[Federal Register: December 28, 2007 (Volume 72, Number 248)]
[Notices]
[Page 73831-73841]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr28de07-111]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-2269-N]
RIN 0938-AO75
Medicaid Program; Fiscal Year Disproportionate Share Hospital
Allotments and Disproportionate Share Hospital Institutions for Mental
Disease 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 (FFY) 2006 and
the preliminary Federal share DSH allotments for FFY 2008. This notice
also announces the final FFY 2006 and the preliminary FFY 2008
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' FFY DSH allotments.
DATES: Effective Date: December 28, 2007.
FOR FURTHER INFORMATION CONTACT: Richard Strauss, (410) 786-2019.
SUPPLEMENTARY INFORMATION:
I. Background
A. Disproportionate Share Hospital Allotments for Federal Fiscal Year
2003
Under section 1923(f)(3) of the Social Security Act (the Act),
States' Federal
[[Page 73832]]
fiscal year (FFY) 2003 disproportionate share hospital (DSH) allotments
were calculated by increasing the amounts of the FFY 2002 allotments
for each State (as specified in the chart, entitled ``DSH Allotment (in
millions of dollars),'' contained in section 1923(f)(2) of the Act) by
the percentage change in the Consumer Price Index for all Urban
Consumers (CPI-U) for the prior fiscal year. The allotment, determined
in this way, is subject to the limitation that an increase to a State's
DSH allotment for a fiscal year cannot result in the DSH allotment
exceeding the greater of the State's DSH allotment for the previous
fiscal year or 12 percent of the State's total medical assistance
expenditures for the allotment year (this is referred to as the 12
percent limit).
Most States' actual FY 2002 allotments were determined in
accordance with the provisions of section 1923(f)(4) of the Act.
However, as indicated previously, the calculation of States' FFY 2003
allotments was not based on the actual FFY 2002 DSH allotments; rather,
section 1923(f)(3) of the Act requires that the States' FY 2003
allotments be determined using the amount of the States' FY 2002
allotments specified in the chart in section 1923(f)(2) of the Act. The
exception to this is the calculation of the FFY 2003 DSH allotments for
certain ``Low-DSH States'' (defined in section 1923(f)(5) of the Act).
Under the Low-DSH State provision, there is a special calculation
methodology for the Low-DSH States only. Under this methodology, the
FFY 2003 allotments were determined by using (that is, increasing)
States' actual FFY 2002 DSH allotments (not their FFY 2002 allotments
specified in the chart in section 1923(f)(2) of the Act) by the
percentage change in the CPI-U for the previous fiscal year.
B. DSH Allotments for FFY 2004
Section 1001(a) of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA) (Pub. L. 108-173, enacted on December
8, 2003) amended section 1923(f)(3) of the Act to provide for a
``Special, Temporary Increase In Allotments On A One-Time, Non-
Cumulative Basis.'' Under this provision, States' FFY 2004 DSH
allotments were determined by increasing their FFY 2003 allotments by
16 percent, and the fiscal year DSH allotment amounts so determined
were not subject to the 12 percent limit.
C. DSH Allotments for Non-Low DSH States for FFY 2005, and Fiscal Years
Thereafter
Under the methodology contained in section 1923(f)(3)(C) of the
Act, as amended by section 1001(a)(2) of the MMA, the non-Low-DSH
States' DSH allotments for FFY 2005 and subsequent fiscal years
continue at the same level as the States' DSH allotments for FFY 2004
until a ``fiscal year specified'' occurs. The ``fiscal year specified''
is the first fiscal year for which the Secretary estimates that a
State's DSH allotment equals (or no longer exceeds) the DSH allotment
as would have been determined under the statute in effect before the
enactment of the MMA. We determine whether the fiscal year specified
has occurred under a special parallel process. Specifically, under this
parallel process, a ``parallel'' DSH allotment is determined for FFYs
after 2003 by increasing the State's DSH allotment for the previous
fiscal year by the percentage change in the CPI-U for the prior fiscal
year, subject to the 12 percent limit. This is the methodology as would
otherwise have been applied under section 1923(f)(3)(A) of the Act
notwithstanding the application of the provisions of MMA. The ``fiscal
year specified,'' is the fiscal year in which the parallel DSH
allotment calculated under this special parallel process finally equals
or exceeds the FY 2004 DSH allotment, as determined under the MMA
provisions. Once the fiscal year specified occurs for a State, that
State's fiscal year DSH allotment will be calculated by increasing the
State's previous actual fiscal year DSH allotment (which would be equal
to the FY 2004 DSH allotment) by the percentage change in the CPI-U for
the previous fiscal year, subject to the 12 percent limit. The
following example illustrates how the fiscal year DSH allotment would
be calculated for fiscal years after FFY 2004.
Example --In this example, we are determining the parallel FFY
2008 DSH allotment. A State's actual FFY 2003 DSH allotment is $100
million. Under the MMA, this State's actual FFY 2004 DSH allotment
would be $116 million ($100 million increased by 16 percent). The
State's DSH allotment for FFY 2005 and subsequent fiscal years would
continue at the $116 million FFY 2004 DSH allotment for fiscal years
following FFY 2004 until the ``fiscal year specified'' occurs. In
the separate parallel process, we determine whether the fiscal year
specified has occurred by calculating the State's DSH allotments in
accordance with the statute in effect before the enactment of the
MMA. Under this special process, we would continue to determine the
State's parallel DSH allotment for each fiscal year by increasing
the State's parallel DSH allotment for the previous fiscal year (as
also determined under the special parallel process) by the
percentage change in the CPI-U for the previous fiscal year, and
subject to the 12 percent limit. Assume for purposes of this example
that, in accordance with this special parallel process, the State's
parallel FFY 2007 DSH allotment was determined to be $115 million
and the percentage change in the CPI-U for FFY 2007 (the previous
fiscal year) relevant for the calculation of the FFY 2008 DSH
allotment was 2.3 percent. That is, the percentage change for the
CPI-U for FFY 2007, the year before FFY 2008, was 2.3 percent.
Therefore, the State's special parallel process FFY 2008 DSH
allotment amount would be calculated by increasing the special
parallel process FFY 2007 DSH allotment amount of $115 million by
2.3 percent; this results in a special DSH allotment process amount
for FFY 2008 of $117.6 million. Since $117.6 million is greater than
$116 million (the actual FFY 2004 DSH allotment calculated under the
MMA), we would determine that FFY 2008 is the ``fiscal year
specified'' (the first year that the FFY 2004 allotment equals or no
longer exceeds the parallel process allotment). We would then
determine the State's FFY 2008 allotment as the State's actual FFY
2007 DSH allotment ($116 million) increased by the percentage change
in the CPI-U for FFY 2007 (2.3 percent). Therefore, the State's FFY
2008 DSH allotment would be $118.67 million ($116 million increased
by 2.3 percent); for purposes of this example, the application of
the 12 percent limit has no effect. Furthermore, for FFY 2009 and
thereafter, the State's DSH allotment would be calculated by
increasing the State's previous fiscal year's DSH allotment by the
percentage change in the CPI-U for the previous fiscal year, subject
to the 12 percent limit.
However, as amended by section 1001(b)(4) of the MMA, section
1923(f)(5)(B) of the Act also contains new criteria for determining
whether a State is a Low-DSH State, beginning with FFY 2004. This
provision is described in section I.D.
Finally, the provisions of section 6054 of the Deficit Reduction
Act (DRA) of 2005 Public Law 109-171, enacted February 8, 2006)
affected the determination of the DSH allotment for the District of
Columbia. Under section 6054 of the DRA, for purposes of determining
only the FFY 2006 and subsequent fiscal year DSH allotments for the
District of Columbia, the table in section 1923(f)(2) of the Act is
amended by increasing the FFY DSH allotment amounts indicated in that
table for the District of Columbia for FFYs 2000, 2001, and 2002 to $49
million for each of those fiscal years. Before the DRA amendment, the
amount in the chart in section 1923(f)(2) of the Act for the District
of Columbia for each of those fiscal years was $32 million. This DRA
provision increases the fiscal year DSH allotment for the District of
Columbia effective with the FFY 2006 DSH
[[Page 73833]]
allotment. This change is because the DSH allotments for FFY 2003 were
based on the amounts of States' DSH allotments for FFY 2002 as
contained in the chart in section 1923(f)(2) of the Act. Since (for
purposes of ultimately determining the FFY 2006 allotment) the DRA
provision increased the FFY 2002 allotment for the District of
Columbia, as indicated above, the FFY 2003 allotment was increased.
Furthermore, for this purpose, the FFY 2004 allotment for the District
of Columbia would then have been determined by increasing the FFY 2003
allotment (as so determined) by 16 percent. For fiscal years subsequent
to FFY 2006, the DSH allotments are determined as described above. The
final FFY 2006 DSH allotment and the preliminary FFY 2008 DSH allotment
for the District of Columbia contained in this notice reflect the
provision of section 6054 of the DRA.
As described below, in accordance with section 6054 of the DRA, the
final FFY 2006 DSH allotment for the District of Columbia is
$57,692,600. As amended by section 6054 of the DRA, the FFY 2002 DSH
allotment amount for the District of Columbia contained in the chart in
section 1923(f)(2) of the Act was increased to $49,000,000. In
accordance with section 1923(f)(3)(A) of the Act, the FFY 2003 DSH
allotment is determined by increasing the $49,000,000 DSH Allotment for
FFY 2002 (as referenced in section 1923(f)(2) of the Act) by the
percentage change in the CPI-U for 2002 (in this case, 1.5 percent) to
$49,735,000. In accordance with section 1923(f)(3)(C)(i) of the Act,
the FFY 2004 DSH allotment is determined by increasing the $49,735,000
FFY 2003 DSH allotment amount by 16 percent to $57,692,600. In
accordance with the provisions of section 1923(f)(3)(C) of the Act, the
District of Columbia's DSH allotments for FFYs 2005, 2006, and 2007 are
also $57,692,600. Finally, in accordance with section 6054 of the DRA,
the District of Columbia's DSH allotment is increased as described
above, effective beginning with FFY 2006.
D. DSH Allotments for Low-DSH States for FFY 2004 and Fiscal Years
Thereafter
Section 1001(b)(1) of the MMA amended section 1923(f)(5) of the Act
regarding the calculation of the fiscal year DSH allotments for ``Low-
DSH'' States for FFY 2004 and subsequent fiscal years. Specifically,
under section 1923(f)(5)(B) of the Act, as amended by section
1001(b)(4) of the MMA, a State is considered a Low-DSH State for FFY
2004 if its total DSH payments under its State plan for FFY 2000
(including Federal and State shares) as reported to CMS as of August
31, 2003, are greater than 0 percent and less than 3 percent of the
State's total FFY 2000 expenditures under its State plan for medical
assistance. For States that meet the new Low-DSH criteria, their FFY
2004 DSH allotments are calculated by increasing their FFY 2003 DSH
allotments by 16 percent. Therefore, for FFY 2004, Low-DSH States'
fiscal year DSH allotments are calculated in the same way as the DSH
allotments for regular States, which under section 1923(f)(3) of the
Act, get the special temporary increase for FFY 2004.
Furthermore, for States meeting the MMA's Low-DSH definition, the
DSH allotments for FFYs 2005 through 2008 will continue to be
determined by increasing the previous fiscal year's DSH allotment by 16
percent. The Low-DSH States' DSH allotments for FFYs 2004 through 2008
are not subject to the 12 percent limit. The Low-DSH States' DSH
allotments for FFYs 2009 and subsequent fiscal years are calculated by
increasing those States' DSH allotments for the prior fiscal year by
the percentage change in the CPI-U for that prior fiscal year. For FFYs
2009 and thereafter, the DSH allotments so determined would be subject
to the 12 percent limit.
E. Institutions for Mental Diseases DSH Limits for FFYs 1998 and
Thereafter
Under section 1923(h) to the Act, Federal financial participation
(FFP) is not available for DSH payments to institutions for mental
diseases (IMDs) and other mental health facilities that are in excess
of State-specific aggregate limits. Under this provision, this
aggregate limit for DSH payments to IMDs and other mental health
facilities is the lesser of a State's FFY 1995 total computable (State
and Federal share) IMD and other mental health facility DSH
expenditures applicable to the State's FFY 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.
Each State's IMD limit on DSH payments to IMDs and other mental
health facilities was calculated by first determining the State's total
computable DSH expenditures attributable to the FFY 1995 DSH allotment
for mental health facilities and inpatient hospitals. This calculation
was based on the total computable DSH expenditures reported by the
State on the Form CMS-64 as mental health DSH and inpatient hospital as
of January 1, 1997. We then calculate an ``applicable percentage.'' The
applicable percentage for FFY 1998 through FFY 2000 (1995 IMD DSH
percentage) is calculated by dividing the total computable amount of
IMD and mental health DSH expenditures applicable to the State's FFY
1995 DSH allotment by the total computable amount of all DSH
expenditures (mental health facility plus inpatient hospital)
applicable to the FFY 1995 DSH allotment. For FFY 2001 and thereafter,
the applicable percentage is defined as the lesser of the applicable
percentage as calculated above (for FFYs 1998 through 2001) or 50
percent for FFY 2001; 40 percent for FFY 2002; and 33 percent for each
subsequent FFY.
The applicable percentage is then applied to each State's total
computable FFY DSH allotment for the current FFY. The State's total
computable FFY DSH allotment is calculated by dividing the State's
Federal share DSH allotment for the FFY by the State's Federal medical
assistance percentage (FMAP) for that FFY.
In the final step of the calculation of the IMD DSH Limit, the
State's total computable IMD DSH limit for the FFY is set at the lesser
of the product of a State's current fiscal year total computable DSH
allotment and the applicable percentage for that fiscal year, or the
State's FFY 1995 total computable IMD and other mental health facility
DSH expenditures applicable to the State's FFY 1995 DSH allotment as
reported on the Form CMS-64.
The MMA legislation did not amend the Medicaid statute with respect
to the calculation of the IMD DSH limit.
F. DSH Allotments and IMD DSH Limits Published in the Federal Register
on October 3, 2006
On October 3, 2006, we published a notice (71 FR 58398) in the
Federal Register that announced the final Federal share DSH allotments
for Federal fiscal year (FFY) 2005, and the preliminary Federal share
DSH allotments for FFY 2006 and FFY 2007. It also announced the final
FFY 2005, and the preliminary FFY 2006 and FFY 2007, limitations on
aggregate DSH payments that States may make to institutions for mental
disease (IMDs) and other mental health facilities.
G. Publication in the Federal Register of Preliminary and Final Notice
for DSH Allotments and IMD DSH Limits
In general, we initially determine States' DSH allotments and IMD
DSH limits for a fiscal year using estimates of medical assistance
expenditures, including DSH expenditures in their
[[Page 73834]]
Medicaid programs. These estimates are provided by States each year on
the August quarterly Medicaid budget reports (Form CMS-37) before the
Federal fiscal year for which the DSH allotments and IMD DSH limits are
being determined. The DSH allotments and IMD DSH limits determined
using these estimates are referred to as ``preliminary.'' Only after we
receive States'' reports of the actual related medical assistance
expenditures through the quarterly expenditure report (Form CMS-64),
which occurs after the end of the fiscal year, are the ``final'' DSH
Allotments and IMD DSH limits determined.
As indicated in section I.F. of this notice, the notice published
in the Federal Register on October 3, 2006 announced the final FFY 2005
DSH allotments and the final FFY 2005 IMD DSH limits (since they were
based on the actual expenditures related to those years), the
preliminary FFYs 2006 and 2007 DSH allotments (based on estimates), and
the preliminary FFYs 2006 and 2007 IMD DSH limits (since they were
based on the preliminary DSH allotments for FFYs 2006 and 2007).
This notice announces the final FFY 2006 DSH allotments and the
final FFY 2006 IMD DSH limits (since these are now based on the actual
expenditures for those fiscal years), the preliminary FFY 2008 DSH
allotments (based on estimates), and the preliminary IMD DSH limits for
FFY 2008 (since they are based on the preliminary DSH allotments for
FFY 2008). This notice does not include the final FFY 2007 DSH
allotments or the final FFY 2007 IMD DSH limits, since the associated
actual expenditures for FFY 2007 are not available at this time.
II. Provisions of the Notice
A. Calculation of the Final FFY 2006 Federal Share State DSH Allotments
the Preliminary FFY 2008 Federal Share State DSH Allotments
Chart 1 of the Addendum to this notice provides the States'
``final'' FFY 2006 DSH allotments. The final FFY 2006 DSH allotments
for each State were computed in accordance with the provisions of the
Medicaid statute as amended by the MMA. As required by the provisions
of the MMA, the final FFY 2004 DSH allotments for the ``Low-DSH''
States and all the other States were calculated by increasing the FFY
2003 DSH allotments by 16 percent. In the notice published on March 26,
2004 in the Federal Register, we explained the definition and
determination of the ``Low-DSH'' States under the MMA provisions.
However, for following fiscal years, the DSH allotments are determined
under a process which incorporates a parallel process described in
section I.C. of this notice. Under that parallel process, States final
FFY 2006 DSH allotments were determined using the States' expenditure
reports (Form CMS-64) for FFY 2006.
Chart 2 of the Addendum to this notice provides the States'
``preliminary'' FFY 2008 DSH allotments. These preliminary allotments
were determined using the States' August 2007 expenditure estimates
submitted by the States on the Form CMS-37. We will publish the final
FFY 2008 DSH allotments for each State following receipt of the States'
four quarterly Medicaid expenditure reports (Form CMS-64) for FFY 2008.
B. Calculation of the FFYs 2006 and FFY 2008 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 IMD or DSH payments that exceed the lesser of the State's FFY 1995
total computable mental health DSH expenditures applicable to the
State's FFY 1995 DSH allotment as reported to us on the Form CMS-64 as
of January 1, 1997; or the amount equal to the product of the State's
current FFY total computable DSH allotment and the applicable
percentage. We are publishing the final FFY 2006 IMD DSH limit, and the
preliminary FFY 2008 IMD DSH limit, along with an explanation of the
calculation of these limits.
For FFY 2003 and following fiscal years, the applicable percentage
is the lesser of 33 percent or the 1995 DSH IMD percentage of the
amount computed for FFY 2000. This percentage was applied to the
State's fiscal year total computable DSH allotment. This result was
then compared to the State's FFY 1995 total computable mental health
DSH expenditures applicable to the State's FFY 1995 DSH allotment as
reported on the Form CMS-64 as of January 1, 1997. The lesser of these
two amounts was the State's limitation on total computable IMD/DSH
expenditures for FFY 2003 and following fiscal years.
Charts 3 and 4 of the Addendum to this notice detail each State's
final IMD/DSH limitation for FFY 2006 and the preliminary IMD/DSH
limitation for FFY 2008, respectively, in accordance with section
1923(h) of the Act.
III. Collection of Information Requirements
This document does not impose information collection and
recordkeeping requirements. Consequently, it need not be reviewed by
the Office of Management and Budget under the authority of the
Paperwork Reduction Act of 1995 (44 U.S.C. 35).
IV. Regulatory Impact Statement
We have examined the impact of this rule as required by Executive
Order 12866 (September 1993, Regulatory Planning and Review), the
Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96-354),
section 1102(b) of the Social Security Act, the Unfunded Mandates
Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132.
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
does not reach the economic threshold and thus is not considered a
major rule.
The RFA requires agencies to analyze options for regulatory relief
of small businesses. 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
$6.5 million to $31 million in any 1 year. Individuals and States are
not included in the definition of a small entity. We are not preparing
an analysis for the RFA because we have determined, and the Secretary
certifies, that this notice will not have significant economic impact
on a substantial number of small entities. Specifically the effects of
the various controlling statutes on providers are not impacted by a
result of any independent regulatory impact and not this notice. The
purpose of the notice is to announce the latest distributions 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
[[Page 73835]]
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 we have determined and the Secretary certifies that this notice
will not have a significant impact on the operations of a substantial
number of small rural hospitals.
In addition, the MMA set statutorily defined limits on the amount
of Federal share DSH expenditures available for FFY 2004 and subsequent
fiscal years. Specifically, section 1001 of the MMA increased the DSH
allotment for States beginning with fiscal year 2004. While overall the
statute mandated some increases in DSH payments, 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. That threshold
level is currently approximately $140 million. This notice will have no
consequential effect on State, local, or tribal governments or on the
private sector.
Executive Order 13132 establishes certain requirements that an
agency must meet when it promulgates a proposed 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, the requirements of E.O. 13132 are not applicable.
In accordance with the provisions of Executive Order 12866, this
notice was reviewed by the Office of Management and Budget.
Addendum
This addendum contains the charts 1 through 4 (preceeded by
associated keys) that are referred to in the preamble of this notice.
Key to Chart 1.--Final DSH Allotments for FY 2006
[Key to the Chart of the Final FFY 2005 DSH Allotments. The final FFY
2006 DSH Allotments for the regular States Are Presented in the Top
Section of this chart and the final FFY 2005 DSH Allotments for the Low-
DSH States Are presented in the Bottom Section of the chart.]
------------------------------------------------------------------------
Column Description
------------------------------------------------------------------------
For Non-Low-DSH States:
Column A...................... State.
Column B...................... Final FY 2004 DSH Allotment Federal
Share--This column contains the
final FFY 2004 DSH Allotments.
Column C...................... FY 2006 DSH Allotment Federal Share--
This column contains the final FFY
2006 DSH Allotments.
Column D...................... MMA Low-DSH Status--This column
indicates the MMA Low-DSH Status of
each State.
For Low-DSH States:
Column A...................... State.
Column B...................... Prior FY DSH Allotment--This column
contains the final FFY 2005 DSH
Allotments.
Column C...................... FY 2006 DSH Allotments Federal
Share--This column contains the
final FFY 2006 DSH Allotments =
Column B multiplied by 1.16.
Column D...................... MMA Low-DSH Status--This column
indicates the MMA Low-DSH Status of
each State.
------------------------------------------------------------------------
Key to Chart 2.--Preliminary DSH Allotments for FY 2008
[Key to the Chart of the Preliminary FFY 2008 DSH Allotments. The
preliminary FFY 2008 DSH Allotments for the regular States are presented
in the top section of this chart and the preliminary FFY 2008 DSH
Allotments for the Low-DSH States are presented in the bottom section of
the chart.]
------------------------------------------------------------------------
Column Description
------------------------------------------------------------------------
For Non-Low-DSH States:
Column A...................... State.
Column B...................... Final FY 2004 DSH Allotment Federal
Share--This column contains the
final FFY 2004 DSH Allotments.
Column C...................... FY 2008 DSH Allotment Federal Share--
This column contains the
preliminary FFY 2008 DSH
Allotments.
Column D...................... MMA Low-DSH Status--This column
indicates the MMA Low-DSH Status of
each State.
For Low-DSH States:
Column A...................... State.
Column B...................... Prior FY DSH Allotment--This column
contains the preliminary FFY 2007
DSH Allotments.
Column C...................... FY 2008 DSH Allotments Federal
Share--This column contains the
preliminary FFY 2008 DSH Allotments
= Column B multiplied by 1.16.
Column D...................... MMA Low-DSH Status--This column
indicates the MMA Low-DSH Status of
each State.
------------------------------------------------------------------------
Key to Chart 3.--Final FFY 2006 IMD DSH Limits
[Key to the Chart of the FFY 2006 IMD Limitations.--The final FFY 2006
IMD DSH Limits for the regular States are presented in the top section
of this chart and the Final FFY IMD DSH Limits for the Low-DSH States
are presented in the Bottom Section of the chart.]
------------------------------------------------------------------------
Column Description
------------------------------------------------------------------------
Column A.......................... State.
Column B.......................... Inpatient Hospital Services FY 95
DSH Total Computable. This column
contains the States' total
computable FFY 1995 inpatient
hospital DSH expenditures as
reported on the Form CMS-64.
Column C.......................... IMD and Mental Health Services FY 95
DSH Total Computable. This column
contains the total computable FFY
1995 mental health facility DSH
expenditures as reported on the
Form CMS-64 as of January 1, 1997.
[[Page 73836]]
Column D.......................... Total Inpatient & 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 FFY 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 FFY 1995 mental health
facility DSH expenditures divided
by total computable all inpatient
hospital and mental health facility
DSH expenditures for FFY 1995 (the
amount in Column C divided by the
amount in Column D) Per section
1923(h)(2)(A)(ii)(II) of the Act,
for FFYs after FY 2002, the
applicable percentage can be no
greater than 33 percent.
Column F.......................... FY 2006 Federal Share DSH Allotment.
This column contains the States'
final FFY 2005 DSH allotments.
Column G.......................... FFY 2006 FMAP.
Column H.......................... FY 2006 DSH Allotments in TC. Col. F/
G. This column contains FFY 2006
total computable DSH allotment
(determined as Column F/Column G).
Column I.......................... Col E * Col H in TC. This column
contains the applicable percent of
FFY 2006 total computable DSH
allotment (calculated as Column E x
Column H).
Column J.......................... FY 2006 IMD DSH Limit Total
Computable. Lesser of Col. C or I.
The column contains the lesser of
the lesser of Column I or C.
Column K.......................... FY 2006 IMD DSH Limit Federal Share,
Col. G x J. This column contains
the total computable IMD DSH Limit
from Col. J and converts that
amount into a Federal share
(calculated as Col. G x Col. J).
Column L.......................... LOW DSH Status. This column contains
Low DSH status for each State.
------------------------------------------------------------------------
Key to Chart 4.--Preliminary FFY 2008 IMD DSH Limits
[Key to the Chart of the FFY 2008 IMD Limitations.--The preliminary FFY
2008 IMD DSH Limits for the regular States are presented in the top
section of this chart and the preliminary FFY 2008 IMD DSH Limits for
the Low-DSH States are presented in the Bottom Section of the Chart
------------------------------------------------------------------------
Column Description
------------------------------------------------------------------------
Column A.......................... State.
Column B.......................... Inpatient Hospital Services FY 95
DSH Total Computable. This column
contains the States' total
computable FFY 1995 inpatient
hospital DSH expenditures as
reported on the Form CMS-64.
Column C.......................... IMD and Mental Health Services FY 95
DSH Total Computable. This column
contains the total computable FFY
1995 mental health facility DSH
expenditures as reported on the
Form CMS-64 as of January 1, 1997.
Column D.......................... Total Inpatient & 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 FFY 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 FFY 1995 mental health
facility DSH expenditures divided
by total computable all inpatient
hospital and mental health facility
DSH expenditures for FFY 1995 (the
amount in Column C divided by the
amount in Column D) Per section
1923(h)(2)(A)(ii)(II) of the Act,
for FFYs after FY 2002, the
applicable percentage can be no
greater than 33 percent.
Column F.......................... FY 2008 Federal Share DSH Allotment.
This column contains the States'
preliminary FFY 2008 DSH
allotments.
Column G.......................... FFY 2008 FMAP.
Column H.......................... FY 2008 DSH Allotment Total
Computable Col. F/G. This column
contains FFY 2008 total computable
DSH allotment (determined as Column
F/Column G).
Column I.......................... Col E * Col H in TC. This column
contains the applicable percent of
FFY 2008 total computable DSH
allotment (calculated as Column E x
Column H)
Column J.......................... FY 2008 IMD DSH Limit Total
Computable. Lesser of Col. C or I.
The column contains the lesser of
the lesser of Column I or C.
Column K.......................... FY 2008 IMD DSH Limit Federal Share,
Col. G x J. This column contains
the total computable IMD DSH Limit
from Col. J and converts that
amount into a Federal share
(calculated as Col. G x Col. J).
Column L.......................... Low DSH Status. This column contains
Low DSH status for each State.
------------------------------------------------------------------------
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BILLING CODE 4120-01-P
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Authority: Section 1923(a)(2), (f), and (h) of the Social
Security Act (42 U.S.C. 1396r-4(a)(2), (f), and (h), and Pub. L.
105-33)
(Catalog of Federal Domestic Assistance Program No. 93.778, Medical
Assistance Program)
Dated: October 23, 3007.
Kerry Weems,
Acting Administrator, Centers for Medicare & Medicaid Services.
Dated: November 8, 2007.
Michael O. Leavitt,
Secretary.
[FR Doc. E7-24486 Filed 12-27-07; 8:45 am]
BILLING CODE 4120-01-C