INPATIENT UPPER PAYMENT LIMIT (UPL) PRIVATE HOSPITALS


Upper Payment Limit (UPL) Supplemental Payment Program

Federal Medicaid regulations allow for State Medicaid Agencies to pay hospitals under a Fee-For-Service environment an amount that would equal what Medicare would have paid for the same services.  This concept is referred to as the Upper Payment Limit (UPL). 
Nevada currently has Inpatient (IP) and Outpatient (OP) Public UPL Supplemental Payment Program, and Inpatient (IP) Private UPL Supplemental Payment Program.  The formula for calculating and distributing these payments is authorized pursuant to the Medicaid State Plan Attachment 4.19 A, Pages 32 - 33a (IP UPLs) and Attachment 4.19-B, Page 20 (OP UPL).

    Last Edited: 12/16/2016