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Upper Payment Limit (UPL) Payments

Hospital Payment Schedule

Payment Made November 7
Payment Made December 25
Payment Made March 31
Payment Made June 2

These dates are preliminary and subject to change.

New Update - Nov. 1, 2016

ODM Finalizes SFY 2017 UPL Payments – Payments Set For Next Week

The Ohio Department of Medicaid has finalized over $538 million in state fiscal year 2017 supplemental Upper Payment Limit payments, and has initiated the payment process. Hospitals should receive the first quarterly payment on or about Monday, Nov. 7. An updated schedule of payments, by hospital, can be found here.
The next quarterly UPL payment will be made after the collection of the second franchise fee due date—Dec. 9—likely around Dec. 25.
Please note these updated UPL payments do not include MCP Incentive payments, which are processed by OHA. Hospitals should receive the final month of SFY 2016 MCP Incentive payments along with the first five months of SFY 2017 MCP Incentive payments on or about Dec. 7.
If you have any questions, please contact Daniel Vielhaber.

New Update - Oct. 24, 2016

On Friday, OHA and our consultants at Health Management Associates were able to make progress towards finalizing SFY 2017 Upper Payment Limit payment amounts with the Ohio Department of Medicaid. While the updated amounts, by hospital, should still be considered subject to change, these are much more firm estimates than what was previously shared with members in September. However, detailed UPL summary reports will not be available until the amounts are finalized.
With the first quarterly franchise fee installment due to ODM Oct. 21, we want to ensure our members had the most up to date payment estimates possible. ODM reiterated on Friday it will process the first quarter of SFY 2017 UPL payments on or about Nov. 4.
Since the previous estimates, ODM has provided OHA with the necessary updated internal claims data, conducted a thorough UPL model review and recommended other adjustments to the original preliminary model. Additionally, ODM clarified its intent regarding expansion-related UPL amounts, applying the same payment formulas to both expansion and non-expansion utilization data.
OHA anticipates finalizing these amounts*, barring any unforeseen circumstances, next week.
Please review the schedule and contact if you have any questions relating to the calculated amounts. We will let you know when UPL payments are finalized.
*-please note these payment amounts include GRF-funded children’s hospital supplemental payments.


OHA Releases Preliminary 2017 Upper Payment Limit Amounts

In late September, OHA has posted online a preliminary schedule of 2017 hospital franchise fee and UPL payment amounts, by hospital. These UPL payments are for fee-for-service Medicaid only, and are based on updated calculations of SFY 2015 Ohio Medicaid cost report information. The UPL payments do not include payment amounts for children’s hospitals under the general revenue funded quality line-item program.
Please note that the Ohio Department of Medicaid continues to review these preliminary calculations and, as such, these numbers are still subject to change and could change significantly. The Medicaid expansion-related UPL payments listed on the schedule are based on placeholder information provided to OHA by ODM and at this time it is uncertain if the underlying data used to make those payments will change or not.

UPL Payment Processed
November 4
December 25
March 31
June 2

New Update - May 26, 2016

2016 Upper Payment Limit with Inpatient and Outpatient Detail

OHA releases further detail behind the supplemental UPL payment information posted last week. To see the detail, including break-downs by inpatient and outpatient, please click here.

New Update - May 20, 2016

2016 Upper Payment Limit Payments Finalized

ODM has finalized the 2016 UPL payments. A list of all payments - and a breakdown of the components of each payment - can be found here

If you have any questions or concerns, please contact Ryan Biles or Daniel Vielhaber.

New Update - Jan. 28, 2016

Supplemental Upper Payment Limit  Payments

CMS has until early May to review and approve the SPAs. This follows the state’s receipt of two formal requests for additional information during CMS’ initial 90-day review period. OHA will attempt to expedite the final CMS 90-day review as much as possible. As of now, OHA anticipates a May/June timeframe for payments of supplemental UPLs. OHA will provide members with updated UPL payment estimates as soon as CMS approval becomes imminent. OHA shared preliminary estimates with members last October, but feel free to request them if you did not receive them earlier by contacting
In the meantime, OHA will continue to process inpatient MCP Incentive payments in partnership with Ohio’s five Medicaid managed care plans. Payments were processed in December for the first five months of SFY 2016, and we anticipate making additional two-month payments in early February, early April and early June. The final month of SFY 2016 MCP Incentive payments will be processed in December, along with the first five months of SFY 2017 incentive payments. 

December 2, 2015

CMS Considers SPA for 2016 and 2017 UPL Payments

The Ohio Department of Medicaid submitted to the Centers for Medicare and Medicaid Services a state plan amendment for the reauthorization of hospital inpatient and outpatient Upper Payment Limit payments for 2016 and 2017 on Sept. 29, 2015. CMS has 90 days from the date of submission, until Dec. 28, to request additional information from ODM or approve the amendment.
At this time, there is no update from ODM on the progress towards approval, and therefore OHA continues to anticipate that CMS will request additional information and push approval back until the spring of 2016. 
In early October, OHA shared hospital-specific franchise fee, UPL and managed care incentive payment estimates with member finance contacts. Those initial estimates are subject to change based on a variety of factors, including any changes requested by CMS in the UPL amendment approval process. As soon as OHA receives more information from ODM on the approval process, we will provide an update to members.

May 11, 2015

Ohio Medicaid Begins Processing SFY 2015 UPL Payments

On Monday, May 11, the Ohio Department of Medicaid (ODM) will pay hospitals 50 percent of the state fiscal year (SFY) 2015 Upper Payment Limit supplemental Medicaid payments for both inpatient and outpatient services. These payments will be consistent with the preliminary UPL payment amounts OHA posted online in January. Hospitals will receive approximately $290.7 million in this round of UPL payments, with another $290.7 million due to be paid to hospitals on or before June 4. UPL payments are supplemental payments that act to bring Medicaid fee-for-service (traditional Medicaid program) payments up to par with what Medicare would have paid for the same services. Please see the updated final payment schedule (link), which is available online.

Other News

ODM Releases Revised Payment Schedule for 2015 Upper Payment Limit Payments

UPL payments are designed to bring Medicaid payment levels up to par with Medicare payment levels for state-owned hospitals, other government-owned hospitals, and private hospitals.  UPL payments for Ohio hospitals in SFY 2014 will amount to nearly $492 million under formulas developed by the OHA in collaboration with ODM and our consultants at Health Management Associates.  OHA will again work with ODM to determine SFY 2015 UPL payments for hospitals, and we hope to release further specifics on next year’s program later this summer.

SFY 2016 UPL Payments
SFY 2015 UPL Payments
SFY 2014 UPL Payments
SFY 2013 UPL Payments
SFY 2012 UPL Payments
SFY 2011 UPL Payments
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