OUTPATIENT UPPER PAYMENT LIMIT (UPL) NSGO-PUBLIC HOSPITAL


Contacts

SFY2017 Reports

SFY2016 Reports

SFY2015 Reports

SFY2014 Reports

SFY2013 Reports

SFY2012 Reports

SFY2011 Reports

SFY2010 Reports

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