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Medicare Department of Health & Human Services (DHHS) Provider Reimbursement Manual Part 2, Provider Cost Reporting Forms and Instructions, Chapter 11, form CMS-339 Centers for Medicare & Medicaid Services (CMS) Transmittal 8 Date: October 2014 HEADER SECTION NUMBERS PAGES TO INSERT PAGES TO DELETE Table of Contents 11-1 (1 p.) 11-1 (1 p.) Sections (cont.) 11-3 - 11-8 (6 p.) 11-3 11-14 (12 p.) Exhibits 1 and 2 11- 9 - 11-14 (6 p.) 11-15 11-39 (25 p.) NOTE: Transmittal 7, dated October 2014, is being rescinded and replaced by Transmittal 8, to change the effective date from cost reporting periods ending on or after June 30, 2014, to cost reporting periods ending on or after September 30, 2014, and to add a portion of sentence to the NOTE under Step on Page 11-11 which was inadvertently omitted.
Form CMS-339 must be completed by all Home Health Agencies (HHAs), Community Mental Health Centers (CMHCs), Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), Hospices, and Organ Procurement Organizations (OPOs) submitting cost reports to the Medicare Administrative Contractor (MAC) under Title XVIII of the Social Security Act (hereafter
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