{
  "id": "RL31021",
  "type": "CRS Report",
  "typeId": "REPORTS",
  "number": "RL31021",
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  "source": "EveryCRSReport.com, University of North Texas Libraries Government Documents Department",
  "versions": [
    {
      "source": "EveryCRSReport.com",
      "id": 306066,
      "date": "2005-01-21",
      "retrieved": "2016-04-07T19:56:31.192029",
      "title": "Medicaid Upper Payment Limits and Intergovernmental Transfers: Current Issues and Recent Regulatory and Legislative Action",
      "summary": "In accordance with Medicaid statute, the Secretary of Health and Human Services (HHS) has\nestablished, through a series of regulatory actions, upper payment limits (UPLs) for inpatient and\noutpatient services provided by certain types of facilities. In late 2000, the Secretary determined that\nregulations in effect at that time created a financial incentive for states to make higher than usual\npayments for care provided at non-state government facilities, namely, county and city facilities,\nallowing these states to claim higher federal matching dollars. States require these facilities to\ntransfer some or all of the excess funds back to the state (called an intergovernmental transfer or\nIGT). Then states use these funds to cover part of the state share of Medicaid costs and/or for other\npurposes. After HHS issued a proposed rule in October of 2000 designed to halt these practices,\nCongress mandated additional changes to upper payment limits in the  Benefits Improvement and\nProtection Act of 2000  (BIPA; incorporated by reference into  P.L. 106-554 ). Final regulations\nthat\nincluded the BIPA provisions were released by the Clinton Administration on January 12, 2001. \n \n Among other changes, this rule established separate UPLs for inpatient services provided by\nlocal government facilities, and for the subset of local public hospitals only, a separate higher\npayment rate was allowed. It also provided a separate UPL for private facilities. Parallel rules were\nestablished for outpatient hospital and clinic services. Three phase-out or transition periods for states\nwith enhanced payment arrangements that were noncompliant were also specified. Application of\na specific transition period to a given state was primarily dependent on the effective date of its plan\ndescribing the enhanced payment arrangement. Phase-out periods varied in duration, and except for\nthe shortest period, required specific percentage reductions in excess payments for each transition\nyear. \n \n The Bush Administration made two changes to the Clinton final rule: (1) creation of a separate,\nminimum 1-year transition period for certain states that have only recently received approval for\nenhanced payment arrangements, and (2) elimination of the higher payment rate for non-state public\nhospitals.\n \n While there was no legislative action in the 108th Congress dealing with Medicaid UPL rules,\nthere has been considerable on-going interest in how states finance the non-federal share of Medicaid\ncosts, especially the use of IGTs. CBO has estimated that \u201cother payments to\nproviders,\u201d largely\ncomprised of UPL dollars, will total $4.8 billion in FY2005, representing approximately 2.7% of\nfederal Medicaid spending this year. The Bush Administration has implemented several strategies\nto rein in both UPL and IGT practices, including greater scrutiny of state financing methods in\nMedicaid waiver applications and state plan amendments, and new administration policy\ndistinguishing IGTs that are permissible (e.g., using state and local tax revenues) from those that are\nimpermissible (e.g., recycling mechanisms under which payments to providers are returned to the\nstates). Additional reforms are expected during the 109th Congress.",
      "type": "CRS Report",
      "typeId": "REPORTS",
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      "topics": []
    },
    {
      "source": "University of North Texas Libraries Government Documents Department",
      "sourceLink": "https://digital.library.unt.edu/ark:/67531/metacrs7486/",
      "id": "RL31021 2002-04-24",
      "date": "2002-04-24",
      "retrieved": "2005-10-24T11:28:47",
      "title": "Medicaid Upper Payment Limits and Intergovernmental Transfers: Current Issues and Recent Regulatory and Legistlative Action",
      "summary": null,
      "type": "CRS Report",
      "typeId": "REPORT",
      "active": false,
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      ],
      "topics": [
        {
          "source": "LIV",
          "id": "Health policy",
          "name": "Health policy"
        },
        {
          "source": "LIV",
          "id": "Intergovernmental fiscal relations",
          "name": "Intergovernmental fiscal relations"
        },
        {
          "source": "LIV",
          "id": "Medicaid",
          "name": "Medicaid"
        },
        {
          "source": "LIV",
          "id": "State and local government",
          "name": "State and local government"
        },
        {
          "source": "LIV",
          "id": "Welfare",
          "name": "Welfare"
        }
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  ],
  "topics": [
    "Health Policy"
  ]
}