Disproportionate Share Hospitals

• Disproportionate Share Hospital Flow Chart (Acrobat/pdf) Find out if your hospital is eligible as a DSH
• Disproportionate Share Hospitals & Their Disproportionate Share Adjustment Percentage (Excel)

  The new DSH List that OPA is posting is based on the 2007 SSI Ratio that has been provided by CMS.

  The spreadsheet is provided to the Office of Pharmacy Affairs (OPA) by the Centers for Medicare and Medicaid Services (CMS).  The spreadsheet is provided for reference purposes only and in some cases the information may not be from the most recently filed cost reporting period.  Covered entities are responsible for ensuring that their eligibility information is accurate and up to date.  CMS is the official source used to verify a hospital’s DSH adjustment percentage. Hospitals with a DSH adjustment percentage of greater than 11.75% meet the adjustment percentage requirement to participate in the 340B program. However, there are other qualifying criteria that must also be met. For-profit hospitals are not eligible to participate in the 340B program.

Hospitals not appearing on the list and hospitals that appear on the list but have a DSH adjustment percentage equal to or less than 11.75% are ineligible to participate in the 340B program. If you wish to challenge the DSH adjustment percentage reported by CMS, please provide to OPA the following:

1. A copy of Worksheet E, Part A from your most recently filed Medicare cost reporting period that indicates a DSH adjustment percentage of greater than 11.75% and
   
   
2. A signed letter from the hospital's Chief Financial Officer certifying the accuracy of the DSH adjustment percentage as reflected on Worksheet E.
   
   OPA will make a determination on eligibility based on a review of the information submitted. Please note that in the future, the spreadsheet will no longer identify those hospitals that have submitted the appropriate information to verify their DSH adjustment percentage as greater than 11.75%.

• Formula used to calculate the DSH adjustment percentage
• Search Frequently Asked Questions by Category (Pharmacy: 340B Program) and by Sub category (Disproportionate Share Hospitals)

Forms & Letters

• Letter to Enroll In 340B Drug Pricing Program (for All Hospitals) (Acrobat/pdf) or as Text File
• Certification Regarding Non-Participation in a Group Purchasing Organization (for All Hospitals) (Acrobat/pdf) or as Text File
• Inclusion of Outpatient DSH Facilities (for All Hospitals) (Text File)
• Additional Form for Private, Non-Profit Facilities
  Certification of a Contract between a Private Non-Profit Hospital and Local Government (Acrobat/pdf)