Template Crosswalk: (Templates: inpatient hospital, outpatient hospital, and nursing facility)

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Overview

Inpatient Hospital
Outpatient Hospital
Nursing Facility

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Sheet 1: Inpatient Hospital

Sheet	Template Section	Location in Original Version	Location in Current Version	Variable Number	Change since last OMB approval January 2021
Required State Input - IPH	Data	A2	A2	001	Guam, Puerto Rico, and U.S. Virgin Islands were added to the drop down menu as valid values.
Required State Input - IPH	Tooltip	A2	A2	001	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the state. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are two character state abbreviations for the 50 states and D.C.
Required State Input - IPH	Tooltip	B2	B2	002	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the demonstration begin date. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are dates in the format MM/DD/YYYY.
Required State Input - IPH	Data	B2	B2	002	Added conditional formatting to mark cells as red if the value for 002 is later than the value for 003.
Required State Input - IPH	Data	C2	C2	003	Added conditional formatting to mark cells as red if the value for 003 is earlier than the value for 002.
Required State Input - IPH	Tooltip	C2	C2	003	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the demonstration end date. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are dates in the format MM/DD/YYYY.
Required State Input - IPH	Data	Column B	Column B	100	Guam, Puerto Rico, and U.S. Virgin Islands were added to the drop down menu as valid values.
Required State Input - IPH	Tooltip	Column B	Column B	100	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the state. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are two character state abbreviations for the 50 states and D.C.
Required State Input - IPH	Tooltip	Column C	Column C	101	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the demonstration rate year. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are 4 digit numeric strings representing the year in the format YYYY.
Required State Input - IPH	Tooltip	Column D	Column D	102	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the service type. A data validation error is triggered when this variable is missing data or has an invalid value. The only valid value for this variable in this template is IP.
Required State Input - IPH	Tooltip	Column E	Column E	104	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the demonstration type. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable include "Cost," "Payment," "Per Diem," and "DRG."
Required State Input - IPH	Data	Column G	Column G	105	Added conditional formatting to flag duplicates across unique combinations of 112, 107, 108, 105.
Required State Input - IPH	Tooltip	Column G	Column G	105	Added the following tool tip to the data entry cells in the required state input tab: Provide if applicable: Enter the Other State Provider ID Number. A data validation error is triggered when duplicate values exist in the provider information variables. The combination of values for variables 105, 112, 107, 108 must be unique.
Data Dictionary	N/A	E13	E13	105	Updated text for Data Dictionary Long Description: State provider ID number that is not a Medicaid (MCD) ID number (if applicable).
Required State Input - IPH	Tooltip	Column F	Column F	106	Added the following tool tip to the data entry cells in the required state input tab: Provide if applicable: Enter the Explanation of Other Demonstration Type. A data validation error is triggered when Demo Type (104) is "Per Diem" and this variable is missing data or contains an invalid value.
Required State Input - IPH	Data	Column J	Column J	107	Added conditional formatting to flag duplicates across unique combinations of 112, 107, 108, 105.
Required State Input - IPH	Tooltip	Column J	Column J	107	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the State-specific Provider ID (Medicaid ID). A data validation error is triggered if data are missing or duplicate values exist in the provider information. The combination of values for variables 105, 112, 107, 108 must be unique.
Data Dictionary	N/A	E15	E15	107	Updated text for Data Dictionary Long Description: Medicaid (MCD) ID number.
Required State Input - IPH	Data	Column K	Column K	108	Added conditional formatting to flag duplicates across unique combinations of 112, 107, 108, 105.
Required State Input - IPH	Tooltip	Column K	Column K	108	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the Provider Name. A data validation error is triggered when this variable is missing data or duplicate values exist in the provider information variables. The combination of values for variables 105, 112, 107, 108 must be unique.
Required State Input - IPH	Data	Column H	Column H	109	Added conditional formatting to flag duplicates of variable 109.
Required State Input - IPH	Tooltip	Column H	Column H	109	Added the following tool tip to the data entry cells in the required state input tab: Provide if applicable: National Provider ID (NPI). A data validation error is triggered when duplicate values exist for this variable.
Required State Input - IPH	Tooltip	Column L	Column L	110	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the ownership category type. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are: Private, NSGO, and SGO.
Required State Input - IPH	Data	Column I	Column I	112	Added conditional formatting to flag duplicates across unique combinations of 112, 107, 108, 105.
Required State Input - IPH	Tooltip	Column I	Column I	112	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the Medicare Certification Number (Medicare ID). A data validation error is triggered if data are missing or duplicate values exist in the provider information. The combination of values for variables 105, 112, 107, 108 must be unique.
Data Dictionary	N/A	E20	E20	112	Updated text for Data Dictionary Long Description: Medicare (MCR) ID number. In the instances where a facility is Not Medicare Certified (NMC), the state should enter "NMC".
Required State Input - IPH	Tooltip	Column M	Column M	113	Added the following tool tip to the data entry cells in the required state input tab: Provide if applicable: Enter the Critical Access Hospital Status. Valid values for this field include "Y" (critical access hospital) and "N" (not a critical access hospital).
Required State Input - IPH	Data	D2	D2	116	Changed variable designation status from Required to "PIA". Removed conditional formatting when this field is missing data.
Data Dictionary	N/A	B23	B23	116	Data dictionary updated to reflect variable designation status changed from Required to "PIA."
Required State Input - IPH	Tooltip	D2	D2	116	Added the following tool tip to the data entry cells in the required state input tab: Provide if applicable: Enter Retrospective or Prospective. A demonstration is retrospective if submitted on or after the start of the demonstration period. A demonstration is prospective if submitted prior to the start of the demonstration period.
Required State Input - IPH	Data	E2	E2	117	Changed variable designation status from Required to "PIA". Removed conditional formatting when this field is missing data.
Data Dictionary	N/A	B24	B24	117	Data dictionary updated to reflect variable designation status changed from Required to "PIA."
Required State Input - IPH	Tooltip	E2	E2	117	Added the following tool tip to the data entry cells in the required state input tab: Provide if applicable: Enter the State Plan Amendment Number. Expected format: 2 letter state abbreviation-##-#### (for example, OR-19-0002).
Required State Input - IPH	Data	Column N	Column N	200.1	Added conditional formatting to mark cells as red if the begin date occurs after the end date.
Required State Input - IPH	Tooltip	Column N	Column N	200.1	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the Medicare Cost Report Begin Date. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are dates in the format MM/DD/YYYY.
Data Dictionary	N/A	E25	E25	200.1	Updated text for Data Dictionary Long Description: Medicare (MCR) Cost Report begin date of MCR data provided that is are used to calculate the UPL.
Required State Input - IPH	Data	Column O	Column O	200.2	Added conditional formatting to mark cells as red if the begin date occurs after the end date.
Required State Input - IPH	Tooltip	Column O	Column O	200.2	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the Medicare Cost Report End Date. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are dates in the format MM/DD/YYYY.
Data Dictionary	N/A	E26	E26	200.2	Updated text for Data Dictionary Long Description: Medicare (MCR) Cost Report end date of MCR data provided that is are used to calculate the UPL.
Required State Input - IPH	Tooltip	Column P	Column P	202	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Medicare Cost Report Filing Status. A data validation error is triggered when this variable is missing data or contains an invalid value. Valid values for this variable include "Filed" and "Settled."
Data Dictionary	N/A	E28	E28	202	Updated text for Data Dictionary Long Description: Medicare (MCR) Cost Report filing status (filed or settled).
Required State Input - IPH	Data	Column Q	Column Q	203	Added conditional formatting to 203 when demonstration type (104) =  Cost or (104 = Per Diem and 106 = Cost Per Diem) and data is missing.
Required State Input - IPH	Label	Column Q	Column Q	203	Changed label from "PIA" to "Required if Cost or Per Diem (Cost Per Diem) Demonstration" in Required State Input tab and IP Cost and Per Diem tab.
IP Cost	Label	Column P	Column P	203	Changed label from "PIA" to "Required if Cost or Per Diem (Cost Per Diem) Demonstration" in Required State Input tab and IP Cost and Per Diem tab.
IP Per Diem	Label	Column Q	Column Q	203	Changed label from "PIA" to "Required if Cost or Per Diem (Cost Per Diem) Demonstration" in Required State Input tab and IP Cost and Per Diem tab.
Data Dictionary	N/A	B29	B29	203	Changed variable designation from "PIA" to "Required if Cost or Per Diem (Cost Per Diem) Demonstration" in Data Dictionary tab.
Required State Input - IPH	Tooltip	Column Q	Column Q	203	Added the following tool tip to the data entry cells in the required state input tab: Required if Cost or Per Diem Demonstration: Enter Medicare Costs. A validation error is triggered when Demo Type (104) is "Cost" or "Per Diem" and this variable is missing data or has a value of $0.
Data Dictionary	N/A	E29	E29	203	Updated text for Data Dictionary Long Description: In IP Cost Template, base year Medicare (MCR) costs used to calculate the MCR Cost-to-Charge Ratio (CCR) (Variable 208). In IP Per Diem Template, base year MCR costs used to calculate the MCR Per Diem (Variable 211), if Cost Per Diem calculation is used. If Payment Per Diem c
Required State Input - IPH	Data	Column S	Column S	204	Added conditional formatting to 204 when demonstration type (104) =  Cost or Payment and data is missing.
Required State Input - IPH	Label	Column S	Column S	204	Changed label from "PIA" to "Required if Cost or Payment Demonstration" in Required State Input tab and IP Cost and Payment tab.
IP Cost	Label	Column Q	Column Q	204	Changed label from "PIA" to "Required if Cost or Payment Demonstration" in Required State Input tab and IP Cost and Payment tab.
IP Payment	Label	Column Q	Column Q	204	Changed label from "PIA" to "Required if Cost or Payment Demonstration" in Required State Input tab and IP Cost and Payment tab.
Data Dictionary	N/A	B30	B30	204	Changed variable designation from "PIA" to "Required if Cost or Payment Demonstration" in Data Dictionary tab.
Required State Input - IPH	Tooltip	Column S	Column S	204	Added the following tool tip to the data entry cells in the required state input tab: Required if Cost or Payment Demonstration: Enter Medicare Charges. A validation error is triggered when Demonstration Type (104) is "Cost" or "Payment" this variable is missing data or has a value of $0. Leave blank if 104 is "Per Diem" or "DRG."
Data Dictionary	N/A	E30	E30	204	In IP Cost Template, base year Medicaid (MCR) charges used to calculate the MCR Cost-to-Charge Ratio (CCR) (Variable 208). In IP Payment Template, base year MCR charges used to calculate the MCR Payment-to-Charge Ratio (PTC) (Variable 209); if net MCR payments are used state should ensure appropriate matching to MCR charges. These charges are usually input as the total charges, regardless of payer, as reported in the Medicare 2552 cost report. Values of blank or zero will trigger an error for this field.
Required State Input - IPH	Data	Column R	Column R	205	Added conditional formatting to 205 when demonstration type (104) =  Payment or (104 = Per Diem and 106 = Payment Per Diem) and data is missing.
IP Payment	Label	Column P	Column P	205	Changed label from "PIA" to "Required if Payment or Per Diem (Payment Per Diem) Demonstration" in Required State Input tab and IP Payment and Per Diem tab.
IP Per Diem	Label	Column R	Column R	205	Changed label from "PIA" to "Required if Payment or Per Diem (Payment Per Diem) Demonstration" in Required State Input tab and IP Payment and Per Diem tab.
Required State Input - IPH	Label	Column R	Column R	205	Changed label from "PIA" to "Required if Payment or Per Diem (Payment Per Diem) Demonstration" in Required State Input tab and IP Payment and Per Diem tab.
Data Dictionary	N/A	B31	B31	205	Changed variable  designation from "PIA" to "Required if Payment or Per Diem (Payment Per Diem) Demonstration" in Data Dictionary tab.
Required State Input - IPH	Tooltip	Column R	Column R	205	Added the following tool tip to the data entry cells in the required state input tab: Required if Payment or Per Diem Demonstration: Enter Medicare Payments. An error is triggered when Demonstration Type (104) is "Per Diem" or "Payment" and this variable is missing data or has a value of $0. Leave blank if 104 is "Cost" or "DRG."
Required State Input - IPH	Data	Column T	Column T	205.1	Added conditional formatting to 205.1 when demonstration type (104) = DRG and data is missing.
Required State Input - IPH	Label	Column T	Column T	205.1	Changed label from "PIA" to "Required if DRG Demonstration" in Required State Input tab and IP DRG tab.
IP DRG	Label	Column P	Column P	205.1	Changed label from "PIA" to "Required if DRG Demonstration" in Required State Input tab and IP DRG tab.
Data Dictionary	N/A	B32	B32	205.1	Changed variable designation from "PIA" to "Required if DRG Demonstration" in Data Dictionary tab.
Required State Input - IPH	Tooltip	Column T	Column T	205.1	Added the following tool tip to the data entry cells in the required state input tab: Required if DRG Demonstration: Enter Medicare Payments Subject to CMI. A data validation error is triggered when Demonstration Type (104) is "DRG" and this variable is missing data. Leave this variable blank if 104 is "Cost," "Payment," or "Per Diem."
Required State Input - IPH	Data	Column U	Column U	205.2	Added conditional formatting to 205.2 when demonstration type (104) = DRG and data is missing.
Required State Input - IPH	Label	Column U	Column U	205.2	Changed label from "PIA" to "Required if DRG Demonstration" in Required State Input tab and IP DRG tab.
IP DRG	Label	Column Q	Column Q	205.2	Changed label from "PIA" to "Required if DRG Demonstration" in Required State Input tab and IP DRG tab.
Data Dictionary	N/A	B33	B33	205.2	Changed variable designation from "PIA" to "Required if DRG Demonstration" in Data Dictionary tab.
Required State Input - IPH	Tooltip	Column U	Column U	205.2	Added the following tool tip to the data entry cells in the required state input tab: Required if DRG Demonstration: Enter Medicare Payments Not Subject to CMI. A data validation error is triggered when Demonstration Type (104) is "DRG" and this variable missing data. Leave this variable blank if 104 is "Cost," "Payment," or "Per Diem."
Required State Input - IPH	Data	Column V	Column V	206	Added conditional formatting to 206 when demonstration type (104) = DRG and data is missing.
Required State Input - IPH	Label	Column V	Column V	206	Changed label from "PIA" to "Required if DRG Demonstration" in Required State Input tab and IP DRG tab.
IP DRG	Label	Column R	Column R	206	Changed label from "PIA" to "Required if DRG Demonstration" in Required State Input tab and IP DRG tab.
Data Dictionary	N/A	B34	B34	206	Changed variable designation from "PIA" to "Required if DRG Demonstration" in Data Dictionary tab.
Required State Input - IPH	Tooltip	Column V	Column V	206	Added the following tool tip to the data entry cells in the required state input tab: Required if DRG Demonstration: Enter Medicare Discharges. A data validation error is triggered when Demonstration Type (104) is "DRG" and this variable is missing data. Leave this variable blank if 104 is "Cost," "Payment," or "Per Diem."
Required State Input - IPH	Data	Column W	Column W	207	Added conditional formatting to 207 when demonstration type (104) = DRG and data is missing.
Required State Input - IPH	Label	Column W	Column W	207	Changed label from "PIA" to "Required if DRG Demonstration" in Required State Input tab and IP DRG tab.
IP DRG	Label	Column S	Column S	207	Changed label from "PIA" to "Required if DRG Demonstration" in Required State Input tab and IP DRG tab.
Data Dictionary	N/A	B35	B35	207	Changed variable designation from "PIA" to "Required if DRG Demonstration" in Data Dictionary tab.
Required State Input - IPH	Tooltip	Column W	Column W	207	Added the following tool tip to the data entry cells in the required state input tab: Required if DRG Demonstration: Enter Case Mix Index (CMI). A data validation error is triggered when Demonstration Type (104) is "DRG" and this variable is missing data. Leave this variable blank if 104 is "Cost," "Payment," or "Per Diem."
Required State Input - IPH	Data	Column X	Column X	210	Added conditional formatting to 210 when demonstration type (104) =  Per Diem and data is missing.
Required State Input - IPH	Label	Column X	Column X	210	Changed label from "PIA" to "Required if Per Diem Demonstration" in Required State Input tab and IP Per Diem tab.
IP Per Diem	Label	Column S	Column S	210	Changed label from "PIA" to "Required if Per Diem Demonstration" in Required State Input tab and IP Per Diem tab.
Data Dictionary	N/A	B38	B38	210	Changed variable designation from "PIA" to "Required if Per Diem Demonstration" in Data Dictionary tab.
Required State Input - IPH	Tooltip	Column X	Column X	210	Added the following tool tip to the data entry cells in the required state input tab: Required if Per Diem Demonstration: Enter Medicare Days. A data validation error is triggered when Demonstration Type (104) is "Per Diem" and this variable is missing data. Leave this variable blank if 104 is "Cost," Payment," or "DRG.
Required State Input - IPH	Tooltip	Column Y	Column Y	300.1	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Time Period of Medicaid Charge and Payment Data - Begin Date. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are dates in the format MM/DD/YYYY.
Required State Input - IPH	Tooltip	Column Z	Column Z	300.2	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Time Period of Medicaid Charge and Payment Data - End Date. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are dates in the format MM/DD/YYYY.
Required State Input - IPH	Data	Column AA	Column AA	301	Added conditional formatting to 301 when demonstration type (104) =  Cost or Payment and data is missing.
Required State Input - IPH	Label	Column AA	Column AA	301	Changed label from "PIA" to "Required if Cost or Payment Demonstration" in Required State Input tab and IP Cost and IP Payment tabs.
IP Payment	Label	Column U	Column U	301	Changed label from "PIA" to "Required if Cost or Payment Demonstration" in Required State Input tab and IP Cost and IP Payment tabs.
IP Cost	Label	Column U	Column U	301	Changed label from "PIA" to "Required if Cost or Payment Demonstration" in Required State Input tab and IP Cost and IP Payment tabs.
Data Dictionary	N/A	B43	B43	301	Changed variable designation from "PIA" to "Required if Cost or Payment Demonstration" in Data Dictionary tab.
Required State Input - IPH	Tooltip	Column AA	Column AA	301	Added the following tool tip to the data entry cells in the required state input tab: Required if Cost or Payment Demonstration: Enter Medicaid Charges. A data validation error is triggered when Demonstration Type (104) is "Cost" or "Payment" and this variable is missing data. Leave this variable blank if 104 is "Per Diem" or "DRG."
Required State Input - IPH	Tooltip	Column AB	Column AB	302	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Medicaid Regular Payments. A data validation error is triggered when this variable is missing data.
IP Per Diem	Label	Column W	Column W	302	Changed variable name from “Medicaid Regular Payments” to “Medicaid Base Payments.” Changed variable label and tool tip on required state input tab, output tab, and updated data dictionary to reflect the change.
IP Payment	Label	Column V	Column V	302	Changed variable name from “Medicaid Regular Payments” to “Medicaid Base Payments.” Changed variable label and tool tip on required state input tab, output tab, and updated data dictionary to reflect the change.
IP DRG	Label	Column V	Column V	302	Changed variable name from “Medicaid Regular Payments” to “Medicaid Base Payments.” Changed variable label and tool tip on required state input tab, output tab, and updated data dictionary to reflect the change.
IP Cost	Label	Column V	Column V	302	Changed variable name from “Medicaid Regular Payments” to “Medicaid Base Payments.” Changed variable label and tool tip on required state input tab, output tab, and updated data dictionary to reflect the change.
Required State Input - IPH	Label	Column AB	Column AB	302	Changed variable name from “Medicaid Regular Payments” to “Medicaid Base Payments.” Changed variable label and tool tip on required state input tab, output tab, and updated data dictionary to reflect the change.
Data Dictionary	N/A	D44	D44	302	Changed variable name from “Medicaid Regular Payments” to “Medicaid Base Payments.” Changed variable label and tool tip on required state input tab, output tab, and updated data dictionary to reflect the change.
Required State Input - IPH	Tooltip	Column AC	Column AC	303.1	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Medicaid Supplemental Payments. A data validation error is triggered when this variable is missing data.
Required State Input - IPH	Tooltip	Column AD	Column AD	303.2	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Medicaid Supplemental Payments (GME/Training). A data validation error is triggered when this variable is missing data.
Required State Input - IPH	Tooltip	Column AE	Column AE	303.3	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Medicaid Supplemental Payments (Other). A data validation error is triggered when this variable is missing data.
Required State Input - IPH	Tooltip	Column AF	Column AF	304	Added the following tool tip to the data entry cells in the required state input tab: Required if DRG Demonstration: Enter Medicaid Discharges. A data validation error is triggered when Demonstration Type (104) has a value of "DRG" and this variable is missing data. Leave blank if 104 is "Per Diem," "Payment," or "Cost."
Required State Input - IPH	Tooltip	Column AG	Column AG	305	Added the following tool tip to the data entry cells in the required state input tab: Required if DRG Demonstration: Enter Medicaid Case Mix Index (CMI). A data validation error is triggered when Demonstration Type (104) is "DRG" and this variable is missing data. Leave this variable blank if 104 is "Cost," "Payment," or "Per Diem."
Required State Input - IPH	Data	Column AH	Column AH	307	Added conditional formatting to 307 for missing values when the value of 308 > 1.
Required State Input - IPH	Tooltip	Column AH	Column AH	307	Added the following tool tip to the data entry cells in the required state input tab: Provide if applicable: Enter Medicaid Inflation Factor Type.
Required State Input - IPH	Tooltip	Column AI	Column AI	308	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Medicaid Inflation Factor. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are numeric values from 1.00 to 1.04.
Required State Input - IPH	Tooltip	Column AJ	Column AJ	309	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Other Adjustment to Medicaid Payments. A data validation error is triggered when this variable is missing data.
Required State Input - IPH	Data	Column AK	Column AK	310	Added conditional formatting to 310 when demonstration type (104) =  Per Diem and data is missing.
Required State Input - IPH	Label	Column AK	Column AK	310	Changed label from "PIA" to "Required if Per Diem Demonstration" in Required State Input tab and IP Per Diem tab.
IP Per Diem	Label	Column AA	Column AA	310	Changed label from "PIA" to "Required if Per Diem Demonstration" in Required State Input tab and IP Per Diem tab.
Data Dictionary	N/A	B48	B48	304	Changed variable designation from "PIA" to "Required if DRG Demonstration" in Data Dictionary tab.
Required State Input - IPH	Tooltip	Column AK	Column AK	310	Added the following tool tip to the data entry cells in the required state input tab: Enter Medicaid Days. A data validation error is triggered when Demonstration Type (104) is "Per Diem" and this variable is missing data. Leave this variable blank if Demonstration Type (104) is "Cost," "Payment", or "DRG."
Required State Input - IPH	Data	Column AN	Column AN	401	Added conditional formatting to 401 when demonstration type (104) =  Cost and data is missing.
Required State Input - IPH	Label	Column AN	Column AN	401	Changed label from "PIA" to "Required if Cost Demonstration" in Required State Input tab and IP Cost tab.
IP Cost	Label	Column AI	Column AI	401	Changed label from "PIA" to "Required if Cost Demonstration" in Required State Input tab and IP Cost tab.
Data Dictionary	N/A	B49	B49	305	Changed variable designation from "PIA" to "Required if DRG Demonstration" in Data Dictionary tab.
Required State Input - IPH	Tooltip	Column AN	Column AN	401	Added the following tool tip to the data entry cells in the required state input tab: Required if Cost Demonstration: Enter Medicaid Provider Tax Cost. A data validation error is triggered when Demonstration Type (104) is "Cost" and this variable is missing data. Leave this variable blank if 104 is "Per Diem," "Payment," or "DRG."
Required State Input - IPH	Tooltip	Column AO	Column AO	402	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Other Adjustments to the UPL Amount. A data validation error is triggered when this variable is missing data.
Required State Input - IPH	Data	Column AL	Column AL	404	Added conditional formatting to 404 for missing values when the value of 308 > 1.
Required State Input - IPH	Data	Column AL	Column AL	404	Added conditional formatting to 404 for missing values when the value of 308 > 1.
Required State Input - IPH	Tooltip	Column AL	Column AL	404	Added the following tool tip to the data entry cells in the required state input tab: Provide if applicable: Enter UPL Inflation Factor Type.
Required State Input - IPH	Tooltip	Column AM	Column AM	405	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the UPL Inflation Factor. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are numeric values from 1.00 to 1.04.
Required State Input - IPH	Tooltip	Column AP	Column AP	408	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the Adjustment to the UPL Gap. A data validation error is triggered when this variable is missing data.
Required State Input - IPH	Data	B2	B2	002	Applied conditional formatting if begin dates are not before end dates.
Required State Input - IPH	Data	Column N	Column N	200.1	Applied conditional formatting if begin dates are not before end dates.
Required State Input - IPH	Data	Column Y	Column Y	300.1	Applied conditional formatting if begin dates are not before end dates.
Required State Input - IPH	Data	C2	C2	003	Applied conditional formatting if begin dates are not before end dates.
Required State Input - IPH	Data	Column O	Column O	200.2	Applied conditional formatting if begin dates are not before end dates.
Required State Input - IPH	Data	Column Z	Column Z	300.2	Applied conditional formatting if begin dates are not before end dates.
Required State Input - IPH	Data	Column AF	Column AF	304	Added conditional formatting to 304 and 305 when demonstration type (104) = DRG and data is missing.
Required State Input - IPH	Data	Column AG	Column AG	305	Added conditional formatting to 304 and 305 when demonstration type (104) = DRG and data is missing.
Required State Input - IPH	Label	Column AF	Column AF	304	Changed labels from "PIA" to "Required if DRG Demonstration" in Required State Input tab and IP DRG tab.
Required State Input - IPH	Label	Column AG	Column AG	305	Changed labels from "PIA" to "Required if DRG Demonstration" in Required State Input tab and IP DRG tab.
IP DRG	Label	Column Z	Column Z	304	Changed labels from "PIA" to "Required if DRG Demonstration" in Required State Input tab and IP DRG tab.
IP DRG	Label	Column AA	Column AA	305	Changed labels from "PIA" to "Required if DRG Demonstration" in Required State Input tab and IP DRG tab.
Data Dictionary	N/A	B54	B54	310	Changed variable designation from "PIA" to "Required if Per Diem Demonstration" in Data Dictionary tab.
Data Dictionary	N/A	B58	B58	401	Changed variable designation from "PIA" to "Required if Cost Demonstration" in Data Dictionary tab.
Overview & Instructions	Sheet	A5	A5	N/A	Changed tab name for required state input from “Required State Input” to: Required State Input – IPH. Updated Overview & Instructions tab to reflect new tab name.
Required State Input - IPH	Sheet	N/A	N/A	N/A	Changed tab name for required state input from “Required State Input” to: Required State Input – IPH. Updated Overview & Instructions tab to reflect new tab name.
State Attestation	Data	N/A	N/A	N/A	Modified state data entry fields (dates, names, etc.) on the “State Attestation” tab to be fillable entry cells rather than hard underlined spaces that move/shift as you enter data.

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Sheet 2: Outpatient Hospital

Sheet	Template Section	Location in Original Version	Location in Current Version	Variable Number	Change since last OMB approval January 2021
Required State Input - OPH	Data	A2	A2	001	Guam, Puerto Rico, and U.S. Virgin Islands were added to the drop down menu as valid values.
Required State Input - OPH	Tooltip	A2	A2	001	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the state. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are two character state abbreviations for the 50 states and D.C.
Required State Input - OPH	Data	B2	B2	002	Added conditional formatting to mark cells as red if the length of time between 002 and 003 is not exactly equal to one year.
Required State Input - OPH	Tooltip	B2	B2	002	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the demonstration begin date. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are dates in the format MM/DD/YYYY.
Required State Input - OPH	Data	B2	B2	002	Applied conditional formatting if begin dates are not before end dates.
Required State Input - OPH	Data	C2	C2	003	Added conditional formatting to mark cells as red if the length of time between 002 and 003 is not exactly equal to one year.
Required State Input - OPH	Tooltip	C2	C2	003	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the demonstration end date. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are dates in the format MM/DD/YYYY.
Required State Input - OPH	Data	C2	C2	003	Applied conditional formatting if begin dates are not before end dates.
Required State Input - OPH	Data	Column B	Column B	100	Guam, Puerto Rico, and U.S. Virgin Islands were added to the drop down menu as valid values.
Required State Input - OPH	Tooltip	Column B	Column B	100	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the state. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are two character state abbreviations for the 50 states and D.C.
Required State Input - OPH	Tooltip	Column C	Column C	101	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the demonstration rate year. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are 4 digit numeric strings representing the year in the format YYYY.
Required State Input - OPH	Tooltip	Column D	Column D	102	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the service type. A data validation error is triggered when this variable is missing data or has an invalid value. The only valid value for this variable in this template is OP.
Required State Input - OPH	Tooltip	Column E	Column E	104	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the demonstration type. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable include "Cost" and "Payment."
Required State Input - OPH	Data	Column F	Column F	105	Added conditional formatting to flag duplicates across unique combinations of 112, 107, 108, 105.
Required State Input - OPH	Tooltip	Column F	Column F	105	Added the following tool tip to the data entry cells in the required state input tab: Provide if applicable: Enter the Other State Provider ID Number. A data validation error is triggered when duplicate values exist in the provider information variables. The combination of values for variables 105, 112, 107, 108 must be unique.
Required State Input - OPH	Data	Column I	Column I	107	Added conditional formatting to flag duplicates across unique combinations of 112, 107, 108, 105.
Required State Input - OPH	Tooltip	Column I	Column I	107	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the State-specific Provider ID (Medicaid ID). A data validation error is triggered if data are missing or duplicate values exist in the provider information. The combination of values for variables 105, 112, 107, 108 must be unique.
Required State Input - OPH	Data	Column J	Column J	108	Added conditional formatting to flag duplicates across unique combinations of 112, 107, 108, 105.
Required State Input - OPH	Tooltip	Column J	Column J	108	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the Provider Name. A data validation error is triggered when this variable is missing data or duplicate values exist in the provider information variables. The combination of values for variables 105, 112, 107, 108 must be unique.
Required State Input - OPH	Data	Column G	Column G	109	Added conditional formatting to flag duplicates of variable 109.
Required State Input - OPH	Tooltip	Column G	Column G	109	Added the following tool tip to the data entry cells in the required state input tab: Provide if applicable: National Provider ID (NPI). A data validation error is triggered when duplicate values exist for this variable.
Required State Input - OPH	Tooltip	Column K	Column K	110	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the ownership category type. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are: Private, NSGO, and SGO.
Required State Input - OPH	Data	Column H	Column H	112	Added conditional formatting to flag duplicates across unique combinations of 112, 107, 108, 105.
Required State Input - OPH	Tooltip	Column H	Column H	112	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the Medicare Certification Number (Medicare ID). A data validation error is triggered if data are missing or duplicate values exist in the provider information. The combination of values for variables 105, 112, 107, 108 must be unique.
Required State Input - OPH	Tooltip	Column L	Column L	113	Added the following tool tip to the data entry cells in the required state input tab: Provide if applicable: Enter the Critical Access Hospital Status. Valid values for this field include "Y" (critical access hospital) and "N" (not a critical access hospital).
Required State Input - OPH	Data	D2	D2	116	Changed variable designation status from Required to "PIA". Removed conditional formatting when this field is missing data.
Data Dictionary	N/A	B21	B23	116	Data dictionary updated to reflect variable designation status changed from Required to "PIA."
Required State Input - OPH	Tooltip	D2	D2	116	Added the following tool tip to the data entry cells in the required state input tab: Provide if applicable: Enter Retrospective or Prospective. A demonstration is retrospective if submitted on or after the start of the demonstration period. A demonstration is prospective if submitted prior to the start of the demonstration period.
Required State Input - OPH	Data	E2	E2	117	Changed variable designation status from Required to "PIA". Removed conditional formatting when this field is missing data.
Data Dictionary	N/A	B22	B24	117	Data dictionary updated to reflect variable designation status changed from Required to "PIA."
Required State Input - OPH	Tooltip	E2	E2	117	Added the following tool tip to the data entry cells in the required state input tab: Provide if applicable: Enter the State Plan Amendment Number. Expected format: 2 letter state abbreviation-##-#### (for example, OR-19-0002).
Required State Input - OPH	Data	Column M	Column M	200.1	Added conditional formatting to mark cells as red/check for date values if the length of time between 200.1 and 200.2 is not exactly equal to one year.
Required State Input - OPH	Tooltip	Column M	Column M	200.1	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the Medicare Cost Report Begin Date. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are dates in the format MM/DD/YYYY.
Required State Input - OPH	Data	Column M	Column M	200.1	Applied conditional formatting if begin dates are not before end dates.
Required State Input - OPH	Data	Column N	Column N	200.2	Added conditional formatting to mark cells as red/check for date values if the length of time between 200.1 and 200.2 is not exactly equal to one year.
Required State Input - OPH	Tooltip	Column N	Column N	200.2	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the Medicare Cost Report End Date. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are dates in the format MM/DD/YYYY.
Required State Input - OPH	Data	Column N	Column N	200.2	Applied conditional formatting if begin dates are not before end dates.
Required State Input - OPH	Tooltip	Column O	Column O	202	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Medicare Cost Report Filing Status. A data validation error is triggered when this variable is missing data or contains an invalid value. Valid values for this variable include "Filed" and "Settled."
Required State Input - OPH	Data	Column Q	Column Q	203	Added conditional formatting to 203 when demonstration type (104) = Cost and data is missing.
Required State Input - OPH	Label	Column Q	Column Q	203	Changed label from "PIA" to "Required if Cost Demonstration" in Required State Input tab and OP Cost tab.
OP Cost	Label	Column P	Column P	203	Changed label from "PIA" to "Required if Cost Demonstration" in Required State Input tab and OP Cost tab.
Data Dictionary	N/A	B27	B29	203	Changed variable designation from "PIA" to "Required if Cost  Demonstration" in Data Dictionary tab.
Required State Input - OPH	Tooltip	Column Q	Column Q	203	Added the following tool tip to the data entry cells in the required state input tab: Required if Cost Demonstration: Enter Medicare Costs. A data validation error is triggered when Demonstration Type (104) is "Cost" and this variable is missing or has a value of $0. Leave this variable blank if 104 is "Payment."
Required State Input - OPH	Tooltip	Column R	Column R	204	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Medicare Charges. A data validation error is triggered if variable 204 is missing data or has a value of $0.
Required State Input - OPH	Data	Column P	Column P	205	Added conditional formatting to 205 when demonstration type (104) = Payment and data is missing.
Required State Input - OPH	Label	Column P	Column P	205	Changed label from "PIA" to "Required if Payment Demonstration" in Required State Input tab and OP Payment tab.
OP Payment	Label	Column P	Column P	205	Changed label from "PIA" to "Required if Payment Demonstration" in Required State Input tab and OP Payment tab.
Data Dictionary	N/A	B29	B31	205	Changed variable designation from "PIA" to "Required if Payment Demonstration" in Data Dictionary tab.
Required State Input - OPH	Tooltip	Column P	Column P	205	Added the following tool tip to the data entry cells in the required state input tab: Required if Payment Demonstration: Enter Medicare Payments. A data validation error is triggered when Demonstration Type (104) is "Payment" and this variable is missing data or has a value of $0. Leave blank if 104 is "Cost."
Required State Input - OPH	Tooltip	Column S	Column S	300.1	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Time Period of Medicaid Charge and Payment Data - Begin Date. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are dates in the format MM/DD/YYYY.
Required State Input - OPH	Data	Column S	Column S	300.1	Applied conditional formatting if begin dates are not before end dates.
Required State Input - OPH	Tooltip	Column T	Column T	300.2	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Time Period of Medicaid Charge and Payment Data - End Date. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are dates in the format MM/DD/YYYY.
Required State Input - OPH	Data	Column T	Column T	300.2	Applied conditional formatting if begin dates are not before end dates.
Required State Input - OPH	Tooltip	Column U	Column U	301	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Medicaid Charges. A data validation error is triggered when this variable is missing data.
Required State Input - OPH	Tooltip	Column V	Column V	302	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Medicaid Regular Payments. A data validation error is triggered when this variable is missing data.
Required State Input - OPH	Label	Column V	Column V	302	Changed variable name from “Medicaid Regular Payments” to “Medicaid Base Payments.” Changed variable label and tool tip on required state input tab, output tab, and updated data dictionary to reflect the change.
OP Cost	Label	Column V	Column V	302	Changed variable name from “Medicaid Regular Payments” to “Medicaid Base Payments.” Changed variable label and tool tip on required state input tab, output tab, and updated data dictionary to reflect the change.
OP Payment	Label	Column V	Column V	302	Changed variable name from “Medicaid Regular Payments” to “Medicaid Base Payments.” Changed variable label and tool tip on required state input tab, output tab, and updated data dictionary to reflect the change.
Data Dictionary	N/A	D37	D39	302	Changed variable name from “Medicaid Regular Payments” to “Medicaid Base Payments.” Changed variable label and tool tip on required state input tab, output tab, and updated data dictionary to reflect the change.
Required State Input - OPH	Tooltip	Column W	Column W	303.1	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Medicaid Supplemental Payments. A data validation error is triggered when this variable is missing data.
Required State Input - OPH	Tooltip	Column X	Column X	303.2	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Medicaid Supplemental Payments (GME/Training). A data validation error is triggered when this variable is missing data.
Required State Input - OPH	Tooltip	Column Y	Column Y	303.3	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Medicaid Supplemental Payments (Other). A data validation error is triggered when this variable is missing data.
Required State Input - OPH	Tooltip	Column Z	Column Z	307	Added the following tool tip to the data entry cells in the required state input tab: Provide if applicable: Enter Medicaid Inflation Factor Type.
Required State Input - OPH	Tooltip	Column AA	Column AA	308	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Medicaid Inflation Factor. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are numeric values from 1.00 to 1.04.
Required State Input - OPH	Tooltip	Column AB	Column AB	309	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Other Adjustment to Medicaid Payments. A data validation error is triggered when this variable is missing data.
Required State Input - OPH	Data	Column AE	Column AE	401	Added conditional formatting to 401 when demonstration type (104) = Cost and data is missing.
Required State Input - OPH	Label	Column AE	Column AE	401	Changed label from "PIA" to "Required if Cost Demonstration" in Required State Input tab and OP Cost tab.
OP Cost	Label	Column AI	Column AI	401	Changed label from "PIA" to "Required if Cost Demonstration" in Required State Input tab and OP Cost tab.
Data Dictionary	N/A	B49	B51	401	Changed variable designation from "PIA" to "Required if Cost  Demonstration" in Data Dictionary tab.
Required State Input - OPH	Tooltip	Column AE	Column AE	401	Added the following tool tip to the data entry cells in the required state input tab: Required if Cost Demonstration: Enter Medicaid Provider Tax Cost. A data validation error is triggered when Demonstration Type (104) is "Cost" and this variable is missing data. Leave this variable blank if 104 is "Payment."
Required State Input - OPH	Tooltip	Column AF	Column AF	402	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Other Adjustments to the UPL Amount. A data validation error is triggered when this variable is missing data.
Required State Input - OPH	Tooltip	Column AC	Column AC	404	Added the following tool tip to the data entry cells in the required state input tab: Provide if applicable: Enter UPL Inflation Factor Type.
Required State Input - OPH	Tooltip	Column AD	Column AD	405	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the UPL Inflation Factor. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are numeric values from 1.00 to 1.04.
Required State Input - OPH	Tooltip	Column AG	Column AG	408	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the Adjustment to the UPL Gap. A data validation error is triggered when this variable is missing data.
Overview & Instructions	Sheet	A5	A5	N/A	Changed tab name for required state input from “Required State Input” to: Required State Input – OPH. Updated Overview & Instructions tab to reflect new tab name.
Required State Input - OPH	Sheet	N/A	N/A	N/A	Changed tab name for required state input from “Required State Input” to: Required State Input – OPH. Updated Overview & Instructions tab to reflect new tab name.
State Attestation	Data	N/A	N/A	N/A	Modified state data entry fields (dates, names, etc.) on the “State Attestation” tab to be fillable entry cells rather than hard underlined spaces that move/shift as you enter data.

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Sheet 3: Nursing Facility

Sheet	Template Section	Location in Original Version	Location in Current Version	Variable Number	Change since last OMB approval January 2021
Required State Input - NF	Data	A2	A2	001	Guam, Puerto Rico, and U.S. Virgin Islands were added to the drop down menu as valid values.
Required State Input - NF	Tooltip	A2	A2	001	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the state. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are two character state abbreviations for the 50 states and D.C.
Required State Input - NF	Data	B2	B2	002	Added conditional formatting to mark cells as red if the length of time between 002 and 003 is not exactly equal to one year.
Required State Input - NF	Tooltip	B2	B2	002	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the demonstration begin date. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are dates in the format MM/DD/YYYY.
Required State Input - NF	Data	B2	B2	002	Applied conditional formatting if begin dates are not before end dates.
Required State Input - NF	Tooltip	C2	C2	003	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the demonstration end date. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are dates in the format MM/DD/YYYY.
Required State Input - NF	Data	C2	C2	003	Applied conditional formatting if begin dates are not before end dates.
Required State Input - NF	Data	Column B	Column B	100	Guam, Puerto Rico, and U.S. Virgin Islands were added to the drop down menu as valid values.
Required State Input - NF	Tooltip	Column B	Column B	100	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the state. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are two character state abbreviations for the 50 states and D.C.
Required State Input - NF	Tooltip	Column C	Column C	101	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the demonstration rate year. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are 4 digit numeric strings representing the year in the format YYYY.
Required State Input - NF	Tooltip	Column D	Column D	102	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the service type. A data validation error is triggered when this variable is missing data or has an invalid value. The only valid value for this variable in this template is NF.
Data Dictionary	N/A	Row 12	Row 12	104	Updated data dictionary fields to include references to PDPM.
Required State Input - NF	Data	Column E	Column E	104	Updated required state input tab. Conditional formatting is present for this field when the record contains invalid data. Valid values include "Cost", "Per Diem", "RUGs", "PDPM"
Required State Input - NF	Data	Column E	Column E	104	Updated required state input tab. Updated dropdown list to add new PDPM valid value. The valid values for this field are: "Cost", "Per Diem", "RUGs", "PDPM"
Required State Input - NF	Tooltip	Column E	Column E	104	Updated tool tip with the following text: Required: Enter the demonstration type. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable include "Cost," "RUGs," "PDPM," and "Per Diem."
Required State Input - NF	Data	Column F	Column F	105	Added conditional formatting to flag duplicates across unique combinations of 112, 107, 108, 105.
Required State Input - NF	Tooltip	Column F	Column F	105	Added the following tool tip to the data entry cells in the required state input tab: Provide if applicable: Enter the Other State Provider ID Number. A data validation error is triggered when duplicate values exist in the provider information variables. The combination of values for variables 105, 112, 107, 108 must be unique.
Required State Input - NF	Data	Column I	Column I	107	Added conditional formatting to flag duplicates across unique combinations of 112, 107, 108, 105.
Required State Input - NF	Tooltip	Column I	Column I	107	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the State-specific Provider ID (Medicaid ID). A data validation error is triggered if data are missing or duplicate values exist in the provider information. The combination of values for variables 105, 112, 107, 108 must be unique.
Required State Input - NF	Data	Column J	Column J	108	Added conditional formatting to flag duplicates across unique combinations of 112, 107, 108, 105.
Required State Input - NF	Tooltip	Column J	Column J	108	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the Provider Name. A data validation error is triggered when this variable is missing data or duplicate values exist in the provider information variables. The combination of values for variables 105, 112, 107, 108 must be unique.
Required State Input - NF	Data	Column G	Column G	109	Added conditional formatting to flag duplicates of variable 109.
Required State Input - NF	Tooltip	Column G	Column G	109	Added the following tool tip to the data entry cells in the required state input tab: Provide if applicable: National Provider ID (NPI). A data validation error is triggered when duplicate values exist for this variable.
Required State Input - NF	Tooltip	Column K	Column K	110	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the ownership category type. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are: Private, NSGO, and SGO.
Required State Input - NF	Data	Column H	Column H	112	Added conditional formatting to flag duplicates across unique combinations of 112, 107, 108, 105.
Required State Input - NF	Tooltip	Column H	Column H	112	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the Medicare Certification Number (Medicare ID). A data validation error is triggered if data are missing or duplicate values exist in the provider information. The combination of values for variables 105, 112, 107, 108 must be unique.
Required State Input - NF	Tooltip	Column L	Column L	115	Added the following tool tip to the data entry cells in the required state input tab: Provide if applicable: Enter Urban/Rural Location. A data validation error is triggered when this variable contains an invalid value. Valid values for this variable include "Urban" and "Rural."
Required State Input - NF	Data	D2	D2	116	Changed variable designation status from Required to "PIA". Removed conditional formatting when this field is missing data.
Required State Input - NF	Tooltip	D2	D2	116	Added the following tool tip to the data entry cells in the required state input tab: Provide if applicable: Enter Retrospective or Prospective. A demonstration is retrospective if submitted on or after the start of the demonstration period. A demonstration is prospective if submitted prior to the start of the demonstration period.
Data Dictionary	N/A	B23	B23	116	Data dictionary updated to reflect variable designation status changed from Required to "PIA."
Required State Input - NF	Data	E2	E2	117	Changed variable designation status from Required to "PIA". Removed conditional formatting when this field is missing data.
Required State Input - NF	Tooltip	E2	E2	117	Added the following tool tip to the data entry cells in the required state input tab: Provide if applicable: Enter the State Plan Amendment Number. Expected format: 2 letter state abbreviation-##-#### (for example, OR-19-0002).
Data Dictionary	N/A	B24	B24	117	Data dictionary updated to reflect variable designation status changed from Required to "PIA."
Required State Input - NF	Data	Column M	Column M	200.1	Added conditional formatting to 200.1 when demonstration type (104) = Cost or Per Diem and data is missing.
Required State Input - NF	Label	Column M	Column M	200.1	Changed label from "PIA" to "Required if Cost or Per Diem Demonstration" in Required State Input tab and NF Per Diem and NF Cost tab.
NF Cost	Label	Column M	Column M	200.1	Changed label from "PIA" to "Required if Cost or Per Diem Demonstration" in Required State Input tab and NF Per Diem and NF Cost tab.
NF Per Diem	Label	Column M	Column M	200.1	Changed label from "PIA" to "Required if Cost or Per Diem Demonstration" in Required State Input tab and NF Per Diem and NF Cost tab.
Required State Input - NF	Tooltip	Column M	Column M	200.1	Added the following tool tip to the data entry cells in the required state input tab: Required if Cost or Per Diem Demonstration: Enter the Medicare Cost Report Begin Date. A data validation error is triggered when Demonstration Type (104) is "Cost" or "Per Diem" and this variable is missing data or has an invalid value.
Data Dictionary	N/A	B25	B25	200.1	Changed variable designation from "PIA" to "Required if Cost or Per Diem Demonstration" in Data Dictionary tab.
Data Dictionary	N/A	Row 25	Row 25	200.1	Updated data dictionary fields to include references to PDPM.
Required State Input - NF	Data	Column M	Column M	200.1	Applied conditional formatting if begin dates are not before end dates.
Required State Input - NF	Data	Column N	Column N	200.2	Added conditional formatting to 200.2 when demonstration type (104) = Cost or Per Diem and data is missing.
NF Per Diem	Label	Column N	Column N	200.2	Changed label from "PIA" to "Required if Cost or Per Diem Demonstration" in Required State Input tab and NF Per Diem and NF Cost tab.
NF Cost	Label	Column N	Column N	200.2	Changed label from "PIA" to "Required if Cost or Per Diem Demonstration" in Required State Input tab and NF Per Diem and NF Cost tab.
Required State Input - NF	Label	Column N	Column N	200.2	Changed label from "PIA" to "Required if Cost or Per Diem Demonstration" in Required State Input tab and NF Per Diem and NF Cost tab.
Required State Input - NF	Tooltip	Column N	Column N	200.2	Added the following tool tip to the data entry cells in the required state input tab: Required if Cost or Per Diem Demonstration: Enter the Medicare Cost Report End Date. A data validation error is triggered when Demonstration Type (104) is "Cost" or "Per Diem" and this variable is missing data or has an invalid value.
Data Dictionary	N/A	B26	B26	200.2	Changed variable designation from "PIA" to "Required if Cost or Per Diem Demonstration" in Data Dictionary tab.
Data Dictionary	N/A	Row 26	Row 26	200.2	Updated data dictionary fields to include references to PDPM.
Required State Input - NF	Data	Column N	Column N	200.2	Applied conditional formatting if begin dates are not before end dates.
Required State Input - NF	Data	Column O	Column O	202	Added conditional formatting to 202 when demonstration type (104) = Cost or Per Diem and data is missing.
NF Cost	Label	Column O	Column O	202	Changed label from "PIA" to "Required if Cost or Per Diem Demonstration" in Required State Input tab and NF Per Diem and NF Cost tab.
NF Per Diem	Label	Column O	Column O	202	Changed label from "PIA" to "Required if Cost or Per Diem Demonstration" in Required State Input tab and NF Per Diem and NF Cost tab.
Required State Input - NF	Label	Column O	Column O	202	Changed label from "PIA" to "Required if Cost or Per Diem Demonstration" in Required State Input tab and NF Per Diem and NF Cost tab.
Required State Input - NF	Tooltip	Column O	Column O	202	Added the following tool tip to the data entry cells in the required state input tab: Required if Cost or Per Diem Demonstration: Enter Medicare Cost Report Filing Status. A data validation error is triggered when Demonstration Type (104) is "Cost" or "Per Diem" and this variable is missing data or has an invalid value.
Data Dictionary	N/A	B28	B28	202	Changed variable designation from "PIA" to "Required if Cost or Per Diem Demonstration" in Data Dictionary tab.
Data Dictionary	N/A	Row 28	Row 28	202	Updated data dictionary fields to include references to PDPM.
Required State Input - NF	Data	Column T	Column T	207	Added conditional formatting to 207 when demonstration type (104) = Per Diem and data is missing.
NF Per Diem	Label	Column T	Column T	207	Changed label from "PIA" to "Required if Per Diem Demonstration" in Required State Input tab and NF Per Diem tab.
Required State Input - NF	Label	Column T	Column T	207	Changed label from "PIA" to "Required if Per Diem Demonstration" in Required State Input tab and NF Per Diem tab.
Data Dictionary	N/A	B30	B30	207	Changed variable designation from "PIA" to "Required if Per Diem Demonstration" in Data Dictionary tab.
Required State Input - NF	Tooltip	Column T	Column T	207	Updated tool tip with the following text: Required if Per Diem Demonstration: Enter Case Mix Index (CMI). A data validation error is triggered when Demonstration Type (104) is "Per Diem" and this variable is missing data. Leave this variable blank if 104 is "Cost," "RUGs," or "PDPM."
Data Dictionary	N/A	Row 32	Row 32	210	Updated data dictionary fields to include references to PDPM.
Required State Input - NF	Tooltip	Column Q	Column Q	210	Updated tool tip with the following text: Provide if Applicable: Enter Medicare Days. This variable should be populated with data when Demonstration Type (104) is "RUGs" or "PDPM" and Medicare days are used in the calculation of RUGs or PDPM rates.
Required State Input - NF	Data	Column P	Column P	211	Added conditional formatting to 211 when demonstration type (104) = Cost or Per Diem  and data is missing.
NF Cost	Label	Column P	Column P	211	Changed label from "PIA" to "Required if Cost or Per Diem Demonstration" in Required State Input tab and NF Cost and Per Diem tabs.
NF Per Diem	Label	Column P	Column P	211	Changed label from "PIA" to "Required if Cost or Per Diem Demonstration" in Required State Input tab and NF Cost and Per Diem tabs.
Required State Input - NF	Label	Column P	Column P	211	Changed label from "PIA" to "Required if Cost or Per Diem Demonstration" in Required State Input tab and NF Cost and Per Diem tabs.
Required State Input - NF	Tooltip	Column P	Column P	211	Added the following tool tip to the data entry cells in the required state input tab: Required if Cost or Per Diem Demonstration. A data validation error is triggered when Demonstration Type (104) is "Cost" or "Per Diem" and this variable is missing data or has an invalid value. Valid values for this field are numeric characters.
Data Dictionary	N/A	B33	B33	211	Changed variable designation from "PIA" to "Required if Cost or Per Diem Demonstration" in Data Dictionary tab.
Required State Input - NF	Data	Column R	Column R	212.1	Added conditional formatting to 212.1 when demonstration type (104) = Cost or Per Diem and data is missing.
Required State Input - NF	Label	Column R	Column R	212.1	Changed label from "PIA" to "Required if Cost or Per Diem Demonstration" in Required State Input tab and NF Per Diem and NF Cost tab.
NF Per Diem	Label	Column Q	Column Q	212.1	Changed label from "PIA" to "Required if Cost or Per Diem Demonstration" in Required State Input tab and NF Per Diem and NF Cost tab.
NF Cost	Label	Column Q	Column Q	212.1	Changed label from "PIA" to "Required if Cost or Per Diem Demonstration" in Required State Input tab and NF Per Diem and NF Cost tab.
Data Dictionary	N/A	B34	B34	212.1	Changed variable designation from "PIA" to "Required if Cost or Per Diem Demonstration" in Data Dictionary tab.
Data Dictionary	N/A	Row 34	Row 34	212.1	Updated data dictionary fields to include references to PDPM.
Required State Input - NF	Tooltip	Column R	Column R	212.1	Updated tool tip with the following text: Required if Cost or Per Diem Demonstration: Enter Adjustments to Medicare Per Diem #1. A data validation error is triggered when Demonstration Type (104) is "Cost" or "Per Diem" and this variable is missing data. Leave blank if 104 is "RUGs" or "PDPM."
Required State Input - NF	Data	Column S	Column S	212.2	Added conditional formatting to 212.2 when demonstration type (104) = Cost or Per Diem and data is missing.
NF Per Diem	Label	Column R	Column R	212.2	Changed label from "PIA" to "Required if Cost or Per Diem Demonstration" in Required State Input tab and NF Per Diem and NF Cost tab.
NF Cost	Label	Column R	Column R	212.2	Changed label from "PIA" to "Required if Cost or Per Diem Demonstration" in Required State Input tab and NF Per Diem and NF Cost tab.
Required State Input - NF	Label	Column S	Column S	212.2	Changed label from "PIA" to "Required if Cost or Per Diem Demonstration" in Required State Input tab and NF Per Diem and NF Cost tab.
Data Dictionary	N/A	B35	B35	212.2	Changed variable designation from "PIA" to "Required if Cost or Per Diem Demonstration" in Data Dictionary tab.
Data Dictionary	N/A	Row 35	Row 35	212.2	Updated data dictionary fields to include references to PDPM.
Required State Input - NF	Tooltip	Column S	Column S	212.2	Updated tool tip with the following text: Required if Cost or Per Diem Demonstration: Enter Adjustments to Medicare Per Diem #2. A data validation error is triggered when Demonstration Type (104) is "Cost" or "Per Diem" and this variable is missing data. Leave blank if 104 is "RUGs" or "PDPM."
Required State Input - NF	Data	Column U	Column U	216	Added conditional formatting to 216 when demonstration type (104) = RUGs or PDPM and data is missing.
NF RUGs	Label	Column Q	Column Q	216	Changed label from "PIA" to "Required if RUGs or PDPM Demonstration" in Required State Input tab and NF RUGs tab.
Required State Input - NF	Label	Column U	Column U	216	Changed label from "PIA" to "Required if RUGs or PDPM Demonstration" in Required State Input tab and NF RUGs tab.
Data Dictionary	N/A	B38	B38	216	Changed variable designation from "PIA" to "Required if RUGs or PDPM Demonstration" in Data Dictionary tab.
Data Dictionary	N/A	Row 38	Row 38	216	Updated data dictionary fields to include references to PDPM.
NF PDPM	Label	Column Q	Column Q	216	Updated variable label to include a reference to PDPM on Required State Input and NF PDPM output tabs.
Required State Input - NF	Label	Column U	Column U	216	Updated variable label to include a reference to PDPM on Required State Input and NF PDPM output tabs.
Required State Input - NF	Tooltip	Column U	Column U	216	Updated tool tip with the following text: Required if RUGs or PDPM Demonstration: Enter Average Medicare RUGs or PDPM Rate Per Diem. A data validation error is triggered when Demonstration Type (104) is "RUGs" or "PDPM" and this variable is missing data. Leave this variable blank if 104 is "Cost" or "Per Diem."
Required State Input - NF	Data	Column V	Column V	217	Added conditional formatting to 217 when demonstration type (104) = RUGs and data is missing.
NF RUGs	Label	Column M	Column M	217	Changed label from "PIA" to "Required if RUGs or PDPM Demonstration" in Required State Input tab and NF RUGs tab.
Required State Input - NF	Label	Column V	Column V	217	Changed label from "PIA" to "Required if RUGs or PDPM Demonstration" in Required State Input tab and NF RUGs tab.
Required State Input - NF	Tooltip	Column V	Column V	217	Added the following tool tip to the data entry cells in the required state input tab: Required if RUGs or PDPM Demonstration: Enter Medicare RUGs or PDPM Type/Version. A data validation error is triggered when Demonstration Type (104) is "RUGs" or "PDPM" and this variable is missing data. Leave this variable blank if 104 is "Cost" or "Per Diem."
Data Dictionary	N/A	B39	B39	217	Changed variable designation from "PIA" to "Required if RUGs  Demonstration" in Data Dictionary tab.
Data Dictionary	N/A	Row 39	Row 39	217	Updated data dictionary fields to include references to PDPM.
NF PDPM	Label	Column M	Column M	217	Updated variable label to include a reference to PDPM on Required State Input and NF PDPM output tabs.
Required State Input - NF	Label	Column V	Column V	217	Updated variable label to include a reference to PDPM on Required State Input and NF PDPM output tabs.
Required State Input - NF	Tooltip	Column V	Column V	217	Updated tool tip with the following text: Required if RUGs or PDPM Demonstration: Enter Medicare RUGs or PDPM Type/Version. A data validation error is triggered when Demonstration Type (104) is "RUGs" or "PDPM" and this variable is missing data. Leave this variable blank if 104 is "Cost" or "Per Diem."
Required State Input - NF	Data	Column W	Column W	218.1	Added conditional formatting to 218.1 when demonstration type (104) = RUGs and data is missing.
Required State Input - NF	Label	Column W	Column W	218.1	Changed label from "PIA" to "Required if RUGs or PDPM Demonstration" in Required State Input tab and NF RUGs tab.
NF RUGs	Label	Column N	Column N	218.1	Changed label from "PIA" to "Required if RUGs or PDPM Demonstration" in Required State Input tab and NF RUGs tab.
Required State Input - NF	Tooltip	Column W	Column W	218.1	Added the following tool tip to the data entry cells in the required state input tab: Required if RUGs or PDPM Demonstration: Enter Medicare RUGs or PDPM Rate - Effective Begin Date. A data validation error is triggered when Demonstration Type (104) is "RUGs" or "PDPM" and this variable is missing data or has an invalid value.
Required State Input - NF	Data	Column W	Column W	218.1	Applied conditional formatting if begin dates are not before end dates.
Data Dictionary	N/A	B40	B40	218.1	Changed variable designation from "PIA" to "Required if RUGs  Demonstration" in Data Dictionary tab.
Data Dictionary	N/A	Row 40	Row 40	218.1	Updated data dictionary fields to include references to PDPM.
NF PDPM	Label	Column N	Column N	218.1	Updated variable label to include a reference to PDPM on Required State Input and NF PDPM output tabs.
Required State Input - NF	Label	Column W	Column W	218.1	Updated variable label to include a reference to PDPM on Required State Input and NF PDPM output tabs.
Required State Input - NF	Tooltip	Column W	Column W	218.1	Updated tool tip with the following text: Required if RUGs or PDPM Demonstration: Enter Medicare RUGs or PDPM Rate - Effective Begin Date. A data validation error is triggered when Demonstration Type (104) is "RUGs" or "PDPM" and this variable is missing data or has an invalid value.
Required State Input - NF	Data	Column X	Column X	218.2	Added conditional formatting to 218.2 when demonstration type (104) = RUGs and data is missing.
Required State Input - NF	Label	Column X	Column X	218.2	Changed label from "PIA" to "Required if RUGs or PDPM Demonstration" in Required State Input tab and NF RUGs tab.
NF RUGs	Label	Column O	Column O	218.2	Changed label from "PIA" to "Required if RUGs or PDPM Demonstration" in Required State Input tab and NF RUGs tab.
Required State Input - NF	Tooltip	Column X	Column X	218.2	Added the following tool tip to the data entry cells in the required state input tab: Required if RUGs or PDPM Demonstration: Enter Medicare RUGs or PDPM Rate - Effective End Date. A data validation error is triggered when Demonstration Type (104) is "RUGs" and this variable is missing data or has an invalid value.
Required State Input - NF	Data	Column X	Column X	218.2	Applied conditional formatting if begin dates are not before end dates.
Data Dictionary	N/A	B41	B41	218.2	Changed variable designation from "PIA" to "Required if RUGs  Demonstration" in Data Dictionary tab.
Data Dictionary	N/A	Row 41	Row 41	218.2	Updated data dictionary fields to include references to PDPM.
NF PDPM	Label	Column O	Column O	218.2	Updated variable label to include a reference to PDPM on Required State Input and NF PDPM output tabs.
Required State Input - NF	Label	Column X	Column X	218.2	Updated variable label to include a reference to PDPM on Required State Input and NF PDPM output tabs.
Required State Input - NF	Tooltip	Column X	Column X	218.2	Updated tool tip with the following text: Required if RUGs or PDPM Demonstration: Enter Medicare RUGs or PDPM Rate - Effective End Date. A data validation error is triggered when Demonstration Type (104) is "RUGs" or "PDPM" and this variable is missing data or has an invalid value.
Required State Input - NF	Data	Column Y	Column Y	219.1	Added conditional formatting to 219.1 when demonstration type (104) = RUGs and data is missing.
Required State Input - NF	Label	Column Y	Column Y	219.1	Changed label from "PIA" to "Required if RUGs Demonstration" in Required State Input tab and NF RUGs tab.
NF RUGs	Label	Column R	Column R	219.1	Changed label from "PIA" to "Required if RUGs Demonstration" in Required State Input tab and NF RUGs tab.
Required State Input - NF	Tooltip	Column Y	Column Y	219.1	Added the following tool tip to the data entry cells in the required state input tab: Required if RUGs Demonstration: Enter Adjustment #1 to RUGs or PDPM Rate. A data validation error is triggered when Demonstration Type (104) is "RUGs" or "PDPM" and this variable is missing data. Leave this variable blank if 104 is "Cost" or "Per Diem."
Data Dictionary	N/A	B42	B42	219.1	Changed variable designation from "PIA" to "Required if RUGs  Demonstration" in Data Dictionary tab.
Data Dictionary	N/A	Row 42	Row 42	219.1	Updated data dictionary fields to include references to PDPM.
NF PDPM	Label	Column R	Column R	219.1	Updated variable label to include a reference to PDPM on Required State Input and NF PDPM output tabs.
Required State Input - NF	Label	Column Y	Column Y	219.1	Updated variable label to include a reference to PDPM on Required State Input and NF PDPM output tabs.
Required State Input - NF	Tooltip	Column Y	Column Y	219.1	Updated tool tip with the following text: Required if RUGs or PDPM Demonstration: Enter Adjustment #1 to RUGs or PDPM Rate. A data validation error is triggered when Demonstration Type (104) is "RUGs" or "PDPM" and this variable is missing data. Leave this variable blank if 104 is "Cost" or "Per Diem."
Required State Input - NF	Data	Column Z	Column Z	219.2	Added conditional formatting to 219.2 when demonstration type (104) = RUGs and data is missing.
Required State Input - NF	Label	Column Z	Column Z	219.2	Changed label from "PIA" to "Required if RUGs or PDPM Demonstration" in Required State Input tab and NF RUGs tab.
NF RUGs	Label	Column S	Column S	219.2	Changed label from "PIA" to "Required if RUGs or PDPM Demonstration" in Required State Input tab and NF RUGs tab.
Required State Input - NF	Tooltip	Column Z	Column Z	219.2	Added the following tool tip to the data entry cells in the required state input tab: Required if RUGs or PDPM Demonstration: Enter Adjustment #2 to RUGs or PDPM Rate. A data validation error is triggered when Demonstration Type (104) is "RUGs" and this variable is missing data. Leave this variable blank if 104 is "Cost" or "Per Diem."
Data Dictionary	N/A	B43	B43	219.2	Changed variable designation from "PIA" to "Required if RUGs  Demonstration" in Data Dictionary tab.
Data Dictionary	N/A	Row 43	Row 43	219.2	Updated data dictionary fields to include references to PDPM.
NF PDPM	Label	Column S	Column S	219.2	Updated variable label to include a reference to PDPM on Required State Input and NF PDPM output tabs.
Required State Input - NF	Label	Column Z	Column Z	219.2	Updated variable label to include a reference to PDPM on Required State Input and NF PDPM output tabs.
Required State Input - NF	Tooltip	Column Z	Column Z	219.2	Updated tool tip with the following text: Required if RUGs or PDPM Demonstration: Enter Adjustment #2 to RUGs or PDPM Rate. A data validation error is triggered when Demonstration Type (104) is "RUGs" or "PDPM" and this variable is missing data. Leave this variable blank if 104 is "Cost" or "Per Diem."
Data Dictionary	N/A	Row 45	Row 45	222	Updated data dictionary fields to include references to PDPM.
NF PDPM	Label	Column T	Column T	222	Updated variable label to include a reference to PDPM on Required State Input and NF PDPM output tabs.
Required State Input - NF	Label	Column T	Column T	222	Updated variable label to include a reference to PDPM on Required State Input and NF PDPM output tabs.
Required State Input - NF	Tooltip	Column AA	Column AA	300.1	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Time Period of Medicaid Days - Begin Date. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are dates in the format MM/DD/YYYY.
Required State Input - NF	Data	Column AA	Column AA	300.1	Applied conditional formatting if begin dates are not before end dates.
Required State Input - NF	Tooltip	Column AB	Column AB	300.2	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Time Period of Medicaid Days - End Date. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are dates in the format MM/DD/YYYY.
Required State Input - NF	Data	Column AB	Column AB	300.2	Applied conditional formatting if begin dates are not before end dates.
Required State Input - NF	Data	Column AL	Column AL	305	Added conditional formatting to 305 when demonstration type (104) = Per Diem and data is missing.
Required State Input - NF	Label	Column AL	Column AL	305	Changed label from "PIA" to "Required if Per Diem Demonstration" in Required State Input tab and NF Per Diem tab.
NF Per Diem	Label	Column AG	Column AG	305	Changed label from "PIA" to "Required if Per Diem Demonstration" in Required State Input tab and NF Per Diem tab.
Required State Input - NF	Tooltip	Column AL	Column AL	305	Added the following tool tip to the data entry cells in the required state input tab: Required if Per Diem Demonstration: Enter Medicaid Case Mix Index (CMI). A data validation error is triggered when Demonstration Type (104) is "Per Diem" and this variable is missing data. Leave this variable blank if 104 is "Cost," "PDPM," or "RUGs."
Data Dictionary	N/A	B50	B50	305	Changed variable designation from "PIA" to "Required if Per Diem Demonstration" in Data Dictionary tab.
Required State Input - NF	Tooltip	Column AM	Column AM	307	Added the following tool tip to the data entry cells in the required state input tab: Provide if applicable: Enter Medicaid Inflation Factor Type.
Required State Input - NF	Tooltip	Column AN	Column AN	308	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Medicaid Inflation Factor. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are numeric values from 1.00 to 1.04.
Required State Input - NF	Tooltip	Column AO	Column AO	309	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Other Adjustment to Medicaid Payments. A data validation error is triggered when this variable is missing data.
Required State Input - NF	Tooltip	Column AC	Column AC	310	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Medicaid Days. A data validation error is triggered when this variable is missing data.
Required State Input - NF	Tooltip	Column AD	Column AD	311.1	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Time Period of Medicaid Rates - Begin Date. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are dates in the format MM/DD/YYYY.
Required State Input - NF	Data	Column AD	Column AD	311.1	Applied conditional formatting if begin dates are not before end dates.
Required State Input - NF	Tooltip	Column AE	Column AE	311.2	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Time Period of Medicaid Rates - End Date. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are dates in the format MM/DD/YYYY.
Required State Input - NF	Data	Column AE	Column AE	311.2	Applied conditional formatting if begin dates are not before end dates.
Required State Input - NF	Tooltip	Column AF	Column AF	312	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Medicaid Regular Payment Per Diem. A data validation error is triggered when this variable is missing data.
NF PDPM	Label	Column Z	Column Z	312	Changed variable name from “Medicaid Regular Payments Per Diem” to “Medicaid Base Payment Per Diem.” Changed variable label and tool tip on required state input tab, output tab, and updated data dictionary to reflect the change.
NF RUGs	Label	Column Z	Column Z	312	Changed variable name from “Medicaid Regular Payments Per Diem” to “Medicaid Base Payment Per Diem.” Changed variable label and tool tip on required state input tab, output tab, and updated data dictionary to reflect the change.
NF Cost	Label	Column Y	Column Y	312	Changed variable name from “Medicaid Regular Payments Per Diem” to “Medicaid Base Payment Per Diem.” Changed variable label and tool tip on required state input tab, output tab, and updated data dictionary to reflect the change.
NF Per Diem	Label	Column Z	Column Z	312	Changed variable name from “Medicaid Regular Payments Per Diem” to “Medicaid Base Payment Per Diem.” Changed variable label and tool tip on required state input tab, output tab, and updated data dictionary to reflect the change.
Required State Input - NF	Label	Column AF	Column AF	312	Changed variable name from “Medicaid Regular Payments Per Diem” to “Medicaid Base Payment Per Diem.” Changed variable label and tool tip on required state input tab, output tab, and updated data dictionary to reflect the change.
Data Dictionary	N/A	D58	D58	312	Changed variable name from “Medicaid Regular Payments Per Diem” to “Medicaid Base Payment Per Diem.” Changed variable label and tool tip on required state input tab, output tab, and updated data dictionary to reflect the change.
Required State Input - NF	Tooltip	Column AG	Column AG	313.1	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Medicaid Supplemental Payment Per Diem. A data validation error is triggered when this variable is missing data.
Required State Input - NF	Tooltip	Column AH	Column AH	313.2	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Medicaid Supplemental Payment Per Diem (GME/Training). A data validation error is triggered when this variable is missing data.
Required State Input - NF	Tooltip	Column AI	Column AI	313.3	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Medicaid Supplemental Payment Per Diem (Other). A data validation error is triggered when this variable is missing data.
Required State Input - NF	Tooltip	Column AJ	Column AJ	314.1	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Adjustment to Medicaid Per Diem #1. A data validation error is triggered when this variable is missing data.
Required State Input - NF	Tooltip	Column AK	Column AK	314.2	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Adjustment to Medicaid Per Diem #2. A data validation error is triggered when this variable is missing data.
Required State Input - NF	Data	Column AR	Column AR	401	Added conditional formatting to 401 when demonstration type (104) = Cost and data is missing.
NF Cost	Label	Column AO	Column AO	401	Changed label from "PIA" to "Required if Cost Demonstration" in Required State Input tab and NF Cost tab.
Required State Input - NF	Label	Column AR	Column AR	401	Changed label from "PIA" to "Required if Cost Demonstration" in Required State Input tab and NF Cost tab.
Data Dictionary	N/A	B69	B69	401	Changed variable designation from "PIA" to "Required if Cost Demonstration" in Data Dictionary tab.
Required State Input - NF	Tooltip	Column AR	Column AR	401	Updated tool tip with the following text: Required if Cost Demonstration: Enter Medicaid Provider Tax Cost. A data validation error is triggered when Demonstration Type (104) is "Cost" and this variable is missing data. Leave this variable blank if 104 is "Per Diem," "PDPM" or "RUGs."
Required State Input - NF	Tooltip	Column AS	Column AS	402	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter Other Adjustments to the UPL Amount. A data validation error is triggered when this variable is missing data.
Required State Input - NF	Tooltip	Column AP	Column AP	404	Added the following tool tip to the data entry cells in the required state input tab: Provide if applicable: Enter UPL Inflation Factor Type.
Required State Input - NF	Tooltip	Column AQ	Column AQ	405	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the UPL Inflation Factor. A data validation error is triggered when this variable is missing data or has an invalid value. Valid values for this variable are numeric values from 1.00 to 1.04.
Required State Input - NF	Tooltip	Column AT	Column AT	408	Added the following tool tip to the data entry cells in the required state input tab: Required: Enter the Adjustment to the UPL Gap. A data validation error is triggered when this variable is missing data.
Overview & Instructions	Sheet	A5	A5	N/A	Changed tab name for required state input from “Required State Input” to: Required State Input – NF. Updated Overview & Instructions tab to reflect new tab name.
Required State Input - NF	Sheet	N/A	N/A	N/A	Changed tab name for required state input from “Required State Input” to: Required State Input – NF. Updated Overview & Instructions tab to reflect new tab name.
State Attestation	Data	N/A	N/A	N/A	Modified state data entry fields (dates, names, etc.) on the “State Attestation” tab to be fillable entry cells rather than hard underlined spaces that move/shift as you enter data.
UPL Demonstration Summary	Sheet	N/A	N/A	N/A	Updated UPL Demonstration Summary tab to incorporate Medicaid days in the calculations for per diem data.
NF PDPM	All	N/A	N/A	N/A	Created new output tab for NF PDPM. Users do not have an option to rename tab labels, delete tabs, add or delete columns, or edit this worksheet.
Overview & Instructions	N/A	A4	A4	N/A	Added "-NF PDPM for _______ (e.g._______)"
Overview & Instructions	N/A	A5	A5	N/A	Added "NF PDPM" to : States may not enter data into the tabs labeled…"
Overview & Instructions	N/A	A7	A7	N/A	Added "PDPM" to : "- Demonstration information asks for basic information such as the state, demonstration rate year, service type (nursing facility), and demonstration type (cost, RUGs, Per Diem, _____)"
Overview & Instructions	Sheet	A5	A5	N/A	Changed tab name for required state input from “Required State Input” to: Required State Input – NF. Updated Overview & Instructions tab to reflect new tab name.
Required State Input - NF	Sheet	N/A	N/A	N/A	Changed tab name for required state input from “Required State Input” to: Required State Input – NF. Updated Overview & Instructions tab to reflect new tab name.
UPL Demonstration Summary	Data	Column B	Column B	N/A	Updated calculation of Total Base Payments on the UPL Demonstration Summary tab to include data from the PDPM tab. Total Base Payments, taken from variable 312 for all providers in NF cost tab, RUGs tab, PDPM tab & Per diem tab
UPL Demonstration Summary	Data	Column C	Column C	N/A	Updated calculation of Total Supplemental Payments on the UPL Demonstration Summary tab to include data from the PDPM tab.Total Supplemental Payments, taken from variable 317 for all providers in NF cost tab, RUGs tab, PDPM tab & Per diem tab
UPL Demonstration Summary	Data	Column D	Column D	N/A	Updated calculation of Total UPL Gap on the UPL Demonstration Summary tab to include data from the PDPM tab. Total Adjusted UPL Gaps, taken from variable 409 for all providers in NF cost tab, RUGs tab, PDPM tab & Per diem tab