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(vi) each service type;

(vii) each payment designation; and

(viii) each date service was provided for outpatient hospital services. (c) When making a DSH classification under (d) of this section, the department will use the following data sources as applicable:

(1) for determination of Medicaid covered inpatient days, Medicaid charges, Medicaid payments, and Medicaid non-covered inpatient days, the MR-0-14 report for the qualifying year that is available at least six months after the end of the hospital’s fiscal year at the time the calculation is performed;

(2) for determination and calculation of total hospital allowable costs, total inpatient hospital costs, Medicaid allowable costs, and physician costs, the Medicare cost report filed for the qualifying year and forms required by (b)(4)(A) of this section;

(3) for total hospital days, total hospital revenues, cash subsidies, and patient revenues, the forms required by (b)(4)(B) of this section;

(4) the log required by (b)(4)(C) of this section;

(5) if the department determines that a piece of data or a data source listed in (1) — (4) of this subsection is unavailable, an alternate data source that the department determines to include the same information as the sources in (1) — (4) of this subsection. (d) A qualifying hospital may receive disproportionate share payments allocated to one or more of the following DSH classifications, if that hospital meets any additional criteria applicable to that classification, and subject to the limitations set out in (e) of this section:

(1) payments allocated to each Medicaid inpatient utilization DSH (MIU DSH), if the qualifying hospital has a state Medicaid inpatient utilization rate at least one standard deviation above the mean of state Medicaid inpatient utilization rates for all hospitals in this state; for purposes of this paragraph,

(A) the state Medicaid inpatient utilization rate is a fraction, expressed as a percentage, of which the numerator is the hospital’s number of Medicaid-eligible inpatient days in this state for the hospital’s qualifying year and the denominator is the total number of the hospital’s inpatient days for its qualifying year; and

(B) the mean of Medicaid inpatient utilization rates for all hospitals in the state is