#13 (Revision): Medicaid Accountability – Nursing Facility, Outpatient Hospital and Inpatient Hospital Upper Payment Limits

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

OMB: 0938-1148

IC ID: 251147

Documents and Forms

Document Name Document Type
Form CMS-10398 #13 #13 (Revision): Medicaid Accountability – Nursing Facility, Outpatient Hospital and Inpatient Hospital Upper Payment Limits Form and Instruction
Form CMS-10398 #13 #13 (Revision): Medicaid Accountability – Nursing Facility, Outpatient Hospital and Inpatient Hospital Upper Payment Limits Form and Instruction
CMS-10398 #13 MACFIN_inpatient-upl-template V MACFIN_inpatient-upl-template.xlsx Form and Instruction
CMS-10398 #13 MACFIN_inpatient-upl-template V MACFIN_inpatient-upl-template.xlsx Form and Instruction
CMS-10398 #13 MACFIN_outpatient-upl-template VI MACFIN_outpatient-upl-template.xlsx Form and Instruction
CMS-10398 #13 MACFIN_outpatient-upl-template VI MACFIN_outpatient-upl-template.xlsx Form and Instruction
CMS-10398 #13 MACFIN_nursing-facility-upl-template VII MACFIN_nursing-facility-upl-template.xlsx Form and Instruction
CMS-10398 #13 MACFIN_nursing-facility-upl-template VII MACFIN_nursing-facility-upl-template.xlsx Form and Instruction
CMS-10398 #13 Guidance Questions: Inpatient VIII UPL Guidance Questions_Master File_Inpatient.pdf Form
CMS-10398 #13 Guidance Questions: Inpatient VIII UPL Guidance Questions_Master File_Inpatient.pdf Form
CMS-10398 #13 Guidance Questions: Nursing IX UPL Guidance Questions_Master File_Nursing Facility.pdf Form
CMS-10398 #13 Guidance Questions: Nursing IX UPL Guidance Questions_Master File_Nursing Facility.pdf Form
CMS-10398 #13 Guidance Questions: Outpatient X UPL Guidance Questions_Master File_Outpatient.pdf Form
CMS-10398 #13 Guidance Questions: Outpatient X UPL Guidance Questions_Master File_Outpatient.pdf Form
I Crosswalk-Guidance-Instructions_PRA-13.xlsx Crosswalk-Guidance-Instructions (inpatient hospital, outpatient hospital, and nursing facility) IC Document
I Crosswalk-Guidance-Instructions_PRA-13.xlsx Crosswalk-Guidance-Instructions (inpatient hospital, outpatient hospital, and nursing facility) IC Document
II PRA_NOV2021_Template Changes_#13.xlsx Template Crosswalk: (Templates: inpatient hospital, outpatient hospital, and nursing facility) IC Document
II PRA_NOV2021_Template Changes_#13.xlsx Template Crosswalk: (Templates: inpatient hospital, outpatient hospital, and nursing facility) IC Document
GenIC #13 - Generic Supporting Statement (2022 version 7).docx Generic Supporting Statement IC Document
GenIC #13 - Generic Supporting Statement (2022 version 7).docx Generic Supporting Statement IC Document
III UPL Guidance Questions Logic_13.xlsx Questions Logic IC Document
III UPL Guidance Questions Logic_13.xlsx Questions Logic IC Document