CMS-10398 #24 MACFIN_intermediate-care-upl-template
[Medicaid] Generic Clearance for Medicaid and CHIP State Plan, Waiver, and Program Submissions (CMS-10398)
VII MACFIN_intermediate-care-upl-template.xlsx
#24 (Revision): Medicaid Accountability – Upper Payment Limits for Clinics, Physician Services, ICF/IID, PRTFs, and IMDs
OMB: 0938-1148
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1148 can be found here: