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HHS/CMS RIN: 0938-AS63 Publication ID: Fall 2019 
Title: Medicaid Disproportionate Share Hospital (DSH) Allotment Reductions (CMS-2394-F) 

The Affordable Care Act amends the Social Security Act by requiring aggregate reductions to state Medicaid DSH allotments from FY 2014 through FY 2020. CMS published a final rule in October 2013 that delineated a methodology to implement the annual reductions only for FY 2014 and FY 2015. Subsequent legislation delayed the start of the reductions until FY 2018. The reductions were delayed further for 2 additional years with larger cuts beginning in 2020 under the 2018 Bipartisan Budget Act. Since the earlier final rule was only limited to FY 2014 and FY 2015, this rule finalizes a methodology to reduce the allotments for FY 2020 through 2025.

Agency: Department of Health and Human Services(HHS)  Priority: Economically Significant 
RIN Status: Previously published in the Unified Agenda Agenda Stage of Rulemaking: Completed Actions 
Major: Yes  Unfunded Mandates: No 
EO 13771 Designation: Other 
CFR Citation: 42 CFR 447   
Legal Authority: Pub. L. 111-148, sec. 1203    Pub. L. 114-10, sec. 412    Pub. L. 115-123, sec. 53101   
Legal Deadline:
Action Source Description Date
Final  Statutory  Bipartisan Budget Act, sec. 53101.  10/01/2017 

Overall Description of Deadline: The statutory deadline was originally October 1, 2014, but was delayed by subsequent legislation until October 1, 2019.

Action Date FR Cite
NPRM  07/28/2017  82 FR 35155   
NPRM Comment Period End  08/28/2017 
Final Action  09/25/2019  84 FR 50308   
Final Action Effective  11/25/2019 
Regulatory Flexibility Analysis Required: No  Government Levels Affected: State 
Small Entities Affected: No  Federalism: No 
Included in the Regulatory Plan: No 
RIN Data Printed in the FR: No 
Related RINs: Related to 0938-AR31 
Agency Contact:
Stuart Goldstein
Health Insurance Specialist
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Center for Medicaid and CHIP Services, MS: S3-14-28, 7500 Security Boulevard,
Baltimore, MD 21244
Phone:410 786-0694