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 Department of Health and Human Services Centers for Medicare & Medicaid Services [CMS-2409-N]
RIN 0938-ZB43
 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 
                    ( print page 51260)
                    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 
                    ( print page 51261)
                    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
TransfersAnnualized 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
DescriptionColumn 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.( print page 51262)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.
 
 
 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 D101.6%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
$333,514,963ARIZONA
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
109,815,903CALIFORNIA
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
1,188,994,401COLORADO
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
100,325,639CONNECTICUT
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
216,920,301DISTRICT 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
66,431,842FLORIDA
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
216,920,301GEORGIA
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
291,486,655ILLINOIS
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
233,189,324INDIANA
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
231,833,573KANSAS
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
44,739,812KENTUCKY
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
157,267,219LOUISIANA 1
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
743,671,360MAINE
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
113,883,158MARYLAND
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
82,700,865MASSACHUSETTS
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
330,803,459MICHIGAN
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
287,419,400MISSISSIPPI
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
165,401,730MISSOURI
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
513,829,963NEVADA
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
50,162,819NEW 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
173,643,098NEW 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
698,212,220NEW 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
1,742,141,169NORTH 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
319,957,444OHIO
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
440,619,363PENNSYLVANIA
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
608,732,595RHODE 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
70,499,098SOUTH 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
355,206,993TENNESSEE 2
na
na
na
na
na
na
na
na
53,100,000TEXAS
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
1,037,150,191VERMONT 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
24,403,535VIRGINIA
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
95,019,307WASHINGTON
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
200,651,279WEST 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
73,210,602TOTAL
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
22,092,999ARKANSAS
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
46,787,305DELAWARE
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
9,819,111HAWAII
52.23
10,403,840
10,570,301
1,957,983,075
0
1,957,983,075
305,042,374.37
305,042,374
10,570,301IDAHO
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
17,828,139IOWA
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
42,712,842MINNESOTA
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
81,007,666MONTANA
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
12,311,068NEBRASKA
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
30,692,294NEW 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
22,092,999NORTH 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
10,360,093OKLAHOMA
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
39,276,442OREGON
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
49,095,555SOUTH DAKOTA
51.64
11,790,395
11,979,041
805,740,131
1,584,383
804,155,748
125,711,209
125,711,209
11,979,041UTAH
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
21,277,695WISCONSIN
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
102,530,441WYOMING
50.00
241,612
245,478
558,961,575
471,420
558,490,155
88,182,656
88,182,656
245,478( print page 51264)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
530,679,469TOTAL
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
11,902,539,0501
                         Louisiana's FY 2015 DSH allotment is determined under the provisions of section 1923(f)(3)(C) and (D) of the Act.2
                         Tennessee's DSH allotment for FY 2015 determined under section 1923(f)(6)(A) of the Act.3
                         FMAP for Vermont for FY 2015 determined in accordance with section 1905(z)(1)(A) of the Act.
 
 
 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
DescriptionColumn 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 HColumn 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.
 
 
 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 D100.9%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
$337,526,148ARIZONA
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
111,136,659CALIFORNIA
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
1,203,294,436COLORADO
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
101,532,256CONNECTICUT
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
219,529,202DISTRICT 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
67,230,818FLORIDA
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
219,529,202GEORGIA
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
294,992,365ILLINOIS
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
235,993,892INDIANA
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
234,621,836KANSAS
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
45,277,897KENTUCKY
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
159,158,672LOUISIANA
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
752,615,495MAINE
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
115,252,830MARYLAND
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
83,695,509MASSACHUSETTS
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
334,782,032MICHIGAN
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
290,876,193MISSISSIPPI
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
167,391,016MISSOURI
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
520,009,796NEVADA
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
50,766,127NEW 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
175,731,503NEW 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
706,609,619NEW 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
1,763,093,901NORTH 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
323,805,572OHIO
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
445,918,692PENNSYLVANIA
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
616,053,822RHODE 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
71,346,990SOUTH 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
359,479,068TENNESSEE 1
64.96
na
na
na
na
na
na
na
53,100,000TEXAS
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
1,049,623,997VERMONT
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
24,697,037VIRGINIA
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
96,162,104WASHINGTON
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
203,064,512WEST 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
74,091,106TOTAL

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
22,358,712ARKANSAS
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
47,350,016DELAWARE
54.20
9,848,568
9,937,205
1,968,900,000
0
1,968,900,000
303,453,213
303,453,213
9,937,205HAWAII
54.93
10,602,012
10,697,430
2,264,951,000
0
2,264,951,000
347,767,319.16
347,767,319
10,697,430IDAHO
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
18,042,558IOWA
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
43,226,550MINNESOTA
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
81,981,945MONTANA
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
12,459,133NEBRASKA
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
31,061,430NEW 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
22,358,712NORTH 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
10,484,694OKLAHOMA
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
39,748,819OREGON
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
49,686,028SOUTH DAKOTA
54.94
12,014,978
12,123,113
906,932,000
1,527,000
905,405,000
139,011,506
139,011,506
12,123,113UTAH
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
21,533,602WISCONSIN
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
103,763,574WYOMING
50.00
246,214
248,430
600,990,000
482,000
600,508,000
94,817,053
94,817,053
248,430( print page 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
537,061,951TOTAL

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
12,045,052,2551
                         Tennessee's DSH allotment for FY 2017 determined under section 1923(f)(6)(A) of the Act.2
                         Expenditures based on the amounts reported by States on the Form CMS-37.
 
 
 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
DescriptionColumn 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.
 
 
 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 JALABAMA
$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
$3,071,276ARIZONA
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
19,493,917CALIFORNIA
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
777,960COLORADO
173,900,441
594,776
174,495,217
0.34
100,325,639
51.01
196,678,375
670,388
594,776
303,395CONNECTICUT
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
52,786,863DISTRICT 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
4,581,595FLORIDA
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
71,583,699GEORGIA
407,343,557
0
407,343,557
0.00
291,486,655
66.94
435,444,659
0
0
0ILLINOIS
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
45,383,641INDIANA
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
76,505,079KANSAS
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
14,764,138KENTUCKY
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
26,187,685LOUISIANA
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
81,595,084MAINE
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
37,581,442MARYLAND
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
27,291,285MASSACHUSETTS
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
52,817,527MICHIGAN
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
94,848,402MISSISSIPPI
182,608,033
0
182,608,033
0.00
165,401,730
73.58
224,791,696
0
0
0MISSOURI
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
131,490,365NEVADA
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
47,376,974NEW 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
178,685,231NEW 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
302,500,000NORTH 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
105,585,957OHIO
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
58,526,280PENNSYLVANIA
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
200,881,756RHODE 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
1,198,917SOUTH 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
50,914,727TENNESSEE *
0
0
0
0.00
53,100,000
64.99
81,704,878
0
0
0TEXAS
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
169,804,140VERMONT **
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
5,098,976VIRGINIA
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
3,885,134WASHINGTON
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
66,214,922WEST 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
13,475,907TOTAL
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
7,290,690ARKANSAS
2,422,649
819,351
3,242,000
25.27
46,787,305
70.88
66,009,177
16,682,506
819,351
580,756DELAWARE
0
7,069,000
7,069,000
33.00
9,819,111
53.63
18,308,989
6,041,966
6,041,966
3,240,307HAWAII
0
0
0
0.00
10,570,301
52.23
20,237,988
0
0
0IDAHO
2,081,429
0
2,081,429
0.00
17,828,139
71.75
24,847,580
0
0
0IOWA
12,011,250
0
12,011,250
0.00
42,712,842
55.54
76,904,649
0
0
0MINNESOTA
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
2,628,607MONTANA
237,048
0
237,048
0.00
12,311,068
65.90
18,681,439
0
0
0NEBRASKA
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
964,899NEW MEXICO
6,490,015
254,786
6,744,801
3.78
22,092,999
69.65
31,720,027
1,198,229
254,786
177,458NORTH DAKOTA
214,523
988,478
1,203,001
33.00
10,360,093
50.00
20,720,186
6,837,661
988,478
494,239OKLAHOMA
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
2,039,234OREGON
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
12,796,044SOUTH DAKOTA
321,120
751,299
1,072,419
33.00
11,979,041
51.64
23,197,213
7,655,080
751,299
387,971UTAH
3,621,116
934,586
4,555,702
20.51
21,277,695
70.56
30,155,463
6,186,286
934,586
659,444WISCONSIN
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
2,617,495WYOMING
0
0
0
0.00
245,478
50.00
490,956
0
0
0( print page 51270)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
33,877,144TOTAL
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.
 
 
 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
DescriptionColumn 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.
 
 
 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 JALABAMA
$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
$3,123,362ARIZONA
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
19,716,021CALIFORNIA
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
777,960COLORADO
173,900,441
594,776
174,495,217
0.34
101,532,256
50.02
202,983,319
691,879
594,776
297,507CONNECTICUT
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
52,786,863DISTRICT 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
4,581,595FLORIDA
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
72,444,637GEORGIA
407,343,557
0
407,343,557
0.00
294,992,365
67.89
434,515,194
0
0
0ILLINOIS
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
45,866,446INDIANA
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
77,425,206KANSAS
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
14,941,706KENTUCKY
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
26,382,389LOUISIANA
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
82,576,428MAINE
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
38,033,434MARYLAND
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
27,619,518MASSACHUSETTS
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
52,817,527MICHIGAN
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
95,989,144MISSISSIPPI
182,608,033
0
182,608,033
0.00
167,391,016
74.63
224,294,541
0
0
0MISSOURI
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
130,993,002NEVADA
73,560,000
0
73,560,000
0.00
50,766,127
64.67
78,500,274
0
0
0NEW 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
47,376,974NEW 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
178,685,231NEW 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
302,500,000NORTH 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
106,855,839OHIO
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
58,227,295PENNSYLVANIA
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
203,297,761RHODE 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
1,223,374SOUTH 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
51,390,431TENNESSEE*
0
0
0
0.00
53,100,000
64.96
81,742,611
0
0
0TEXAS
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
164,334,136VERMONT
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
4,940,228VIRGINIA
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
3,885,134WASHINGTON
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
67,011,289WEST 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
13,560,898TOTAL
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
7,378,375ARKANSAS
2,422,649
819,351
3,242,000
25.27
47,350,016
69.69
67,943,774
17,171,437
819,351
571,006DELAWARE
0
7,069,000
7,069,000
33.00
9,937,205
54.20
18,334,327
6,050,328
6,050,328
3,279,278HAWAII
0
0
0
0.00
10,697,430
54.93
19,474,659
0
0
0IDAHO
2,081,429
0
2,081,429
0.00
18,042,558
71.51
25,230,818
0
0
0IOWA
12,011,250
0
12,011,250
0.00
43,226,550
56.74
76,183,557
0
0
0MINNESOTA
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
2,628,607MONTANA
237,048
0
237,048
0.00
12,459,133
65.56
19,004,169
0
0
0NEBRASKA
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
939,178NEW MEXICO
6,490,015
254,786
6,744,801
3.78
22,358,712
71.13
31,433,589
1,187,409
254,786
181,229NORTH DAKOTA
214,523
988,478
1,203,001
33.00
10,484,694
50.00
20,969,388
6,919,898
988,478
494,239OKLAHOMA
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
1,961,985OREGON
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
12,877,942SOUTH DAKOTA
321,120
751,299
1,072,419
33.00
12,123,113
54.94
22,066,096
7,281,812
751,299
412,764UTAH
3,621,116
934,586
4,555,702
20.51
21,533,602
69.90
30,806,298
6,319,802
934,586
653,276WISCONSIN
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
2,628,276WYOMING
0
0
0
0.00
248,430
50.00
496,860
0
0
0( print page 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
34,006,155TOTAL
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.


[FR Doc. 2017-23933 Filed 11-2-17; 8:45 am] BILLING CODE 4120-01-P