Public Hospital UPL Program

Background

Facing a $70 million dollar budget gap, a large county-owned teaching hospital was in need of additional revenue to continue fulfilling the critical safety net services it provided to the community. Sellers Dorsey worked with its client, a key stakeholder committed to the success of the hospital, to approach hospital leadership with Medicaid financing initiatives to generate additional federal Medicaid funds for the hospital. Together with its client and the leadership of the hospital, Sellers Dorsey worked with the key partners to seek local, state, and federal approval for hospital inpatient and outpatient upper payment limit (UPL) programs.

The Collaboration

In working with our client and its partners, Sellers Dorsey:

  • Developed and outlined an alternative UPL methodology for additional federal claiming;
  • Reinstated a graduate medical education supplemental program with a new methodology and new state share;
  • Engaged county officials and board members to further their understanding of the programs;
  • Examined claims data to determine available room in the UPL;
  • Participated in discussions with state officials to obtain state support;
  • Drafted public notices, state plan amendments, and answers to CMS questions; and
  • Provided technical expertise during discussions between the state and CMS to secure approval.

The Results

Sellers Dorsey successfully identified a source of state share for additional federal Medicaid participation, leading to an approved set of state plan amendments from CMS.  These initiatives have been implemented and are estimated to generate $35 million annually for the safety net hospital in federal Medicaid revenue.