View Information Collection (IC)

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#13: Medicaid Accountability – Nursing Facility, Outpatient Hospital and Inpatient Hospital Upper Payment Limits
 
New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10398 (#13) Inpatient Hospital UPL Guidance Inpatient Hospital UPL Guidance final.docx Yes Yes Fillable Printable
Instruction IP_instructions_final_REVISED.docx No   Printable Only
Instruction NF instructions final.docx No   Printable Only
Form CMS-10398 (#13) Nursing Facility UPL Guidance Nursing Facility UPL Guidance final.docx Yes Yes Fillable Printable
Instruction OP_instructions final.docx No   Printable Only
Form CMS-10398 (#13) Outpatient Hospital UPL Guidance Outpatient Hospital UPL Guidance final.docx Yes Yes Fillable Printable
Instruction SMD_accountability_letter_CMS revised 2-1-13.docx No   Printable Only

Health Health Care Services

 

56 0
   
State, Local, and Tribal Governments
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 56 0 56 0 0 0
Annual IC Time Burden (Hours) 2,240 0 2,240 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
#13 Medicaid Accountability – Nursing Facility, Outpatient Hospital and Inpatient Hospital Upper Payment Limits #13 Medicaid Accountability Upper Payment Limits Supporting Statement {Dec 2014].docx 12/22/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.