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SPA 18-0002 Physician UPL submitted to CMS

State Plan Amendment (SPA) 18-0002 Physician Upper Payment Limit (UPL) is being submitted to allow the Division of Medicaid to update the initial Medicare equivalent of the average commercial rate (ACR) ratio, effective January 1, 2018.

Pursuant to the Social Security Act § 1902(a)(30) and 42 CFR §§ 447.10, 447.204 and Miss. Code Ann. § 43-13-17, Mississippi Medicaid makes supplemental payments for physicians and other professional services practitioners who are employed by or contracted with a qualifying hospital. The term “qualifying hospital” means a Mississippi state-owned academic health science center with a Level 1 trauma center, Level 4 neonatal intensive care nursery, an organ transplant program, and more than a four hundred (400) physician multispecialty practice group. These supplemental payments will equal the difference between the Medicare equivalent of the ACR and the Medicaid allowed amount.

The Medicare equivalent ratio must be rebased/updated every three (3) years under the Medicare equivalent of the ACR methodology as required by SPA 15-005. The initial Medicare equivalent of the ACR ratio, 1.5914, was determined effective January 1, 2015. A new Medicare equivalent of the ACR ratio, 1.5880, was determined with an effective date of January 1, 2018.

SPA 18-0002 Physician UPL proposed pages