Health Care Industry Brochure

Upper Payment Limit (UPL) Supplemental Payment Program

Many states have an Upper Payment Limit (UPL) Supplemental Payment program or are developing one. These programs generate significant additional reimbursement opportunities for participants and usually allow nursing home providers whose operating license is owned by a nonstate government-owned entity to participate.

UPL programs allow participating facilities to receive additional payments for their Medicaid residents up to an amount that would have otherwise been paid by Medicare Part A for the same service. Participating entities make intergovernmental transfer (IGT) payments to the state, which subsequently draw down federal matching dollars. These funds are then redistributed to participating facilities.

Because these programs vary by state, we encourage you to contact us for the latest information on your state’s program.

Is this an opportunity in my state?
These programs are quickly changing and expanding. BKD is actively involved in helping many states develop or redesign their UPL program, so contact us and we’d be happy to give you the most current news in your state.

What makes this program so attractive?
This structure:

Download our UPL program overview for deal and administration considerations as well as an overall program snapshot.

Kevin Pahud

Partner
317.383.4000

Chris Murphy

Partner
918.584.2900

University Health Care System

“BKD has introduced to us multiple subject matter experts and several proactive ideas regarding opportunities for additional reimbursement and operational improvements, one of which already yielded substantial additional reimbursement.”

— Tom Lowenkamp, Vice President of Continuing Care
University Health Care System

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