CMS rejects Oklahoma nursing home UPL program

Posted on: 7/26/17

Oklahoma’s application for a Medicaid nursing home “Upper Payment Limit” program has been disapproved by the Centers for Medicare & Medicaid Services (CMS), according to the Oklahoma Health Care Authority (OHCA).  

The nursing facility UPL program has been under development in Oklahoma since 2015. Under the proposal, “non-state government” nursing homes (owned by cities or counties) could have been eligible for additional Medicaid payments, if the city or county agreed to provide the state’s share of the additional payment, and if quality goals were met.

OHCA submitted the State Plan Amendment for this program to CMS for approval in December 2016. CMS requested additional information from the state in March 2017, and OHCA responded on May 15; CMS then asked follow-up questions on June 13 that OHCA answered on June 30. 

See related Sept. 7 OHA Hotline article, “Update on the Medicaid Nursing Facility Upper Payment Limit (UPL) program." (Rick Snyder)

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