Number: RL31021
Title: Medicaid Upper Payment Limits and Intergovernmental Transfers: Current Issues and Recent Regulatory and Legislative Action
Authors: Elicia J. Herz, Domestic Social Policy Division 
Abstract: Final regulations that included the BIPA provisions were released by the Clinton Administration on January 12, 2001. Among other changes, this rule established separate UPLs for inpatient services provided by local government facilities, and for the subset of local public hospitals only, a separate higher payment rate was allowed. It also provided a separate UPL for private facilities. Parallel rules were established for outpatient hospital and clinic services. Three phase-out or transition periods for states with enhanced payment arrangements that were noncompliant were also specified. Application of a specific transition period to a given state was primarily dependent on the effective date of its plan describing the enhanced payment arrangement. Phase-out periods varied in duration, and except for the shortest period, required specific percentage reductions in excess payments for each transition year. The Bush Administration made two changes to the Clinton final rule: (1) creation of a separate, maximum 1-year transition period for certain states that have only recently received approval for enhanced payment arrangements, and (2) elimination of the higher payment rate for non-state public hospitals.
Pages: 20
Date: January 21, 2005