Specifications include, but are not limited to: The contractor shall develop and calculate the Upper Payment Limit (hereinafter referred to as UPL) demonstrations requested by the Department of Social Services (DSS), MO HealthNet Division (hereinafter referred to as the state agency). The UPL demonstrations may include those for nursing facilities, inpatient and outpatient hospitals, clinics, physicians, intermediate care facilities for individuals with intellectual disabilities (hereinafter referred to as ICF/IIDs), psychiatric residential treatment facilities (hereinafter referred to as PRTFs), and institutes for mental disease (hereinafter referred to IMDs). Other UPL demonstrations may include those requested by the Centers for Medicare & Medicaid Services (hereinafter referred to as CMS) and by the state agency. The contractor shall perform all services in accordance with the provisions and requirements stated herein and to the sole satisfaction of the state agency.
