Upper Payment Limit FAQs
Are states required to use the Outpatient Hospital Serves (OPH) Upper Payment Limit (UPL) template to demonstrate the clinical diagnostic laboratory (CDL) services UPL?
No, the template does not include variables to report clinical diagnostic laboratory services.
FAQ ID:92371
How and when should the Medicaid hospital tax/provider assessment be included in the inpatient hospital template?
The cost of the tax should be reported in Variable 401 - MCD Provider Tax Cost. A state may separately report the Medicaid portion of the cost of a provider assessment/tax only when it is using a cost based methodology to calculate the UPL. A state may not include this cost when calculating a DRG or Payment based UPL demonstration.
FAQ ID:92366
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