GenIC #13 (Extension w/o change): Medicaid Accountability – Nursing Facility, Outpatient Hospital and Inpatient Hospital Upper Payment Limits

Generic Clearance for Medicaid and CHIP State Plan, Waiver, and Program Submissions (CMS-10398)

OMB: 0938-1148

IC ID: 229611

Information Collection (IC) Details

View Information Collection (IC)

GenIC #13 (Extension w/o change): Medicaid Accountability – Nursing Facility, Outpatient Hospital and Inpatient Hospital Upper Payment Limits
 
New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction 13 - Attachment C -- OP Instructions.docx No   Printable Only
Form and Instruction CMS-10398 #13 Outpatient Hospital UPL Guidance 13 - Attachment D -- OP Guidance.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10398 #13 Inpatient Hospital UPL Guidance 13 - Attachment F -- IP Guidance.docx Yes Yes Fillable Fileable
Form CMS-10398 #13 NF Template 13 - Attachment G -- NF Template.xlsx Yes Yes Fillable Fileable
Form CMS-10398 #13 OP Template 13 - Attachment H -- OP Template.xlsx Yes Yes Fillable Fileable
Form CMS-10398 #13 IP Template 13 - Attachment I -- IP Template.xlsx Yes Yes Fillable Fileable
Form CMS-10398 #13 Inpatient Hospital UPL Guidance 13 - Inpatient Hospital UPL Guidance final.docx Yes Yes Fillable Fileable
Form CMS-10398 #13 Outpatient Hospital UPL Guidance 13 - Outpatient Hospital UPL Guidance final.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10398 #13 Nursing Facility UPL Guidance 13 - Attachment B -- NF Guidance.docx Yes Yes Fillable Fileable
Instruction 13 - Attachment A -- NF Instructions.docx No   Printable Only

Health Health Care Services

 

56 0
   
State, Local, and Tribal Governments
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 56 0 56 0 0 0
Annual IC Time Burden (Hours) 2,240 0 2,240 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
#13 - Supporting Statement 13 - Supporting Statement Medicaid Accountability Nursing Outpatient Hospital and Inpatient Hospital Upper Payment Limits.docx 12/29/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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