CMS-2552-10 Crosswalk

2025 R23P240 Crosswalk.docx

Hospitals and Health Care Complex Cost Report (CMS-2552-10)

CMS-2552-10 Crosswalk

OMB: 0938-0050

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FORM CMS-2552-10 HOSPITAL AND HOSPITAL HEALTHCARE COMPLEX

FORMS AND INSTRUCTIONS


The Form CMS-2552-10, Hospital and Hospital Healthcare Complex Cost Report, updates the existing Form CMS-2552-10 by subsuming the Supplemental to Form CMS-2552-10 Payment Adjustment for Establishing and Maintaining Access to a Buffer Stock of Essential Medicines (OMB Control No. 0938-1473) and the Supplemental to Form CMS-2552-10 Payment Adjustment for Domestic NIOSH-Approved Surgical N95 Respirators (OMB Control No. 0938-1425). Subsuming the worksheets results in an increase to the burden for the Hospital and Hospital Healthcare Complex Cost Report of 1 hour. Changes to the revised cost report forms and instructions include:


  1. Added Worksheet E-90, Payment Adjustment for Establishing and Maintaining Access to a Buffer Stock of Essential Medicines, and instructions

  2. Added Worksheet E-95, Payment Adjustment for Domestic NIOSH-Approved Surgical N95 Respirators, and instructions



#

FORM CMS‑2552‑10

CURRENTLY APPROVED

PROPOSED FORM CMS‑2552‑10

REASON FOR THE CHANGE / APPLICATION OF THE INSTRUCTIONS AND ACCOMPANYING WORKSHEETS

BURDEN EFFECT

WORKSHEET

INSTRUCTIONS

WORKSHEET

PAGE #

SECTION #

PAGE #

1.

N/A (currently approved as OMB Control No. 0938-1473)

Worksheet E-90

40-599.2 - 40-599.3

4038 - 4038.2

40-216.8 - 40-216.9

Added Worksheet E-90, Payment Adjustment for Establishing and Maintaining Access to a Buffer Stock of Essential Medicines

.75

2.

N/A (currently approved as OMB Control No. 0938-1425)

Worksheet E-95

40-599.4

4039 - 4039.3

40-216.10 - 40-216.12

Added Worksheet E-95, Payment Adjustment for Domestic NIOSH-Approved Surgical N95 Respirators

.25




File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleIssue #
AuthorCMS
File Modified0000-00-00
File Created2025-06-12

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