Budget Neutrality Aggregate Cap Clause Samples

Budget Neutrality Aggregate Cap. Budget neutrality is determined on an aggregate cap basis as shown below in Table 11: Table 11 50. Upper Payment Limit (UPL). Payments under the Medicaid State plan (including any supplemental payments), when added to payments under the Demonstration, must not exceed the State’s UPLs established at 42 CFR 447.272 and 42 CFR 447.321 for the following services and classes of providers: a. Inpatient hospital services – State government-owned or operated b. Outpatient hospital services – State government-owned or operated c. Nursing facility services – Non-State government-owned or operated d. Nursing facility services – Privately-owned and operated The State must continue to use a cost-based UPL methodology for State government-owned or operated outpatient hospital services. The State will annually review the outpatient UPL and, to the extent necessary, reduce claimed expenditures under the Demonstration to the extent the UPL is exceeded. The Demonstration expenditures should be accounted for in all State plan UPL demonstrations, based on provider class and service type as identified in Table 12 below, to ensure that the sum of State plan and Demonstration expenditures do not exceed the applicable UPLs. Table 12 State Government Inpatient Hospital $6,191,661 $8,234,499 $10,320,236 $6,224,887 $30,971,283 State Government Outpatient Hospital $6,258,670 $6,671,086 $7,088,452 $3,755,413 $23,773,621 Non-State Government Nursing Facility $6,328,779 $5,743,268 $6,404,191 $3,539,496 $22,015,734 Private Nursing Facility $124,561,677 $132,725,789 $140,297,988 $74,279,518 $471,864,972 Total $143,340,787 $153,374,642 $164,110,867 $87,799,314 $548,625,610 51. Future Adjustments to the Budget Neutrality Expenditure Limit. CMS reserves the right to adjust the budget neutrality expenditure limit to be consistent with enforcement of impermissible provider payments, health care related taxes, new Federal statutes, or policy interpretations implemented through letters, memoranda, or regulations with respect to the provision of services covered under IowaCare.