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Elizabeth M. Whitehorn, Director

Provider Notice issued 03/31/15

RY2016 Disproportionate Share Determination Action Notice

To:​

Hospitals (Chief Financial Officer / Chief Executive Officer)​

​Date:

​March 31, 2014

​Re:

RY2016 Disproportionate Share Determination Action Notice ​

In an effort to increase efficiency and reduce waste, the Department’s annual 2016 disproportionate share determination action notice has been posted to the Department’s Hospital Provider Notices webpage.

The associated required forms are available for download on the HFS Medical Providers Cost Reports
webpage.

As in prior years, these forms should be completed and mailed to the contact person and address specified on the form by the appropriate due date.

Completion of these forms is vital to the accurate completion of the annual determinations and could
significantly impact a provider’s qualification for a number of reimbursement programs administered by the Department.

If you have questions, or problems downloading these files, please contact Kristy Sommer at 217/785-0710.

Sincerely,


Daniel Jenkins, Bureau Chief
Bureau of Rate Development and Analysis