

13771 on Reducing Regulation and 

Controlling Regulatory Costs (January 

30, 2017). 

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 2015 DSH allotments 

being published in this notice are 

approximately $11 million more than 

the preliminary FY 2015 DSH 

allotments published in the February 2, 

2016 Federal Register (81 FR 5448). The 

increase in the final FY 2015 DSH 

allotments is a result of being calculated 

by multiplying the actual increase in the 

CPI–U for 2014 by the final FY 2014 

DSH allotments, while the preliminary 

FY 2015 DSH allotments were 

calculated by multiplying the estimated 

CPI–U for 2014 by the preliminary FY 

2014 DSH allotments. Although the 

estimated and actual increase in the 

CPI–U remained the same at 1.6 percent, 

the preliminary FY 2014 DSH 

allotments were lower than the final FY 

2014 DSH allotments and therefore the 

final FY 2015 DSH allotments are higher 

than the preliminary FY 2015 DSH 

allotments. The final FY 2015 IMD DSH 

limits being published in this notice are 

approximately $695,000 more than the 

preliminary FY 2015 IMD DSH limits 

published in the February 2, 2016 

Federal Register (81 FR 5448). The 

increases in the IMD DSH limits are 

because the DSH allotment for a FY is 

a factor in the determination of the IMD 

DSH limit for the FY. Since the final FY 

2015 DSH allotments were increased as 

compared to the preliminary FY 2015 

DSH allotments, the associated FY 2015 

IMD DSH limits for some states were 

also increased. 

The preliminary FY 2017 DSH 

allotments being published in this 

notice have been increased by 

approximately $118 million more than 

the preliminary FY 2016 DSH 

allotments published in the October 26, 

2016 Federal Register (81 FR 74432). 

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 

2017 IMD DSH limits being published 

in this notice are approximately $5.5 

million more than the preliminary FY 

2016 IMD DSH limits published in the 

October 2, 2016 Federal Register (81 FR 

74432). The increases in the IMD DSH 

limits are 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 2017 DSH allotments 

are greater than the preliminary FY 2016 

DSH allotments, the associated 

preliminary FY 2017 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 $7.0 million to $34.5 

million in any one year. Individuals and 

states are not included in the definition 

of a small entity. We are not preparing 

an analysis for the RFA because the 

Secretary has determined that this 

notice will not have significant 


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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 DSH 

allotments and IMD DSH limits, 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. For this reason, 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 2017, that threshold is approximately 

$148 million. This notice will have no 

consequential effect on spending by 

state, local, or tribal governments, in the 

aggregate, or on the private sector. 

Executive Order 13132 establishes 

certain requirements that an agency 

must meet when it promulgates a 

proposed rule (and subsequent final 

rule) that imposes substantial direct 

requirement costs on state and local 

governments, preempts state law, or 

otherwise has Federalism implications. 

Since this notice does not impose any 

costs on state or local governments or 

otherwise have Federalism implications, 

the requirements of E.O. 13132 are not 

applicable. 

Executive Order 13771, titled 

‘‘Reducing Regulation and Controlling 

Regulatory Costs,’’ was issued on 

January 30, 2017. It has been 

determined that this notice is a transfer 

rule and is not a regulatory action for 

the purposes of Executive Order 13771. 

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 and 

limits as specified in statute. This notice 

does not put forward any further 

discretionary administrative policies for 

determining such allotments and limits, 

or otherwise. 

B. Accounting Statement 

As required by OMB Circular A–4 

(available at http://www.whitehouse.gov

/omb/circulars/a004/a-4.pdf), in 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 2016 to FY 

2017. 

TABLE 1—ACCOUNTING STATEMENT: 

CLASSIFICATION OF ESTIMATED EXPENDITURES, FROM THE FY 2016 TO

FY 2017 

[In millions] 

Category Transfers 

Annualized Monetized 

Transfers.

$118. 

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 October 11, 2017. 

Seema Verma, 

Administrator, Centers for Medicare & 

Medicaid Services. 

Dated October 27, 2017. 

Eric D. Hargan, 

Acting Secretary, Department of Health and 

Human Services. 

KEY TO ADDENDUM 1—FINAL DSH ALLOTMENTS FOR FY 2015 

[The Final FY 2015 DSH Allotments for the NON-Low DSH States are presented in the top section of this addendum, and the Final 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) × (100percent + Percentage Increase in CPIU): 101.6 percent. This column contains 

the amount in Column C increased by 1 plus the 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’ 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’ FY 2015 total computable DSH expenditures. 

Column G ......... FY 2015 TC MAP Exp. Net of DSH. This column contains the amount of the States’ 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. 


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KEY TO ADDENDUM 1—FINAL DSH ALLOTMENTS FOR FY 2015—Continued 

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

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

Column Description 

Column J .......... FY 2015 DSH Allotment. This column contains the States’ final 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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ADDENDUM 1—FINAL DSH ALLOTMENTS FOR

FISCAL

YEAR: 2015 

State 

FY 2015 

FMAPs 

(percent) 

Prior FY (2014) 

DSH 

allotments 

Prior FY (2014) 

DSH allotment 

(Col C) × 100% + 

Pct increase in 

CPIU: 

FY 2015 TC MAP 

Exp. including 

DSH 

FY 2015 

TC DSH 

expenditures 

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 

101.6% 

ALABAMA ....................................... 68.99 $328,262,759 $333,514,963 $5,264,823,220 $482,949,270 $4,781,873,950 $694,651,308 $694,651,308 $333,514,963 ARIZONA ........................................ 68.46 108,086,519 109,815,903 10,617,725,498 171,078,470 10,446,647,028 1,520,037,100 1,520,037,100 109,815,903 CALIFORNIA .................................. 50.00 1,170,270,080 1,188,994,401 82,139,045,889 2,390,079,654 79,748,966,235 12,591,942,037 12,591,942,037 1,188,994,401 COLORADO ................................... 51.01 98,745,708 100,325,639 7,301,119,320 196,484,794 7,104,634,526 1,114,813,865 1,114,813,865 100,325,639 CONNECTICUT .............................. 50.00 213,504,233 216,920,301 7,183,360,060 129,030,409 7,054,329,651 1,113,841,524 1,113,841,524 216,920,301 DISTRICT OF COLUMBIA ............. 70.00 65,385,671 66,431,842 2,369,871,903 36,875,089 2,332,996,814 337,882,297 337,882,297 66,431,842 FLORIDA ........................................ 59.72 213,504,233 216,920,301 21,320,462,370 358,797,341 20,961,665,029 3,147,939,570 3,147,939,570 216,920,301 GEORGIA ....................................... 66.94 286,896,314 291,486,655 9,664,791,833 435,016,070 9,229,775,763 1,349,489,311 1,349,489,311 291,486,655 ILLINOIS ......................................... 50.76 229,517,051 233,189,324 16,938,472,430 442,188,036 16,496,284,394 2,592,419,182 2,592,419,182 233,189,324 INDIANA ......................................... 66.52 228,182,651 231,833,573 9,249,771,996 232,141,314 9,017,630,682 1,320,292,281 1,320,292,281 231,833,573 KANSAS ......................................... 56.63 44,035,248 44,739,812 3,010,910,864 78,925,971 2,931,984,893 446,439,537 446,439,537 44,739,812 KENTUCKY .................................... 69.94 154,790,570 157,267,219 9,423,467,372 226,627,736 9,196,839,636 1,332,192,539 1,332,192,539 157,267,219 LOUISIANA1 ................................... 62.05 731,960,000 743,671,360 7,863,181,815 1,329,125,915 6,534,055,900 972,079,525 972,079,525 743,671,360 MAINE ............................................. 61.88 112,089,722 113,883,158 2,477,405,878 42,093,817 2,435,312,061 362,543,168 362,543,168 113,883,158 MARYLAND .................................... 50.00 81,398,489 82,700,865 9,410,240,087 107,964,734 9,302,275,353 1,468,780,319 1,468,780,319 82,700,865 MASSACHUSETTS ........................ 50.00 325,593,956 330,803,459 15,378,247,995 0 15,378,247,995 2,428,144,420 2,428,144,420 330,803,459 MICHIGAN ...................................... 65.54 282,893,110 287,419,400 15,867,358,420 336,597,089 15,530,761,331 2,281,403,282 2,281,403,282 287,419,400 MISSISSIPPI ................................... 73.58 162,796,978 165,401,730 5,136,317,498 224,546,417 4,911,771,081 704,270,444 704,270,444 165,401,730 MISSOURI ...................................... 63.45 505,738,153 513,829,963 9,518,489,904 680,860,006 8,837,629,898 1,307,866,162 1,307,866,162 513,829,963 NEVADA ......................................... 64.36 49,372,853 50,162,819 3,105,613,113 77,953,523 3,027,659,590 446,585,572 446,585,572 50,162,819 NEW HAMPSHIRE ......................... 50.00 170,908,561 173,643,098 1,716,225,884 108,694,387 1,607,531,497 253,820,763 253,820,763 173,643,098 NEW JERSEY ................................ 50.00 687,216,752 698,212,220 14,049,422,255 1,089,139,502 12,960,282,753 2,046,360,435 2,046,360,435 698,212,220 NEW YORK .................................... 50.00 1,714,705,875 1,742,141,169 57,896,956,615 3,431,160,259 54,465,796,356 8,599,862,583 8,599,862,583 1,742,141,169 NORTH CAROLINA ........................ 65.88 314,918,744 319,957,444 13,212,668,475 531,329,898 12,681,338,577 1,860,682,818 1,860,682,818 319,957,444 OHIO ............................................... 62.64 433,680,475 440,619,363 21,423,012,674 686,937,454 20,736,075,220 3,077,980,454 3,077,980,454 440,619,363 PENNSYLVANIA ............................ 51.82 599,146,255 608,732,595 23,223,615,661 750,991,666 22,472,623,995 3,509,386,365 3,509,386,365 608,732,595 RHODE ISLAND ............................. 50.00 69,388,876 70,499,098 2,584,840,295 140,548,917 2,444,291,378 385,940,744 385,940,744 70,499,098 SOUTH CAROLINA ........................ 70.64 349,613,182 355,206,993 5,767,691,574 487,856,512 5,279,835,062 763,235,093 763,235,093 355,206,993 TENNESSEE2 ................................ na na na na na na na na 53,100,000 TEXAS ............................................ 58.05 1,020,817,117 1,037,150,191 34,691,253,016 2,330,024,141 32,361,228,875 4,895,294,687 4,895,294,687 1,037,150,191 VERMONT 3 .................................... 56.21 24,019,227 24,403,535 1,632,611,663 37,448,781 1,595,162,882 243,376,898 243,376,898 24,403,535 VIRGINIA ........................................ 50.00 93,522,940 95,019,307 8,032,760,161 20,698,074 8,012,062,087 1,265,062,435 1,265,062,435 95,019,307 WASHINGTON ............................... 50.03 197,491,416 200,651,279 10,494,138,618 362,580,070 10,131,558,548 1,599,416,905 1,599,416,905 200,651,279 WEST VIRGINIA ............................. 71.35 72,057,679 73,210,602 3,646,548,197 72,590,493 3,573,957,704 515,589,315 515,589,315 73,210,602 

TOTAL ..................................... 0.00 11,140,511,397 11,318,759,579 451,612,422,553 18,029,335,809 433,583,086,744 66,549,622,938 66,549,622,938 11,371,859,581 

LOW DSH STATES 

ALASKA .......................................... 50.00 21,745,078 22,092,999 1,405,373,754 19,880,034 1,385,493,720 218,762,166.32 218,762,166 22,092,999 ARKANSAS .................................... 70.88 46,050,497 46,787,305 5,469,511,577 64,862,196 5,404,649,381 780,736,851 780,736,851 46,787,305 DELAWARE .................................... 53.63 9,664,479 9,819,111 1,860,130,571 14,439,649 1,845,690,922 285,326,171 285,326,171 9,819,111 HAWAII ........................................... 52.23 10,403,840 10,570,301 1,957,983,075 0 1,957,983,075 305,042,374.37 305,042,374 10,570,301 IDAHO ............................................. 71.75 17,547,381 17,828,139 1,715,448,736 24,187,617 1,691,261,119 243,711,434.89 243,711,435 17,828,139 IOWA .............................................. 55.54 42,040,199 42,712,842 4,476,316,992 47,094,445 4,429,222,547 677,994,544 677,994,544 42,712,842 MINNESOTA ................................... 50.00 79,731,955 81,007,666 10,704,500,992 57,035,579 10,647,465,413 1,681,178,749 1,681,178,749 81,007,666 MONTANA ...................................... 65.90 12,117,193 12,311,068 1,132,392,709 18,620,317 1,113,772,392 163,408,387 163,408,387 12,311,068 NEBRASKA .................................... 53.27 30,208,951 30,692,294 1,846,405,999 38,427,073 1,807,978,926 280,041,785 280,041,785 30,692,294 NEW MEXICO ................................ 69.65 21,745,078 22,092,999 4,920,345,001 22,732,973 4,897,612,028 710,047,551 710,047,551 22,092,999 NORTH DAKOTA ........................... 50.00 10,196,942 10,360,093 1,085,776,090 2,594,883 1,083,181,207 171,028,612 171,028,612 10,360,093 OKLAHOMA .................................... 62.30 38,657,915 39,276,442 4,703,038,531 43,517,776 4,659,520,755 692,536,325 692,536,325 39,276,442 OREGON ........................................ 64.06 48,322,397 49,095,555 8,027,137,262 60,717,454 7,966,419,808 1,176,324,671 1,176,324,671 49,095,555 SOUTH DAKOTA ........................... 51.64 11,790,395 11,979,041 805,740,131 1,584,383 804,155,748 125,711,209 125,711,209 11,979,041 UTAH .............................................. 70.56 20,942,613 21,277,695 2,147,978,557 25,398,058 2,122,580,499 306,904,262 306,904,262 21,277,695 WISCONSIN ................................... 58.27 100,915,788 102,530,441 7,893,501,866 31,421,346 7,862,080,520 1,188,130,794 1,188,130,794 102,530,441 WYOMING ...................................... 50.00 241,612 245,478 558,961,575 471,420 558,490,155 88,182,656 88,182,656 245,478 


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51264 Federal Register / Vol. 82, No. 212 / Friday, November 3, 2017 / Notices 

ADDENDUM 1—FINAL DSH ALLOTMENTS FOR

FISCAL

YEAR: 2015—Continued 

State 

FY 2015 

FMAPs 

(percent) 

Prior FY (2014) 

DSH 

allotments 

Prior FY (2014) 

DSH allotment 

(Col C) × 100% + 

Pct increase in 

CPIU: 

FY 2015 TC MAP 

Exp. including 

DSH 

FY 2015 

TC DSH 

expenditures 

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 

101.6% 

TOTAL LOW DSH STATES .... 0.00 522,322,313 530,679,470 60,710,543,418 472,985,203 60,237,558,215 9,095,068,543 9,095,068,543 530,679,469 

TOTAL .............................. 0.00 11,662,833,710 11,849,439,049 512,322,965,971 18,502,321,012 493,820,644,959 75,644,691,482 75,644,691,482 11,902,539,050 

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) of the Act. 3FMAP for Vermont for FY 2015 determined in accordance with section 1905(z)(1)(A) of the Act. 


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Federal Register / Vol. 82, No. 212 / Friday, November 3, 2017 / Notices 51265 

KEY TO ADDENDUM 2: PRELIMINARY DSH ALLOTMENTS FOR FY 2017 

[The Preliminary FY 2017 DSH Allotments for the NON-Low DSH States are presented in the top section of this addendum, and the Preliminary 

FY 2017 DSH Allotments for the Low-DSH States are presented in the bottom section of this addendum.] 

Column Description 

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

Column B .......... FY 2017 FMAPs. This column contains the States’ FY 2017 Federal Medical Assistance Percentages. 

Column C ......... Prior FY (2016) DSH Allotments. This column contains the States’ prior preliminary FY 2016 DSH Allotments. 

Column D ......... Prior FY (2016) DSH Allotments (Col C) × (100 percent + Percentage Increase in CPIU): 100.9 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 (100.9 percent). 

Column E .......... FY 2017 TC MAP Exp. Including DSH. This column contains the amount of the States’ projected FY 2017 total computable 

(TC) medical assistance expenditures including DSH expenditures. 

Column F .......... FY 2017 TC DSH Expenditures. This column contains the amount of the States’ projected FY 2017 total computable DSH expenditures. 

Column G ......... FY 2017 TC MAP Exp. Net of DSH. This column contains the amount of the States’ projected FY 2017 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 2016 Allotment or 12 percent Limit. This column contains the greater of the State’s preliminary prior FY (FY 

2016) 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 2017 DSH Allotment. This column contains the States’ preliminary FY 2017 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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51266 Federal Register / Vol. 82, No. 212 / Friday, November 3, 2017 / Notices 

ADDENDUM 2—PRELIMINARY DSH ALLOTMENTS FOR

FISCAL

YEAR: 2017 

State 

FY 2017 

FMAPs 

(percent) 

Prior FY (2016) 

DSH allotments 

Prior FY (2016) 

DSH allotment 

(Col C) × 100% + 

Pct increase in 

CPIU: 

FY 2017 TC MAP 

Exp. including 

DSH 2

FY 2017 TC DSH 

expenditures 2

FY 2017 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 2016 

allotment) 

FY 2017 DSH 

allotment MIN 

Col I, Col D 

100.9% 

ALABAMA ....................................... 70.16 $334,515,508 $337,526,148 $5,722,108,000 $480,212,000 $5,241,896,000 $758,813,116 $758,813,116 $337,526,148 ARIZONA ........................................ 69.24 110,145,351 111,136,659 12,751,216,000 161,305,000 12,589,911,000 1,827,516,641 1,827,516,641 111,136,659 CALIFORNIA .................................. 50.00 1,192,561,384 1,203,294,436 92,799,788,000 128,407,000 92,671,381,000 14,632,323,316 14,632,323,316 1,203,294,436 COLORADO ................................... 50.02 100,626,616 101,532,256 8,208,119,000 199,337,000 8,008,782,000 1,264,384,878 1,264,384,878 101,532,256 CONNECTICUT .............................. 50.00 217,571,062 219,529,202 7,618,871,000 141,094,000 7,477,777,000 1,180,701,632 1,180,701,632 219,529,202 DISTRICT OF COLUMBIA ............. 70.00 66,631,138 67,230,818 2,789,426,000 10,000,000 2,779,426,000 402,537,559 402,537,559 67,230,818 FLORIDA ........................................ 61.10 217,571,062 219,529,202 24,118,173,000 358,261,000 23,759,912,000 3,548,017,816 3,548,017,816 219,529,202 GEORGIA ....................................... 67.89 292,361,115 294,992,365 10,198,853,000 581,504,000 9,617,349,000 1,401,871,870 1,401,871,870 294,992,365 ILLINOIS ......................................... 51.30 233,888,892 235,993,892 16,836,812,000 459,144,000 16,377,668,000 2,565,417,919 2,565,417,919 235,993,892 INDIANA ......................................... 66.74 232,529,074 234,621,836 11,762,997,000 811,661,000 10,951,336,000 1,602,248,077 1,602,248,077 234,621,836 KANSAS ......................................... 56.21 44,874,031 45,277,897 3,410,646,000 77,573,000 3,333,073,000 508,533,002 508,533,002 45,277,897 KENTUCKY .................................... 70.46 157,739,021 159,158,672 10,676,966,000 227,501,000 10,449,465,000 1,511,329,396 1,511,329,396 159,158,672 LOUISIANA ..................................... 62.28 745,902,374 752,615,495 11,132,573,000 1,117,522,000 10,015,051,000 1,488,633,356 1,488,633,356 752,615,495 MAINE ............................................. 64.38 114,224,807 115,252,830 2,663,472,000 42,296,000 2,621,176,000 386,600,941 386,600,941 115,252,830 MARYLAND .................................... 50.00 82,948,968 83,695,509 11,950,442,000 153,711,000 11,796,731,000 1,862,641,737 1,862,641,737 83,695,509 MASSACHUSETTS ........................ 50.00 331,795,869 334,782,032 18,581,439,000 0 18,581,439,000 2,933,911,421 2,933,911,421 334,782,032 MICHIGAN ...................................... 65.15 288,281,658 290,876,193 18,171,344,000 372,764,000 17,798,580,000 2,618,048,889 2,618,048,889 290,876,193 MISSISSIPPI ................................... 74.63 165,897,935 167,391,016 5,723,846,000 225,000,000 5,498,846,000 786,291,957 786,291,957 167,391,016 MISSOURI ...................................... 63.21 515,371,453 520,009,796 10,670,006,000 693,986,000 9,976,020,000 1,477,643,173 1,477,643,173 520,009,796 NEVADA ......................................... 64.67 50,313,307 50,766,127 3,578,926,000 80,370,000 3,498,556,000 515,477,387 515,477,387 50,766,127 NEW HAMPSHIRE ......................... 50.00 174,164,027 175,731,503 2,169,830,000 247,753,000 1,922,077,000 303,485,842 303,485,842 175,731,503 NEW JERSEY ................................ 50.00 700,306,857 706,609,619 15,361,605,000 850,921,000 14,510,684,000 2,291,160,632 2,291,160,632 706,609,619 NEW YORK .................................... 50.00 1,747,367,593 1,763,093,901 71,683,117,000 5,973,100,000 65,710,017,000 10,375,265,842 10,375,265,842 1,763,093,901 NORTH CAROLINA ........................ 66.88 320,917,316 323,805,572 13,175,069,000 257,682,000 12,917,387,000 1,889,026,624 1,889,026,624 323,805,572 OHIO ............................................... 62.32 441,941,221 445,918,692 24,746,576,000 0 24,746,576,000 3,677,758,227 3,677,758,227 445,918,692 PENNSYLVANIA ............................ 51.78 610,558,793 616,053,822 30,203,978,000 890,607,000 29,313,371,000 4,578,722,022 4,578,722,022 616,053,822 RHODE ISLAND ............................. 51.02 70,710,595 71,346,990 2,718,936,000 144,308,000 2,574,628,000 403,969,822 403,969,822 71,346,990 SOUTH CAROLINA ........................ 71.30 356,272,614 359,479,068 6,171,883,000 503,738,000 5,668,145,000 817,818,695 817,818,695 359,479,068 TENNESSEE1 ................................ 64.96 na na na na na na na 53,100,000 TEXAS ............................................ 56.18 1,040,261,642 1,049,623,997 40,497,188,000 1,853,258,000 38,643,930,000 5,896,829,300 5,896,829,300 1,049,623,997 VERMONT ...................................... 54.46 24,476,746 24,697,037 1,726,339,000 37,449,000 1,688,890,000 259,944,275 259,944,275 24,697,037 VIRGINIA ........................................ 50.00 95,304,365 96,162,104 9,016,918,000 190,421,000 8,826,497,000 1,393,657,421 1,393,657,421 96,162,104 WASHINGTON ............................... 50.00 201,253,233 203,064,512 12,794,211,000 429,915,000 12,364,296,000 1,952,257,263 1,952,257,263 203,064,512 WEST VIRGINIA ............................. 71.80 73,430,234 74,091,106 4,246,975,000 73,358,000 4,173,617,000 601,335,854 601,335,854 74,091,106 

TOTAL ..................................... ................ 11,352,715,861 11,454,890,304 523,878,648,000 17,774,158,000 506,104,490,000 77,714,175,902 77,714,175,902 11,507,990,304 

LOW DSH STATES 

ALASKA .......................................... 50.00 22,159,278 22,358,712 2,521,495,000 25,641,000 2,495,854,000 394,082,210.53 394,082,211 22,358,712 ARKANSAS .................................... 69.69 46,927,667 47,350,016 6,490,998,000 50,820,000 6,440,178,000 933,574,633 933,574,633 47,350,016 DELAWARE .................................... 54.20 9,848,568 9,937,205 1,968,900,000 0 1,968,900,000 303,453,213 303,453,213 9,937,205 HAWAII ........................................... 54.93 10,602,012 10,697,430 2,264,951,000 0 2,264,951,000 347,767,319.16 347,767,319 10,697,430 IDAHO ............................................. 71.51 17,881,623 18,042,558 2,075,465,000 27,147,000 2,048,318,000 295,362,568.00 295,362,568 18,042,558 IOWA .............................................. 56.74 42,840,981 43,226,550 4,891,542,000 48,927,000 4,842,615,000 736,978,029 736,978,029 43,226,550 MINNESOTA ................................... 50.00 81,250,689 81,981,945 12,229,177,000 154,641,000 12,074,536,000 1,906,505,684 1,906,505,684 81,981,945 MONTANA ...................................... 65.56 12,348,001 12,459,133 1,664,645,000 1,810,000 1,662,835,000 244,246,742 244,246,742 12,459,133 NEBRASKA .................................... 51.85 30,784,371 31,061,430 2,166,975,000 41,996,000 2,124,979,000 331,784,676 331,784,676 31,061,430 NEW MEXICO ................................ 71.13 22,159,278 22,358,712 5,528,792,000 31,460,000 5,497,332,000 793,557,027 793,557,027 22,358,712 NORTH DAKOTA ........................... 50.00 10,391,173 10,484,694 1,305,889,000 1,485,000 1,304,404,000 205,958,526 205,958,526 10,484,694 OKLAHOMA .................................... 59.94 39,394,271 39,748,819 5,276,333,000 47,870,000 5,228,463,000 784,465,763 784,465,763 39,748,819 OREGON ........................................ 64.47 49,242,842 49,686,028 9,814,476,000 81,372,000 9,733,104,000 1,435,090,257 1,435,090,257 49,686,028 SOUTH DAKOTA ........................... 54.94 12,014,978 12,123,113 906,932,000 1,527,000 905,405,000 139,011,506 139,011,506 12,123,113 UTAH .............................................. 69.90 21,341,528 21,533,602 2,638,196,000 33,036,000 2,605,160,000 377,410,744 377,410,744 21,533,602 WISCONSIN ................................... 58.51 102,838,032 103,763,574 8,862,528,000 102,737,000 8,759,791,000 1,322,387,542 1,322,387,542 103,763,574 WYOMING ...................................... 50.00 246,214 248,430 600,990,000 482,000 600,508,000 94,817,053 94,817,053 248,430 


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Federal Register / Vol. 82, No. 212 / Friday, November 3, 2017 / Notices 51267 

TOTAL LOW DSH STATES .... ................ 532,271,506 537,061,950 71,208,284,000 650,951,000 70,557,333,000 10,646,453,493 10,646,453,493 537,061,951 

TOTAL .............................. ................ 11,884,987,367 11,991,952,253 595,086,932,000 18,425,109,000 576,661,823,000 88,360,629,395 88,360,629,395 12,045,052,255 

1Tennessee’s DSH allotment for FY 2017 determined under section 1923(f)(6)(A) of the Act. 2Expenditures based on the amounts reported by States on the Form CMS–37. 


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51268 Federal Register / Vol. 82, No. 212 / Friday, November 3, 2017 / Notices 

KEY TO ADDENDUM 3—FINAL IMD DSH LIMITS FOR FY 2015 

[The final 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 as of January 1, 1997. 

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’ FY 2015 DSH allotments from Addendum 1, Column 

J. 

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 2015 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 x 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. 82, No. 212 / Friday, November 3, 2017 / Notices 51269 

ADDENDUM 3—FINAL IMD DSH LIMIT 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 x Col H 

FY 2015 

TC IMD limit 

(lesser of Col I 

or Col C) 

FY 2015 IMD 

limit in FS 

Col G x J 

ALABAMA ......................................................... $413,006,229 $4,451,770 $417,457,999 1.07 $333,514,963 68.99 $483,425,080 $5,155,243 $4,451,770 $3,071,276 ARIZONA .......................................................... 93,916,100 28,474,900 122,391,000 23.27 109,815,903 68.46 160,408,856 37,319,951 28,474,900 19,493,917 CALIFORNIA .................................................... 2,189,879,543 1,555,919 2,191,435,462 0.07 1,188,994,401 50.00 2,377,988,802 1,688,372 1,555,919 777,960 COLORADO ..................................................... 173,900,441 594,776 174,495,217 0.34 100,325,639 51.01 196,678,375 670,388 594,776 303,395 CONNECTICUT ................................................ 303,359,275 105,573,725 408,933,000 25.82 216,920,301 50.00 433,840,602 112,004,090 105,573,725 52,786,863 DISTRICT OF COLUMBIA ............................... 39,532,234 6,545,136 46,077,370 14.20 66,431,842 70.00 94,902,631 13,480,601 6,545,136 4,581,595 FLORIDA .......................................................... 184,468,014 149,714,986 334,183,000 33.00 216,920,301 59.72 363,228,903 119,865,538 119,865,538 71,583,699 GEORGIA ......................................................... 407,343,557 0 407,343,557 0.00 291,486,655 66.94 435,444,659 0 0 0 ILLINOIS ........................................................... 315,868,508 89,408,276 405,276,784 22.06 233,189,324 50.76 459,395,831 101,347,501 89,408,276 45,383,641 INDIANA ........................................................... 79,960,783 153,566,302 233,527,085 33.00 231,833,573 66.52 348,517,097 115,010,642 115,010,642 76,505,079 KANSAS ........................................................... 11,587,208 76,663,508 88,250,716 33.00 44,739,812 56.63 79,003,729 26,071,231 26,071,231 14,764,138 KENTUCKY ...................................................... 158,804,908 37,443,073 196,247,981 19.08 157,267,219 69.94 224,860,193 42,902,131 37,443,073 26,187,685 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 MAINE ............................................................... 99,957,958 60,958,342 160,916,300 33.00 113,883,158 61.88 184,038,717 60,732,777 60,732,777 37,581,442 MARYLAND ...................................................... 22,226,467 120,873,531 143,099,998 33.00 82,700,865 50.00 165,401,730 54,582,571 54,582,571 27,291,285 MASSACHUSETTS .......................................... 469,653,946 105,635,054 575,289,000 18.36 330,803,459 50.00 661,606,918 121,484,823 105,635,054 52,817,527 MICHIGAN ........................................................ 133,258,800 304,765,552 438,024,352 33.00 287,419,400 65.54 438,540,433 144,718,343 144,718,343 94,848,402 MISSISSIPPI ..................................................... 182,608,033 0 182,608,033 0.00 165,401,730 73.58 224,791,696 0 0 0 MISSOURI ........................................................ 521,946,524 207,234,618 729,181,142 28.42 513,829,963 63.45 809,818,697 230,151,959 207,234,618 131,490,365 NEVADA ........................................................... 73,560,000 0 73,560,000 0.00 50,162,819 64.36 77,940,987 0 0 0NEW HAMPSHIRE ........................................... 92,675,916 94,753,948 187,429,864 33.00 173,643,098 50.00 347,286,196 114,604,445 94,753,948 47,376,974 NEW JERSEY .................................................. 736,742,539 357,370,461 1,094,113,000 32.66 698,212,220 50.00 1,396,424,440 456,114,538 357,370,461 178,685,231 NEW YORK ...................................................... 2,418,869,368 605,000,000 3,023,869,368 20.01 1,742,141,169 50.00 3,484,282,338 697,117,024 605,000,000 302,500,000 NORTH CAROLINA .......................................... 193,201,966 236,072,627 429,274,593 33.00 319,957,444 65.88 485,667,037 160,270,122 160,270,122 105,585,957 OHIO ................................................................. 535,731,956 93,432,758 629,164,714 14.85 440,619,363 62.64 703,415,330 104,459,187 93,432,758 58,526,280 PENNSYLVANIA .............................................. 388,207,319 579,199,682 967,407,001 33.00 608,732,595 51.82 1,174,705,895 387,652,945 387,652,945 200,881,756 RHODE ISLAND ............................................... 108,503,167 2,397,833 110,901,000 2.16 70,499,098 50.00 140,998,196 3,048,576 2,397,833 1,198,917 SOUTH CAROLINA .......................................... 366,681,364 72,076,341 438,757,705 16.43 355,206,993 70.64 502,841,157 82,603,565 72,076,341 50,914,727 TENNESSEE * .................................................. 0 0 0 0.00 53,100,000 64.99 81,704,878 0 0 0 TEXAS .............................................................. 1,220,515,401 292,513,592 1,513,028,993 19.33 1,037,150,191 58.05 1,786,649,769 345,412,642 292,513,592 169,804,140 VERMONT ** ..................................................... 19,979,252 9,071,297 29,050,549 31.23 24,403,535 56.21 43,414,935 13,556,707 9,071,297 5,098,976 VIRGINIA .......................................................... 129,313,480 7,770,268 137,083,748 5.67 95,019,307 50.00 190,038,614 10,771,889 7,770,268 3,885,134 WASHINGTON ................................................. 171,725,815 163,836,435 335,562,250 33.00 200,651,279 50.03 401,061,921 132,350,434 132,350,434 66,214,922 WEST VIRGINIA ............................................... 66,962,606 18,887,045 85,849,651 22.00 73,210,602 71.35 102,607,711 22,573,842 18,887,045 13,475,907 

TOTAL ....................................................... 13,402,460,846 4,118,758,904 17,521,219,750 ................ 11,371,859,581 ................ 20,259,435,756 3,849,221,003 3,472,944,320 1,945,212,274 

LOW DSH STATES 

ALASKA ............................................................ 2,506,827 17,611,765 20,118,592 33.00 22,092,999 50.00 44,185,998 14,581,379 14,581,379 7,290,690 ARKANSAS ...................................................... 2,422,649 819,351 3,242,000 25.27 46,787,305 70.88 66,009,177 16,682,506 819,351 580,756 DELAWARE ...................................................... 0 7,069,000 7,069,000 33.00 9,819,111 53.63 18,308,989 6,041,966 6,041,966 3,240,307 HAWAII ............................................................. 0 0 0 0.00 10,570,301 52.23 20,237,988 0 0 0 IDAHO ............................................................... 2,081,429 0 2,081,429 0.00 17,828,139 71.75 24,847,580 0 0 0 IOWA ................................................................ 12,011,250 0 12,011,250 0.00 42,712,842 55.54 76,904,649 0 0 0 MINNESOTA ..................................................... 24,240,000 5,257,214 29,497,214 17.82 81,007,666 50.00 162,015,332 28,875,584 5,257,214 2,628,607 MONTANA ........................................................ 237,048 0 237,048 0.00 12,311,068 65.90 18,681,439 0 0 0 NEBRASKA ...................................................... 6,449,102 1,811,337 8,260,439 21.93 30,692,294 53.27 57,616,471 12,634,056 1,811,337 964,899 NEW MEXICO .................................................. 6,490,015 254,786 6,744,801 3.78 22,092,999 69.65 31,720,027 1,198,229 254,786 177,458 NORTH DAKOTA ............................................. 214,523 988,478 1,203,001 33.00 10,360,093 50.00 20,720,186 6,837,661 988,478 494,239 OKLAHOMA ...................................................... 20,019,969 3,273,248 23,293,217 14.05 39,276,442 62.30 63,044,048 8,859,180 3,273,248 2,039,234 OREGON .......................................................... 11,437,908 19,975,092 31,413,000 33.00 49,095,555 64.06 76,639,955 25,291,185 19,975,092 12,796,044 SOUTH DAKOTA ............................................. 321,120 751,299 1,072,419 33.00 11,979,041 51.64 23,197,213 7,655,080 751,299 387,971 UTAH ................................................................ 3,621,116 934,586 4,555,702 20.51 21,277,695 70.56 30,155,463 6,186,286 934,586 659,444 WISCONSIN ..................................................... 6,609,524 4,492,011 11,101,535 33.00 102,530,441 58.27 175,957,510 58,065,978 4,492,011 2,617,495 WYOMING ........................................................ 0 0 0 0.00 245,478 50.00 490,956 0 0 0 


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51270 Federal Register / Vol. 82, No. 212 / Friday, November 3, 2017 / Notices 

ADDENDUM 3—FINAL IMD DSH LIMIT 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 x Col H 

FY 2015 

TC IMD limit 

(lesser of Col I 

or Col C) 

FY 2015 IMD 

limit in FS 

Col G x J 

TOTAL LOW DSH STATES ...................... 98,662,480 63,238,167 161,900,647 ................ 530,679,469 ................ 910,732,982 192,909,092 59,180,748 33,877,144 

TOTAL ................................................ 13,501,123,326 4,181,997,071 17,683,120,397 ................ 11,902,539,050 ................ 21,170,168,738 4,042,130,095 3,532,125,067 1,979,089,418 

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


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Federal Register / Vol. 82, No. 212 / Friday, November 3, 2017 / Notices 51271 

KEY TO ADDENDUM 4—PRELIMINARY IMD DSH LIMITS FOR FY 2017 

[The preliminary FY 2017 IMD DSH Limits for the Non-Low DSH States are presented in the top section of this addendum and the preliminary 

FY 2017 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 as of January 1, 1997. 

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 2017 Federal Share DSH Allotment. This column contains the states’ preliminary FY 2017 DSH allotments from Addendum 1, Column J. 

Column G ......... FY 2017 FMAP. 

Column H ......... FY 2017 DSH Allotments in Total Computable, Col. F/G. This column contains states’ FY 2017 total computable DSH allotment (determined as Column F/Column G). 

Column I ........... Applicable Percentage Applied to FY 2017 Allotments in TC, Col E x Col H. This column contains the applicable percentage 

of FY 2016 total computable DSH allotment (calculated as the percentage in Column E multiplied by the amount in Column 

H). 

Column J .......... FY 2017 TC IMD DSH Limit. Lesser of Col. I or C. This column contains the total computable FY 2017 TC IMD DSH Limit 

equal to the lesser of the amount in Column I or Column C. 

Column K .......... FY 2017 IMD DSH Limit in Federal Share, Col. G x J. This column contains the FY 2017 Federal Share IMD DSH limit determined by converting the total computable FY 2017 IMD DSH Limit from Column J into a federal share amount by multiplying it by the FY 2017 FMAP in Column G. 


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51272 Federal Register / Vol. 82, No. 212 / Friday, November 3, 2017 / Notices 

ADDENDUM 4—PRELIMINARY IMD DSH LIMIT FOR

FISCAL

YEAR: 2017 

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 2017 

allotment 

in FS 

FY 2017 

FMAPs 

(percent) 

FY 2017 

allotments 

in TC 

Col F/G 

Applicable 

percentage 

applied to 

FY 2017 

allotments 

in TC 

Col E x Col H 

FY 2017 

TC IMD limit 

(lesser of Col I 

or Col C) 

FY 2017 IMD 

limit in FS 

Col G x J 

ALABAMA ........................................................... $413,006,229 $4,451,770 $417,457,999 1.07 $337,526,148 70.16 $481,080,599 $5,130,241 $4,451,770 $3,123,362 ARIZONA ............................................................ 93,916,100 28,474,900 122,391,000 23.27 111,136,659 69.24 160,509,328 37,343,327 28,474,900 19,716,021 CALIFORNIA ...................................................... 2,189,879,543 1,555,919 2,191,435,462 0.07 1,203,294,436 50.00 2,406,588,872 1,708,678 1,555,919 777,960 COLORADO ....................................................... 173,900,441 594,776 174,495,217 0.34 101,532,256 50.02 202,983,319 691,879 594,776 297,507 CONNECTICUT .................................................. 303,359,275 105,573,725 408,933,000 25.82 219,529,202 50.00 439,058,404 113,351,163 105,573,725 52,786,863 DISTRICT OF COLUMBIA ................................. 39,532,234 6,545,136 46,077,370 14.20 67,230,818 70.00 96,044,026 13,642,732 6,545,136 4,581,595 FLORIDA ............................................................ 184,468,014 149,714,986 334,183,000 33.00 219,529,202 61.10 359,294,930 118,567,327 118,567,327 72,444,637 GEORGIA ........................................................... 407,343,557 0 407,343,557 0.00 294,992,365 67.89 434,515,194 0 0 0 ILLINOIS ............................................................. 315,868,508 89,408,276 405,276,784 22.06 235,993,892 51.30 460,027,080 101,486,761 89,408,276 45,866,446 INDIANA ............................................................. 79,960,783 153,566,302 233,527,085 33.00 234,621,836 66.74 351,546,053 116,010,198 116,010,198 77,425,206 KANSAS ............................................................. 11,587,208 76,663,508 88,250,716 33.00 45,277,897 56.21 80,551,320 26,581,936 26,581,936 14,941,706 KENTUCKY ........................................................ 158,804,908 37,443,073 196,247,981 19.08 159,158,672 70.46 225,885,143 43,097,686 37,443,073 26,382,389 LOUISIANA ......................................................... 1,078,512,169 132,917,149 1,211,429,318 10.97 752,615,495 62.28 1,208,438,496 132,588,998 132,588,998 82,576,428 MAINE ................................................................. 99,957,958 60,958,342 160,916,300 33.00 115,252,830 64.38 179,019,618 59,076,474 59,076,474 38,033,434 MARYLAND ........................................................ 22,226,467 120,873,531 143,099,998 33.00 83,695,509 50.00 167,391,018 55,239,036 55,239,036 27,619,518 MASSACHUSETTS ............................................ 469,653,946 105,635,054 575,289,000 18.36 334,782,032 50.00 669,564,064 122,945,921 105,635,054 52,817,527 MICHIGAN .......................................................... 133,258,800 304,765,552 438,024,352 33.00 290,876,193 65.15 446,471,517 147,335,600 147,335,600 95,989,144 MISSISSIPPI ....................................................... 182,608,033 0 182,608,033 0.00 167,391,016 74.63 224,294,541 0 0 0 MISSOURI .......................................................... 521,946,524 207,234,618 729,181,142 28.42 520,009,796 63.21 822,670,141 233,804,363 207,234,618 130,993,002 NEVADA ............................................................. 73,560,000 0 73,560,000 0.00 50,766,127 64.67 78,500,274 0 0 0 NEW HAMPSHIRE ............................................. 92,675,916 94,753,948 187,429,864 33.00 175,731,503 50.00 351,463,006 115,982,792 94,753,948 47,376,974 NEW JERSEY .................................................... 736,742,539 357,370,461 1,094,113,000 32.66 706,609,619 50.00 1,413,219,238 461,600,228 357,370,461 178,685,231 NEW YORK ........................................................ 2,418,869,368 605,000,000 3,023,869,368 20.01 1,763,093,901 50.00 3,526,187,802 705,501,250 605,000,000 302,500,000 NORTH CAROLINA ............................................ 193,201,966 236,072,627 429,274,593 33.00 323,805,572 66.88 484,159,049 159,772,486 159,772,486 106,855,839 OHIO ................................................................... 535,731,956 93,432,758 629,164,714 14.85 445,918,692 62.32 715,530,635 106,258,344 93,432,758 58,227,295 PENNSYLVANIA ................................................ 388,207,319 579,199,682 967,407,001 33.00 616,053,822 51.78 1,189,752,457 392,618,311 392,618,311 203,297,761 RHODE ISLAND ................................................. 108,503,167 2,397,833 110,901,000 2.16 71,346,990 51.02 139,841,219 3,023,561 2,397,833 1,223,374 SOUTH CAROLINA ............................................ 366,681,364 72,076,341 438,757,705 16.43 359,479,068 71.30 504,178,216 82,823,209 72,076,341 51,390,431 TENNESSEE* ..................................................... 0 0 0 0.00 53,100,000 64.96 81,742,611 0 0 0 TEXAS ................................................................ 1,220,515,401 292,513,592 1,513,028,993 19.33 1,049,623,997 56.18 1,868,323,241 361,202,558 292,513,592 164,334,136 VERMONT .......................................................... 19,979,252 9,071,297 29,050,549 31.23 24,697,037 54.46 45,348,948 14,160,620 9,071,297 4,940,228 VIRGINIA ............................................................ 129,313,480 7,770,268 137,083,748 5.67 96,162,104 50.00 192,324,208 10,901,443 7,770,268 3,885,134 WASHINGTON ................................................... 171,725,815 163,836,435 335,562,250 33.00 203,064,512 50.00 406,129,024 134,022,578 134,022,578 67,011,289 WEST VIRGINIA ................................................. 66,962,606 18,887,045 85,849,651 22.00 74,091,106 71.80 103,190,955 22,702,157 18,887,045 13,560,898 

TOTAL ......................................................... 13,402,460,846 4,118,758,904 17,521,219,750 ................ 11,507,990,304 ................ 20,515,824,545 3,899,171,855 3,482,003,733 1,949,661,335 

LOW DSH STATES 

ALASKA .............................................................. 2,506,827 17,611,765 20,118,592 33.00 22,358,712 50.00 44,717,424 14,756,750 14,756,750 7,378,375 ARKANSAS ........................................................ 2,422,649 819,351 3,242,000 25.27 47,350,016 69.69 67,943,774 17,171,437 819,351 571,006 DELAWARE ........................................................ 0 7,069,000 7,069,000 33.00 9,937,205 54.20 18,334,327 6,050,328 6,050,328 3,279,278 HAWAII ............................................................... 0 0 0 0.00 10,697,430 54.93 19,474,659 0 0 0 IDAHO ................................................................. 2,081,429 0 2,081,429 0.00 18,042,558 71.51 25,230,818 0 0 0 IOWA .................................................................. 12,011,250 0 12,011,250 0.00 43,226,550 56.74 76,183,557 0 0 0 MINNESOTA ....................................................... 24,240,000 5,257,214 29,497,214 17.82 81,981,945 50.00 163,963,890 29,222,870 5,257,214 2,628,607 MONTANA .......................................................... 237,048 0 237,048 0.00 12,459,133 65.56 19,004,169 0 0 0 NEBRASKA ........................................................ 6,449,102 1,811,337 8,260,439 21.93 31,061,430 51.85 59,906,326 13,136,172 1,811,337 939,178 NEW MEXICO .................................................... 6,490,015 254,786 6,744,801 3.78 22,358,712 71.13 31,433,589 1,187,409 254,786 181,229 NORTH DAKOTA ............................................... 214,523 988,478 1,203,001 33.00 10,484,694 50.00 20,969,388 6,919,898 988,478 494,239 OKLAHOMA ........................................................ 20,019,969 3,273,248 23,293,217 14.05 39,748,819 59.94 66,314,346 9,318,734 3,273,248 1,961,985 OREGON ............................................................ 11,437,908 19,975,092 31,413,000 33.00 49,686,028 64.47 77,068,447 25,432,588 19,975,092 12,877,942 SOUTH DAKOTA ............................................... 321,120 751,299 1,072,419 33.00 12,123,113 54.94 22,066,096 7,281,812 751,299 412,764 UTAH .................................................................. 3,621,116 934,586 4,555,702 20.51 21,533,602 69.90 30,806,298 6,319,802 934,586 653,276 WISCONSIN ....................................................... 6,609,524 4,492,011 11,101,535 33.00 103,763,574 58.51 177,343,316 58,523,294 4,492,011 2,628,276 WYOMING .......................................................... 0 0 0 0.00 248,430 50.00 496,860 0 0 0 


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Federal Register / Vol. 82, No. 212 / Friday, November 3, 2017 / Notices 51273 

TOTAL LOW DSH STATES ........................ 98,662,480 63,238,167 161,900,647 ................ 537,061,951 ................ 921,257,282 195,321,094 59,364,480 34,006,155 

TOTAL .................................................. 13,501,123,326 4,181,997,071 17,683,120,397 ................ 12,045,052,255 ................ 21,437,081,826 4,094,492,949 3,541,368,213 1,983,667,490 

* Tennessee’s DSH allotment for FY 2017, determined under section 1923(f)(6)(A) of the Act, is $53,100,000. 


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51274 Federal Register / Vol. 82, No. 212 / Friday, November 3, 2017 / Notices 

1As noted in the preamble to the final rule with 

comment period implementing the moratorium 

authority (February 2, 2011, CMS–6028–FC (76 FR 

5870), home health agency subunits and branch 

locations are subject to the moratoria to the same 

extent as any other newly enrolling home health 

agency. 

2CMS also concurrently announced a 

demonstration under the authority provided in 

section 402(a)(l)(J) of the Social Security 

Amendments of 1967 (42 U.S.C. 1395b–l(a)(l)(J)) 

that allows for access to care-based exceptions to 

the moratoria in certain limited circumstances after 

a heightened review of that provider has been 

conducted. This demonstration also applies to 

Medicaid and CHIP providers in each state. This 

announcement may be found in the Federal 

Register document issued on August 3, 2016 (81 FR 

51116). 

[FR Doc. 2017–23933 Filed 11–2–17; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–6077–N] 

Medicare, Medicaid, and Children’s 

Health Insurance Programs: 

Announcement of Decision To Lift the 

Temporary Moratorium on Enrollment 

of Non-Emergency Ground Ambulance 

Suppliers in Texas 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Lifting of temporary enrollment 

moratorium on non-emergency ground 

ambulance suppliers in Texas. 

SUMMARY: This document announces 

that on September 1, 2017, the statewide 

temporary moratorium on the 

enrollment of new Medicare Part B nonemergency ground ambulance suppliers 

in Texas was lifted. This announcement 

also applies to the temporary 

moratorium on enrollment of nonemergency ground ambulance suppliers 

in Medicaid and the Children’s Health 

Insurance Program in Texas. 

FOR FURTHER INFORMATION CONTACT: Jung 

Kim, (410) 786–9370. News media 

representatives must contact CMS’ 

Public Affairs Office at (202) 690–6145 

or email them at press@cms.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

I. Background 

A. CMS’ Implementation of Temporary 

Enrollment Moratoria 

The Social Security Act (the Act) 

provides the Secretary with tools and 

resources to combat fraud, waste, and 

abuse in Medicare, Medicaid, and the 

Children’s Health Insurance Program 

(CHIP). In particular, section 1866(j)(7) 

of the Act provides the Secretary with 

authority to impose a temporary 

moratorium on the enrollment of new 

Medicare, Medicaid, or CHIP providers 

and suppliers, including categories of 

providers and suppliers, if the Secretary 

determines such a moratorium is 

necessary to prevent or combat fraud, 

waste, or abuse under these programs. 

Regarding Medicaid, section 1902(kk)(4) 

of the Act requires States to comply 

with any moratorium imposed by the 

Secretary unless the State determines 

that the imposition of such temporary 

moratorium would adversely impact 

Medicaid beneficiaries’ access to care. 

In addition, section 2107(e)(1)(F) of the 

Act provides that the Medicaid 

provisions in 1902(kk) are also 

applicable to CHIP. 

In the February 2, 2011 Federal 

Register (76 FR 5862), CMS published a 

final rule with comment period titled, 

‘‘Medicare, Medicaid, and Children’s 

Health Insurance Programs; Additional 

Screening Requirements, Application 

Fees, Temporary Enrollment Moratoria, 

Payment Suspensions and Compliance 

Plans for Providers and Suppliers,’’ 

which implemented section 1866(j)(7) of 

the Act by establishing new regulations 

at 42 CFR 424.570. Under 

§ 424.570(a)(2)(i) and (iv), CMS, or CMS 

in consultation with the Department of 

Health and Human Services’ Office of 

Inspector General (HHS–OIG) or the 

Department of Justice (DOJ), or both, 

may impose a temporary moratorium on 

newly enrolling Medicare providers and 

suppliers if CMS determines that there 

is a significant potential for fraud, 

waste, or abuse with respect to a 

particular provider or supplier type, or 

particular geographic locations, or both. 

At § 424.570(a)(1)(ii), CMS stated that it 

would announce any temporary 

moratorium in a Federal Register 

document that includes the rationale for 

the imposition of such moratorium. 

Based on this authority and our 

regulations at § 424.570, we initially 

imposed moratoria to prevent 

enrollment of new Home Health 

Agencies, subunits, and branch 

locations 1 (hereafter referred to as 

HHAs) in Miami-Dade County, Florida 

and Cook County, Illinois, as well as 

surrounding counties, and Medicare 

Part B ground ambulance suppliers in 

Harris County, Texas and surrounding 

counties, in a notice issued on July 31, 

2013 (78 FR 46339). These moratoria 

also applied to Medicaid and CHIP. We 

exercised this authority again in a notice 

published on February 4, 2014 (79 FR 

6475) when we extended the existing 

moratoria for an additional 6 months 

and expanded them to include 

enrollment of HHAs in Broward County, 

Florida; Dallas County, Texas; Harris 

County, Texas; and Wayne County, 

Michigan and surrounding counties, 

and enrollment of ground ambulance 

suppliers in Philadelphia, Pennsylvania 

and surrounding counties. Then, we 

further extended these moratoria in 

documents issued on August 1, 2014 (79 

FR 44702), February 2, 2015 (80 FR 

5551), July 28, 2015 (80 FR 44967), and 

February 2, 2016 (81 FR 5444). On 

August 3, 2016 (81 FR 51120), we 

extended the moratoria for an additional 

6 months and expanded them to 

statewide for enrollment of HHAs in 

Florida, Illinois, Michigan, and Texas, 

and non-emergency ground ambulance 

suppliers in New Jersey, Pennsylvania, 

and Texas. We also announced the 

lifting of temporary moratoria for all 

Part B emergency ambulance suppliers 

as well as emergency ambulance 

providers in Medicaid and CHIP.2

Finally, on January 29, 2017 (82 FR 

2363) and again on July 28, 2017 (82 FR 

35122), we extended the statewide 

moratoria of HHAs in Florida, Illinois, 

Michigan, and Texas, and Part B nonemergency ground ambulance suppliers 

in New Jersey, Pennsylvania, and Texas 

for additional 6 month periods. These 

extensions also applied to such 

providers in Medicaid and CHIP. 

II. Lifting a Temporary Moratorium 

CMS has authority under § 424.570(d) 

to lift a temporary moratorium at any 

time in specified situations, including if 

the President declares an area a disaster 

under the Robert T. Stafford Disaster 

Relief and Emergency Assistance Act. 

On August 25, 2017, the President of the 

United States signed the Presidential 

Disaster Declaration for several counties 

in the State of Texas. As a result of the 

President’s declaration, CMS carefully 

reviewed the potential impact of 

continued moratoria in Texas, and 

decided to lift the temporary enrollment 

moratorium on Medicare Part B nonemergency ground ambulance suppliers 

in Texas in order to aid in the disaster 

response to Hurricane Harvey. This 

lifting of the moratorium also applied to 

Medicaid and CHIP in Texas. A 

notification that CMS lifted the 

moratorium was published at https://

www.cms.gov/Medicare/ProviderEnrollment-and-Certification/Medicare

ProviderSupEnroll/ProviderEnrollment

Moratorium.html and became effective 

on September 1, 2017. In accordance 

with § 424.570(d), CMS is also 

publishing this document in the Federal 

Register to announce this action. Nonemergency ground ambulance suppliers 

that were previously unable to enroll in 

Medicare, Medicaid or CHIP in Texas 


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