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#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
OMB.report
HHS/CMS
OMB 0938-1148
ICR 202401-0938-016
IC 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_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 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: 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
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
III UPL Guidance Questions Logic_13.xlsx
Questions Logic
IC Document
Information Collection (IC) Details
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