[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR447.297]



[Page 324]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 447_PAYMENTS FOR SERVICES--Table of Contents

 

        Subpart E_Payment Adjustments for Hospitals That Serve a 

             Disproportionate Number of Low-Income Patients

 

Sec.  447.297  Limitations on aggregate payments for disproportionate 



share hospitals beginning October 1, 1992.



    (a) Applicability. The provisions of this section apply to the 50 

States and the District of Columbia, but not to any State whose entire 

Medicaid program is operated under a waiver granted under section 1115 

of the Act.

    (b) National payment target. The national payment target for 

disproportionate share hospital (DSH) payments for any Federal fiscal 

year is equal to 12 percent of the total medical assistance expenditures 

that will be made during the Federal fiscal year under State plans, 

excluding administrative costs. A preliminary national expenditure 

target will be published by CMS prior to October 1 of each year. This 

preliminary national expenditure target will be superseded by a final 

national expenditure target published by April 1 of each Federal fiscal 

year, as specified in paragraph (d) of this section.

    (c) State disproportionate share hospital allotments. Prior to 

October 1 of each Federal fiscal year, CMS will publish in the Federal 

Register preliminary State DSH allotments for each State. These 

preliminary State DSH allotments will be determined using the most 

current applicable actual and estimated State expenditure information as 

reported to CMS and adjusted by CMS as may be necessary using the 

methodology described in Sec.  447.298. CMS will publish final State DSH 

allotments by April 1 of each Federal fiscal year, as described in 

paragraph (d) of this section.

    (d) Final national disproportionate share hospitals expenditure 

target and State disproportionate share hospitals allotments.

    (1) CMS will revise the preliminary national expenditure target and 

the preliminary State DSH allotments by April 1 of each Federal fiscal 

year. The final national DSH expenditure target and State DSH allotments 

will be based on the most current applicable actual and estimated 

expenditure information reported to CMS and adjusted by CMS as may be 

necessary immediately prior to the April 1 publication date. The final 

national expenditure target and State DSH allotments will not be 

recalculated for that Federal fiscal year based upon any subsequent 

actual or estimated expenditure information reported to CMS.

    (2) If CMS determines that at any time a State has exceeded its 

final DSH allotment for a Federal fiscal year, FFP attributable to the 

excess DSH expenditures will be disallowed.

    (3) If a State's actual DSH expenditures applicable to a Federal 

fiscal year are less than its final State DSH allotment for that Federal 

fiscal year, the State is permitted, to the extent allowed by its 

approved State plan, to make additional DSH expenditures applicable to 

that Federal fiscal year up to the amount of its final DSH allotment for 

that Federal fiscal year.

    (e) Publication of limits. (1) Before the beginning of each Federal 

fiscal year, CMS will publish in the Federal Register--

    (i) A preliminary national DSH expenditure target for the Federal 

fiscal year; and

    (ii) A preliminary DSH allotment for each State for the Federal 

fiscal year.

    (2) The final national DSH expenditure target and State DSH 

allotments will be published in the Federal Register by April 1 of each 

Federal fiscal year.



[57 FR 55143, Nov. 24, 1992, as amended at 58 FR 43182, Aug. 13, 1993]