DSH-001 2015-2025 free printable template

Application for Disproportionate Share Hospital Program DSH and Medicaid/KCHIP Screening Form The following information is used to determine if an individual who requests or has already received hospital services is eligible for Disproportionate Share Hospital services or should be referred instead to the Department for Community Based Services DCBS or to benefind.ky. gov to apply for Medicaid or KCHIP. Refer all children aged 19 and under to benefind*ky. gov or to the DCBS office in the...

How to fill out share program medicaid kchip form

How to fill out DSH-001

1. Gather all necessary personal information, including your name, address, and contact details.
2. Read the instructions carefully before starting to fill out the form.
3. Fill in the sections related to your financial information accurately.
4. Provide any required documentation as specified in the instructions.
5. Review your completed form to ensure all information is correct and complete.
6. Sign and date the form before submission.
7. Submit the form according to the provided guidelines, either electronically or via mail.

Who needs DSH-001?

1. Individuals seeking assistance or benefits related to DSH programs.
2. Applicants who meet specific eligibility criteria set by the DSH authority.
3. Organizations helping individuals complete the DSH-001 form for funding or services.

People Also Ask about hospital dsh form

Which provisions reduced disproportionate share hospital payments?

the American Taxpayer Relief Act of 2012 (P.L. 112-240), enacted on January 2, 2013, extended the reductions to FY 2022.

What is meant by Medicare disproportionate share hospitals?

Disproportionate Share Hospitals serve a significantly disproportionate number of low-income patients and receive payments from the Centers for Medicaid and Medicare Services to cover the costs of providing care to uninsured patients.

What is Section 3133 of the Affordable Care Act?

Changes to Medicare DSH: Section 3133 of the Affordable Care Act. Section 3133 of the Affordable Care Act amends the Medicare DSH adjustment provision under section 1886(d) (5) (F) of the Act, and establishes 1886(r) which provides for an additional payment for a hospital's uncompensated care.

What does DSH stand for in healthcare?

Federal law requires that state Medicaid programs make Disproportionate Share Hospital (DSH) payments to qualifying hospitals that serve a large number of Medicaid and uninsured individuals.

Is DSH the same as 340B?

There are six hospital types eligible to participate in the 340B Program: Disproportionate Share Hospitals (DSH) Sole Community Hospitals (SCH)

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What is DSH-001?

DSH-001 is a form used to report specific data related to healthcare services, particularly focusing on hospitals and other providers to ensure compliance with certain regulations.

Who is required to file DSH-001?

Health care providers that receive Disproportionate Share Hospital (DSH) payments are typically required to file DSH-001.

How to fill out DSH-001?

To fill out DSH-001, providers must gather the necessary financial and operational data, and accurately complete the form following the instructions provided by the relevant regulatory body, typically including details about patient care services and financial management.

What is the purpose of DSH-001?

The purpose of DSH-001 is to ensure that hospitals and healthcare providers receiving DSH payments are adhering to federal requirements and that the funds are being utilized appropriately to support healthcare for low-income and uninsured patients.

What information must be reported on DSH-001?

Information that must be reported on DSH-001 includes patient demographics, financial data, service utilization metrics, and other related operational statistics that demonstrate compliance with DSH payment requirements.