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

• 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 limitation established pursuant to 42 C.F.R. 447.272 that disallows federal matching funds when state Medicaid agencies pay certain classes of nursing care facilities an aggregate amount for services furnished by that class of nursing care facilities that would exceed the amount that would be paid under Medicare payment principles.

• Upper payment limit assurance.Payments made to state-operated ICFs-MR ICFs/IID in accordance with this rule under medicaid are, in the aggregate on a statewide basis, equal to or less than amounts which would have been recognized under Title XVIII (medicare) for comparable services in accordance with 42 CFR 447.272 effective October 31, 2000October 1, 2014, and available at www.cms.hhs.gov.

• Upper payment limit (UPL) payments, Trauma Add-On payments and Trauma Outlier payments, if applicable, will be included in addition to the above other Medicaid payments for purposes of determining the hospital-spe- cific DSH limit in the annual independent DSH audit.

• AMENDATORY SECTION (Amending WSR 11-14-075, filed 6/30/11, effective 7/1/11) WAC 182-550-5425 Upper payment limit (UPL) payments for inpa­ tient hospital services.

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

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.

Upper payment limit means the lesser of the customary charges of the medical transportation provider or the prevailing charges in the locality of the medical transportation provider for comparable services under comparable circumstances, calculated according to methodology in an approved state plan amendment for the Arkansas Medicaid Program; and