Examples of Upper payment limit in a sentence
The difference between the Medicaid Upper Payment Limit of the Medical Homes Network enrollees as defined/calculated in Appendix B of the Contract and the total amount of covered claim expenditures incurred by Medical Homes Network enrollees (including the prospective per member per month case management/care coordination fee payments) during the contract period.
The parties agree that Total Medicaid payments to the Hospitals may include, but are not necessarily limited to, Upper Payment Limit reimbursement, Disproportionate Share payments, and the amount of any Medicaid managed care payments above the base rates that the Hospitals negotiate with Medicaid managed care organizations but excludes any Medicaid fee-for-service or Medicaid managed care claims reimbursements.
Contractor shall assist State with the development of the State Plan Amendment (SPA) submission to the Center for Medicaid and Medicare Services (CMS), responses to questions from CMS about the SPA, and shall provide all of the calculations necessary to demonstrate that the methodology will produce payments that are within the Upper Payment Limit (UPL).
Previously these payments were made under the Upper Payment Limit (UPL) system, and without it, many providers would not be able to afford to provide services to Medicaid clients and patients who cannot afford to pay.
Letter dated March 12, 2004 to Acting CMS Administrator Xxxxxx Xxxxx, signed by Senator Xxxxxxxx, Senator Xxxxxx, Representative Xxxxxxx, Representative Xxxxx, Representative King, Representative Xxxxxx and Representative Nussle Benefits to CMS: Beginning on July 1, 2005, Iowa will : Eliminate all of the following Intergovernmental Transfers: ❑ Hospital Upper Payment Limit Transfer from Franklin Memorial Hospital.