Upper payment limit definition

Upper payment limit means the maximum ceiling imposed by

Upper payment limit means the aggregate federal upper

Upper payment limit means a federal upper payment limit on the amount of the Medicaid payment for which federal financial participation is available for a class of service and a class of health care providers, as specified in Part 447 of Title 42 of the Code of Federal Regulations. The applicable upper payment limit shall be separately calculated for inpatient and outpatient hospital services.

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.

More Definitions of Upper payment limit

Upper payment limit or "UPL" means the methodology permitted by federal

Upper payment limit. (UPL)" means the maximum ceiling imposed by 42 C F R ''42 C.F.R. §§ 447.272 and 447.321 on hospital Medicaid reimbursement for inpatient and outpatient services, other than to hospitals owned or operated by state government.

Upper payment limit. (UPL)" means the maximum ceiling imposed by 42 C F R ''42 Code of Federal Regulations (C.F.R.) §§

Upper payment limit means a federal upper payment limit on the amount of the medicaid payment for which federal financial participation is available for a class of services and a class of health care providers, as specified in 42 CFR 447.

Upper payment limit or "UPL" means the methodology permitted by federal regulation to achieve the maximum allowable amount on aggregate hospital Medicaid payments to non-state government-owned hospitals and private hospitals under 42 C.F.R. sec. 447.272. A separate UPL shall be estimated for non-state government-owned hospitals and private hospitals; and

Upper payment limit means the aggregate federal upper payment limit on the amount of the medicaid payment for which federal financial participation is available for a class of service and a class of health care providers, as specified in 42 C.F.R. Part 47, as separately determined for inpatient and outpatient hospital services.

Upper payment limit means the lesser of the customary charges of the ASP or the prevailing charges in the locality of the ASP for comparable services under comparable circumstances, calculated according to methodology in an approved state plan amendment for the state Medicaid program.