The Centers for Medicare & Medicaid Services Friday released additional changes to the instructions for Medicare cost report Worksheet S-10, which is used in calculating Medicare disproportionate share payments to hospitals. The changes primarily clarify that discounts provided to uninsured patients who meet a hospital’s charity care, financial assistance or uninsured discount policies may be included as part of the worksheet’s “total initial obligation of patients approved for charity care” (Line 20, column 1). Among other changes, CMS modified how it applies the cost-to-charge-ratio. AHA staff are analyzing the changes and will continue to work with CMS on steps the agency could take to improve the quality of the data. CMS also extended the deadline for hospitals to amend their fiscal year 2014 and 2015 Worksheet S-10s to Oct. 31. Hospitals may add data and resubmit those worksheets if they choose. The additional data will not be used to calculate DSH payments for FY 2018, but will be available in future years if the future methodology for determining DSH payments uses FY 2014 and 2015 worksheet data.