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

Section 1923(a)(2)(D) of the Act requires the States to submit an annual report that identifies each DHS 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 and such other information as the Secretary determines necessary to ensure the appropriateness of DHS payments. The information supplied will satisfy the requirements under section 1923(a)(2)(D) of the Act as well.

The latest form for Medicaid Disproportionate Share Hospital Annual Reporting (CMS-R-266) expires 2023-09-30 and can be found here.