Medicaid Disproportionate Share Hospital (DSH) Annual Report

Medicaid Disproportionate Share Hospital Annual Reporting (CMS-R-266)

OMB: 0938-0746

IC ID: 8445

Documents and Forms

Document Name Document Type
Form CMS-R-266 Medicaid Disproportionate Share Hospital (DSH) Annual Report Form
CMS-R-266 Data Element Report Template CMS-R-266_spreadsheet_DSHauditrevision_CMS-2445-F version 3.xlsx Form
CMS2445P_spreadsheetPRAupdate_Crosswalk_CMS-2445-F .xlsx Crosswalk: Data Element Report Template IC Document
CMS-R-266_spreadsheet_DSHauditrevision_CMS-2445-F version 3 Redline.pdf Redline: Data Element Report Template IC Document