[Federal Register Volume 82, Number 212 (Friday, November 3, 2017)]
[Notices]
[Pages 51259-51274]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-23933]



[[Page 51259]]

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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.

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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

[[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

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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) x
                            (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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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.
------------------------------------------------------------------------


[[Page 51263]]


                                                                     Addendum 1--Final DSH Allotments for Fiscal Year: 2015
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                                                              Prior FY (2014)
                                                               DSH allotment
                                FY 2015                       (Col C) x 100% +    FY 2015 TC MAP                        FY 2015 TC MAP    ``12% Amount'' =   Greater of Col H     FY 2015 DSH
            State                FMAPs     Prior FY (2014)    Pct increase in     Exp. including     FY 2015 TC DSH    EXP.net net OF DSH    Col G x .12/(1-     Or Col C (12%    allotment MIN Col
                               (percent)    DSH allotments         CPIU:               DSH            expenditures         Col E-F        .12/Col B)* (In     Limit, FY 2014        I, Col D
                                                            -------------------                                                                 FS)             allotment)
                                                                   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
LOUISIANA \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        743,671,360
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
TENNESSEE \2\................         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
                              ------------------------------------------------------------------------------------------------------------------------------------------------------------------

[[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        530,679,469
                              ------------------------------------------------------------------------------------------------------------------------------------------------------------------
        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.
\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.


[[Page 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) x (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.
------------------------------------------------------------------------


[[Page 51266]]


                                                                  Addendum 2--Preliminary DSH Allotments for Fiscal Year: 2017
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                              Prior FY (2016)
                                                               DSH allotment
                                FY 2017                       (Col C) x 100% +    FY 2017 TC MAP                        FY 2017 TC MAP    ``12% Amount`` =   Greater of Col H     FY 2017 DSH
            State                FMAPs     Prior FY (2016)    Pct increase in     Exp. including     FY 2017 TC DSH    EXP.net net Of DSH    Col G x .12/(1-     Or Col C (12%    allotment MIN Col
                               (percent)    DSH allotments         CPIU:             DSH \2\        expenditures \2\       Col E-F        .12/Col B)*  (In    Limit, FY 2016        I, Col D
                                                            -------------------                                                                 FS)             allotment)
                                                                   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
TENNESSEE \1\................      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
                              ------------------------------------------------------------------------------------------------------------------------------------------------------------------

[[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        537,061,951
                              ------------------------------------------------------------------------------------------------------------------------------------------------------------------
        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
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ 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.


[[Page 51268]]


           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.
------------------------------------------------------------------------


[[Page 51269]]


                                                                          Addendum 3--Final IMD DSH Limit for FY: 2015
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                                    Applicable
                                         Inpatient         IMD and     Total inpatient                                                              percentage
                                          hospital      mental health   & IMD & mental  Applicable                     FY 2015       FY 2015      applied to  FY    FY 2015  TC     FY 2015 IMD
                State                 services  FY 95   services  FY     health FY 95     percent        FY 2015        FMAPs     allotments  in       2015          IMD limit      limit in FS
                                         DSH  total     95 DSH  total     DSH total       Col C/D   allotment  in FS  (percent)    TC  Col F/G    allotments  in  (lesser of Col     Col G x J
                                         computable      computable    computable  Col                                                              TC  Col E x    I  or Col C)
                                                                            B + C                                                                      Col H
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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               0
NEW 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
                                     -----------------------------------------------------------------------------------------------------------------------------------------------------------

[[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      33,877,144
                                     -----------------------------------------------------------------------------------------------------------------------------------------------------------
        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.


[[Page 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.
------------------------------------------------------------------------


[[Page 51272]]


                                                                   Addendum 4--Preliminary IMD DSH Limit for Fiscal Year: 2017
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                                    Applicable
                                          Inpatient         IMD and     Total inpatient                                                             percentage
                                           hospital      mental health   & IMD & mental  Applicable      FY 2017       FY 2017       FY 2017      applied to  FY    FY 2017  TC     FY 2017 IMD
                State                  services  FY 95   services  FY     health FY 95     percent    allotment  in     FMAPs     allotments  in       2017          IMD limit      limit in FS
                                          DSH  total     95 DSH  total     DSH total       Col C/D          FS        (percent)    TC  Col F/G    allotments  in  (lesser of Col     Col G x J
                                          computable      computable    computable  Col                                                             TC  Col E x    I  or Col C)
                                                                             B + C                                                                     Col H
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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
                                      ----------------------------------------------------------------------------------------------------------------------------------------------------------

[[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      34,006,155
                                      ----------------------------------------------------------------------------------------------------------------------------------------------------------
        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.


[[Page 51274]]

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