Inpatient and Outpatient Hospital UPL Payment Programs
The State Plan Amendment (SPA) 23-0029 for Hospital Upper Payment Limit (UPL) payments has been approved by the Centers for Medicare & Medicaid Services (CMS). This SPA allows the Division of Medicaid (DOM) to establish a hospital UPL program effective October 1, 2023 for inpatient and outpatient hospital services. UPL payments are supplemental payments and are intended to make up the difference between Medicaid fee-for-service base payments and the amount that Medicare would have paid for the same service. The state legislature grants authority for the UPL payment program in Miss. Code Annotated § 43-13-117 (A) (18) (b) (i) 1. The program is funded by the hospital provider tax authorized in Miss. Code Annotated § 43-13-117 (A) (18) (b) (ii). UPL calculations are reviewed and approved by CMS annually.
The Inpatient State Plan pages may be found in Attachment 4.19-A, Pages 67-69, and the Outpatient State Plan pages may be found in Attachment 4.19-B, Pages 2a.6-2a.9. The SPA submission for both may also be found here.
Federal regulations govern these UPL calculations and require the total UPL to be divided into three hospital ownership classes – State Government Owned (SGO), Non-State Government Owned (NSGO) and Private. DOM further divides these three classes into Small Rural Hospitals and Other Hospitals for the UPL payment allocations. The Small Rural Hospital payments in each class may be increased by up to a factor of two (2) compared to the Other Hospital payments in that class. The percentages allocated to Small Rural Hospitals and Other Hospitals will not change by more than ten (10) percentage points from one year to the next.
Inpatient payments are allocated by hospital within the hospital class based on historic hospital total inpatient days as filed on the hospitals’ cost reports. Outpatient payments are allocated by hospital within the hospital class based on historic outpatient utilization (based on Medicaid payments) as filed on the hospitals’ cost reports.
DOM used the hospital cost reports for fiscal year 2022 as the base data period for the State Fiscal Year 2024 UPL calculation.
2024 Inpatient Upper Payment Limit Allocation for Small Rural/Other Hospitals
2024 Outpatient Upper Payment Limit Allocation for Small Rural/Other Hospitals
