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:
Added Worksheet E-90, Payment Adjustment for Establishing and Maintaining Access to a Buffer Stock of Essential Medicines, and instructions
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 Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | Issue # |
Author | CMS |
File Modified | 0000-00-00 |
File Created | 2025-06-12 |