Frequently Asked Questions are used to provide additional information and/or statutory guidance not found in State Medicaid Director Letters, State Health Official Letters, or CMCS Informational Bulletins. The different sets of FAQs as originally released can be accessed below.
Frequently Asked Questions
What are examples of what would be appropriate adjustments to the Upper Payment Limit (UPL) in step 9 (Adjustments to the UPL and UPL Gap Calculation) (field 408) of the template?
Variable 408 (Adjustment to the UPL Gap) is intended to allow states to report adjustments to their UPL gap, to the extent that these adjustments are not accounted for in other variables. Here, states could report broad-based increases or reductions in payment, such as a Medicaid volume adjustment for managed care expansion. The source of values input into variable 408 may differ by state. Whenever a state reports data in variable 408 it must include a comprehensive note describing the adjustment.
FAQ ID:92301
SHARE URLFor our Nursing Facility (NF) Upper Payment Limit (UPL) calculation we separate Medicaid allowable costs into three categories: salaries and benefits, operating costs, and property costs. Based on previous guidance from CMS, we do not apply an inflation factor to the property costs. In looking at the template, it appears the inflation factor is applied to all costs. Is this correct?
Where inflation is not applied to property costs, please separate out this cost from the Medicare UPL by reporting these amounts in variable 402 - Adjustment to the Medicare UPL.
FAQ ID:92361
SHARE URLHow 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
SHARE URLAre 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
SHARE URLWhat information does CMS expect to be included in the Notes tab?
The Notes tab should include any and all information to fully support the state's UPL demonstration. CMS expects states to provide clarifying information in the Notes tab. For example, this information would provide details for the adjustments to Medicare as input in variables 212.1 and 212.2, various supplemental payments in variables 313.1, 313.2, and 313.3, and adjustments to Medicaid in variables 314.1 and 314.2. In addition to reporting through the notes tab, the state also has the option of using the guidance document or narrative to fully support its UPL demonstration.
FAQ ID:92376
SHARE URLOur state covered institutions for mental disease (IMD) under the inpatient hospital and nursing benefit. Should we conduct a separate UPL for these facilities?
No, facilities that are licensed, covered, and paid under the Medicaid state plan as inpatient hospital or nursing facilities should be included in the UPL calculated for those services. There is no regulatory requirement to conduct separate calculations for designated facility "types" within each of the applicable service categories. States do not need to provide separate UPL demonstrations for IMDs covered under the inpatient hospital or nursing facility services benefit.
FAQ ID:92381
SHARE URLThis table indicates what reports are available to CMS Users. These can be found under the "Reports" tab.
|
Report Name |
Description |
Available For |
|
Clock Status Report |
View the regulatory clock statuses |
CPOC, CMS Disapproval Coordinator, SRT Admin CMS Report Admin, |
|
State Agency Profile Report |
Overview of a State's Medicaid Plan including the prior 12 months' submission package history |
CPOC, CMS Disapproval Coordinator, SRT Admin, CMS Report Admin, CSA, SRT |
|
Submission Detail Report |
View details on packages by date |
CPOC, CMS Disapproval Coordinator, SRT Admin, CMS Report Admin, SME, PA, PD,SRRVW, SRT |
|
Submission Statistics Detail Report |
View all Submission Packages currently in review |
CPOC, CMS Disapproval Coordinator, SRT Admin, CMS Report Admin, SME, PA, PD, SRRVW, SRT |
|
Submission Statistics Summary Report |
View summary of Submission Packages in a specific review status within a specified date range. |
CPOC, CMS Disapproval Coordinator, SRT Admin, CMS Report Admin, SME, PA, PD,SRRVW, SRT |
|
Submission Summary Report |
Overview of submitted packages by date |
CPOC, CMS Disapproval Coordinator, SRT Admin, CMS Report Admin, SME, PA, PD,SRRVW, SRT |
|
Staff Workload Report |
View the number of Submission Packages assigned to each CPOC and SRT member, as of the report run date. |
CMS Disapproval Coordinator, SRT Admin, CMS Report Admin, CSA |
FAQ ID:92871
SHARE URLWhat is the Review Tool Report?
The Review Tool Report is a feature CPOCs, SRTs, Senior Reviewers, Package Approvers, Package Disapprovers, and CMS Report Admins can utilize to see Package Reviewable Units, Reviewers, Reviewable Unit Assessment Values, and Notes.
Log in as CMS Point of Contact or Submission Review Team member. Under the "Records" tab, select "Submission Packages". Then select the link to the submission package. In the left panel, select "Review Tool Report". You may sort the reviews of all Review Team members by Package Reviewable Unit, Reviewer, Reviewable Unit Assessment Value, or Note/Assessments by utilizing the drop-down boxes. You also have the ability to export this report to Excel by selecting "Export to Excel."
FAQ ID:92876
SHARE URLWhat is the purpose of each Analyst Note Type?
Analyst Notes are a form of brief internal communication for the CMS Review Team. These notes are a part of the official record; however, State users are not able to see these notes. Analyst Notes are part of the Review Tool for each Reviewable Unit and the SRT or CPOC may view the notes from other Review Team members (depending on the type of note) within the Review Tool, and add his/her own notes.
The CMS Point of Contact or Submission Review Team members may add Analysts Notes through the Review Tool. The types of notes available are referenced in a table below. You will start by logging in as the CMS Point of Contact or Submission Review Team member, then going to the "Records" tab. Under the "Records" tab select "Submission Packages" and then select the link to the package. In the left panel select "Analyst Notes". You will then have the ability to search notes entered by Review Team Members.
| Analyst Note Type | Description | Visible By |
| Note to self | Private note for self only | Self |
| For POC (Formal Review) | Indicates information that should be included in disposition | CPOC |
| For Review Team | For other Review Team members | CPOC and SRT |
| For RAI | Indicates something that requires RAI | CPOC and SRT |
| For Correspondence Log | Indicates information that should be communicated to the SPOC | CPOC and SRT |
| Non SRT-User | Note on behalf of a CMS participant outside of the Review Team | CPOC and SRT |
| General Note | A note that doesn't fall into another category | All |
| Justification | Provides bases for a recommended disposition | POC Admin, CPOC and SRT |
| Post-Recommendation | Included by other CMS users during the package disposition review | POC Admin, CPOC and SRT |
FAQ ID:92881
SHARE URLCertain fields within the reviewable units seem misaligned, how do I fix this issue?
If certain fields are misaligned you may need to adjust your compatibility settings. Click the Tools button in the upper right side of your screen, and then click Compatibility View settings. Next click the Add button. The website is added to your Compatibility View and the screen will realign. You can always remove the website by clicking on the website in the list and clicking the Remove button. If an issue persists, please email the MACPro Help Desk at MACPro_HelpDesk@cms.hhs.gov
FAQ ID:92886
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