Skip to Main Content
Don't have an account? Create Account
Don't have an account? Create Account

CMS Issues Guidance on Medicare Payment Oversight



This week in Washington—CMS issues guidance on Medicaid payment oversight. You are tuning in to the National Association of Public Hospitals and Health Systems health policy update for the week of March 25, 2013.

On March 18, the federal Centers for Medicare & Medicaid Services (CMS) issued a letter to state Medicaid directors providing guidance on federal-state efforts to strengthen financial management and program integrity within the Medicaid program. States will now be required to report information on upper payment limit (UPL) demonstrations and financing sources for Medicaid payments on an annual basis. Right now, that information is collected or updated only when a state requests a state plan amendment or a waiver. These reports will be due prior to the start of the state fiscal year, which for most states will mean by June 30.

Starting in 2013, states must submit UPL demonstrations for inpatient hospital services, outpatient hospital services and nursing facilities. Then, beginning in 2014, states will also be required to submit UPL demonstrations for clinics, physician services, institutions for mental diseases and intermediate care facilities for the developmentally disabled. As part of the new reporting requirements, states must also include provider-specific reporting on all payments made to the applicable providers, including supplemental payments.

Additionally, CMS released reporting guidance and instructions specific to each of the three UPL demonstrations required for 2013. This marks the first time that CMS has required this kind of consistent reporting across states. Similar guidance will be released in the future for the remaining services. When that is released, it will be the first time that CMS has officially released any guidance on UPL for physician services. Currently, there are no physician UPL regulations.

Thanks for listening to another edition of This Week in Washington. I’m Zina Gontscharow; join us next week for another update.



About the Author

Dedicated staff at America's Essential Hospitals work together to produce high-quality, reliable content. Please view the about section for more details about staff.

Previous Next
Test Caption
Test Description goes like this