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Medicaid program; modification of the Medicaid upper payment limit for non-state government-owned or operated

Federal Register

|January 22, 2002

Abstract:

This final rule modifies the Medicaid upper payment limit (UPL) provisions to remove the 150 percent UPL for inpatient hospital services and outpatient hospital services furnished by non-State government-owned or operated hospitals. This final rule is part of this Administration's efforts to restore fiscal integrity to the Medicaid program and reduce the opportunity for abusive funding practices based on payments unrelated to actual covered Medicaid services.

Insights

The Medicaid upper payment limit (UPL) rule is changing. The 150% UPL for public hospitals

Area of Science:

Health Policy
Healthcare Finance
Government Regulations

Background:

Medicaid program financing relies on upper payment limits (UPLs).
Certain UPL provisions have enabled potentially abusive funding practices.
Restoring fiscal integrity is a key administration goal.

Purpose of the Study:

To modify Medicaid UPL provisions.
To eliminate the 150% UPL for specific hospital services.
To prevent funding practices unrelated to actual Medicaid services.

Main Methods:

Final rule modification.
Removal of the 150% UPL threshold.
Application to non-State government-owned or operated hospitals.

Main Results:

The 150% UPL for inpatient and outpatient hospital services is removed.
This change applies to non-State government-owned or operated facilities.
Reduced opportunity for abusive funding practices.

Conclusions:

The modification enhances fiscal integrity in the Medicaid program.
This rule addresses concerns regarding payments not tied to services.
Aimed at ensuring responsible Medicaid program funding.

Read full analysis

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