OMB control number
Medicare Disproportionate Share Hospital (DSH) Payments: Counting Days Associated With Section 1115 Demonstrations in the Medicaid Fraction (CMS-10839)
OMB 0938-1447 · HHS/CMS.
OMB 0938-1447
CMS issued a proposed rule (CMS-1788-P, RIN 0938-AV17) (88 FR 12623) with a proposal to refine our policy for counting inpatient days associated with patients who are regarded as eligible for medical assistance under a State Medicaid plan to include those who receive health insurance authorized by a section 1115 demonstration or patients who pay for all of the cost of such health insurance with premium assistance authorized by a section 1115 demonstration and such health insurance provides inpatient coverage.
The latest form for Medicare Disproportionate Share Hospital (DSH) Payments: Counting Days Associated With Section 1115 Demonstrations in the Medicaid Fraction (CMS-10839) expires 2027-04-30 and is listed under ICR 202308-0938-014.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 CMS-10839.Supporting Statement Part A (final rule).docx | Supporting Statement A |
 Medicare Disproportionate Share Hospital (DSH) Payments: Counting Days Associated with Section 1115 Demonstrations in the Medicaid Fraction |
Information collection |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202308-0938-014 | New collection (Request for a new OMB Control Number) | 2023-08-28 | Approved with change | |
| 202305-0938-013 | New collection (Request for a new OMB Control Number) | 2023-06-02 | Comment filed on proposed rule |