#24 (Revision): Medicaid Accountability – Upper Payment Limits for Clinics, Physician Services, ICF/IID, PRTFs, and IMDs

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

OMB: 0938-1148

IC ID: 251148

Documents and Forms

Document Name Document Type
Form CMS-10398 #24 #24 (Revision): Medicaid Accountability – Upper Payment Limits for Clinics, Physician Services, ICF/IID, PRTFs, and IMDs Form and Instruction
Form CMS-10398 #24 #24 (Revision): Medicaid Accountability – Upper Payment Limits for Clinics, Physician Services, ICF/IID, PRTFs, and IMDs Form and Instruction
CMS-10398 #24 Standard Funding Questions IV - Standard Funding Questions-24.docx Form and Instruction
CMS-10398 #24 MACFIN_clinic-services-template VI MACFIN_clinic-services-template.xlsx Form and Instruction
CMS-10398 #24 MACFIN_intermediate-care-upl-template VII MACFIN_intermediate-care-upl-template.xlsx Form and Instruction
CMS-10398 #24 MACFIN_mental-disease-upl-template VIII MACFIN_mental-disease-upl-template.xlsx Form and Instruction
CMS-10398 #24 MACFIN_physician-upl-template IX MACFIN_physician-upl-template.xlsx Form and Instruction
CMS-10398 #24 MACFIN_prtf-upl-template X MACFIN_prtf-upl-template.xlsx Form and Instruction
CMS-10398 #24 Guidance Questions_Master File_Clinic XI UPL Guidance Questions_Master File_Clinic.pdf Form
CMS-10398 #24 Guidance Questions_Master File_ICF IID XII UPL Guidance Questions_Master File_ICF IID.pdf Form
CMS-10398 #24 Guidance Questions_Master File_IMD XIII UPL Guidance Questions_Master File_IMD.pdf Form
CMS-10398 #24 Guidance Questions_Master File_Physician XIV UPL Guidance Questions_Master File_Physician.pdf Form
CMS-10398 #24 Guidance Questions_Master File_PRTF XV UPL Guidance Questions_Master File_PRTF.pdf Form
I Crosswalk-Guidance-Instructions_PRA-24.xlsx Crosswalk 1 of 2 (Changes in guidance and instructions documents: IMD, ICF IID, PRTF, Clinic, and Physician) and Crosswalk 2 of 2 (Standard Funding Questions) IC Document
II PRA_NOV2021_Template Changes Crosswalk_#24.xlsx Crosswalk for Templates: IMD, ICF IID, PRTF, Clinic, and Physician IC Document
V 24 -Generic Supporting Statement (2022 version 3).docx Generic Supporting Statement IC Document
III UPL Guidance Questions Logic_24.xlsx Questions Logic IC Document