Upper Payment Limit FAQs
Can a contractor that acts on behalf of the Medicaid agency submit the Upper Payment Limit (UPL) demonstrations to CMS?
No, the information must be submitted by the State Medicaid Director (or designated state official).
FAQ ID:92246
How should a state report Upper Payment Limit (UPL) data for out of state providers?
The UPL data for out of state providers does not need to be included in the UPL demonstration. If the state has provider level data then it may include it in the demonstration within the private ownership category of providers.
FAQ ID:92426
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