CMS-R-266 supporting statement (DSH)

Supporting Statement for Medicaid Disproportionate Share Hospital (DSH) Annual Reporting Requirements

A. Background

The attached notice provides for a collection of hospital specific DSH payment information as required by section 1923(j)(1) of the Social Security Act (the Act). The collection of data will be submitted to CMS on an annual basis by each State.

B. Justification

1. Need and Legal Basis

The authorization for the DSH information collection is from Section 1001 of the Medicare Modernization Act.

Section 1923(j)(1) of the Act requires States to submit an annual report that includes the following:

• Identification of each DSH that received a DSH payment under the State’s Medicaid program in the preceding fiscal year and the amount of DSH payments paid to that hospital in the same year.

• Such other information as the Secretary determines necessary to ensure the appropriateness of DSH payments.

2. Information Users

This information will be used by CMS and Congress to assess the utilization of the disproportionate share hospital program dollars.

3. Use of Information Technology

CMS recommends the State use a standard software spreadsheet package to compile the information before submitting the information to the regional offices.

4. Duplication of Efforts

This information collection does not duplicate any other effort and the information cannot be obtained from any other source.

5. Small Businesses

These requirements do not affect small businesses.

6. Less Frequent Collection

Failure of the State to submit this information will result in the State being out of compliance with section 1923(j)(1) of the Social Security Act.

7. Special Circumstances

There are no special circumstances regarding the collection of this information.

8. Federal Register Notice/Outside Consultation:

A 60-day Federal Register Notice was published on 3/14/2008.

9. Payment/Gift To Respondent.

There is no payment/gift to respondent.

10. Confidentiality

The information submitted by a State is not of a proprietary nature. This information will be made available to the public.

11. Sensitive Questions

Questions of a sensitive nature are not being asked.

12. Burden Estimate (Total Hours & Wages)

The information submitted by each State is required annually, beginning at the end of the first quarter of the fiscal year following the reporting period. It requires a submission of hospital specific payment data related to the disproportionate share hospital program. The submission of this data in an electronic spreadsheet format will take each State approximately 38 hours. At 38 hours per State the total number of hours will be approximately 1976 for all 52 States. Wage levels would vary depending on the level of staff utilized by individual States, but estimating this expense at $15.00 per hour, $15.00 X 38 hours equals $570.00.

13. Capital Costs

There should be no capital costs related to the collection of this data.

14. Cost to Federal Government

The information submitted by each State will be compiled and evaluated by an employee/contractor of the Federal government. The approximate amount of staff time utilized will be one half hour per State submission which will total 25 hours per annum staff time. Wage levels would approximate $33.00 an hour, costing the government $825 per annum to compile and evaluate this data.

15. Changes to Burden

There are no changes.

16. Publication/Tabulation Dates

CMS is requesting the information be tabulated and submitted to the regional offices by the end of the first quarter of the Federal fiscal year following the reporting year.

17. Expiration Date

This information does not lend itself to an expiration date.

18. Certification Statement

There are no exceptions to the certification statement.

C. Collection of Information Employing Statistical Methods

N/A. This collection does not employ statistical methods.

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