Medicaid is rapidly becoming every state’s largest health insurer, and with that status comes an increasing focus on Medicaid’s payment policies. Yet to date, Medicaid payment reform initiatives have largely neglected to address a significant component of Medicaid payment policies — https://turbo-tax.org/. Combined, the two most significant forms of supplemental payments — Disproportionate Share Hospital (DSH) Payments and Upper Payment Limit (UPL) payments — represent more than one-third of Medicaid fee-for-service payments to hospitals, and hospital payments constitute 23 percent of all Medicaid spending.

• The cost of the bond is covered by your policy as long as the bond amount is within the applicable limit of insurance.
• The report breaks down supplemental payments into FFS payments, managed care pass-through payments, and Medicaid waiver supplemental payments.
• When you log in, click on “Full Catalog” in the left-hand menu and type “Supplement” into the search box.
• The Ambulance Services Supplemental Payment Program is an enhanced supplemental payment program for publicly owned ground emergency ambulance providers in Medicaid Fee-for-Service.

Although states are required to make Medicaid DSH payments, no federal requirement exists for states to make other Medicaid supplemental payments (i.e., non-DSH supplemental payments). However, in FY2017, all states except Alaska, Delaware, and Vermont made non-DSH supplemental payments.21 Among the states that make non-DSH supplemental payments, most states make such payments to hospitals and nursing homes. Some of these states also make supplemental payments to other providers, including intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs), physicians, and freestanding nonhospital clinics. These payments are included in the payments states make to MCOs, and the MCOs are expected to make the payments to providers as directed by the state. The Centers for Medicare & Medicaid Services (CMS) also may provide Medicaid waiver authority to permit states to make certain supplemental payments that they are not otherwise permitted to make under Medicaid rules.

Payroll Information & Tax Forms for Inactive and Retired Employees

Montana is implementing the Supplemental Payment program to support maintaining a stable workforce and preserve significantly impacted home and community-based service behavioral health provider networks. These payments are intended to support providers with the increased costs of hazard/retention pay, higher staffing levels, and personal protective equipment and other supplies. Many liability insurance policies will include clauses in which that insurer agrees to pay for supplementary payments. This can be extremely helpful if an insured party has to participate in a claims investigation.

Any financial incentives provided to FQHCs under their MA contracts, such as risk pool payments, bonuses, or withholds, are prohibited from being included in the calculation of supplemental payments due to the FQHC. In New York, voluntary hospitals receive $235 million through UPL payments, with the nonfederal portion derived from State revenues.3 The UPL amount received by voluntary hospitals is credited against their Indigent Care Pool allotments, with the combined total set at $995 million each year. Benefits like stipends, vacation pay, and paid time off don’t qualify as supplemental income. In the case of vacation pay and PTO, they are subject to the same withheld income tax as regular pay. For example, suppose your policy includes a $100,000 limit for damage to premises rented to you.

Disproportionate Share Hospital Payments

This report provides an overview of the most prevalent types of Medicaid supplemental payments, including FFS supplemental payments, managed care pass-through payments, and Section 1115 waiver payments. The report also presents data about Medicaid FFS supplemental payment spending by state and by provider type. Graduate Medical Education are supplemental payments to support medical residency training for medical school graduates at teaching hospitals. Teaching hospitals typically incur additional costs because they are a training site for medical school graduates to receive hands-on, practical experience in treating patients. In addition to medical residents’ salary and benefits, teaching hospitals also incur additional costs for more testing and for treating sicker and more complex patients.

• States also have used Delivery System Reform Incentive Payment (DSRIP) waivers to maintain supplemental payments after conversion to a managed care delivery model.
• These payments are made to many different Medicaid providers, including hospitals, nursing facilities, physicians, and mental health facilities.
• For more information about the federal medical assistance percentage, see CRS Report R42865, Medicaid Disproportionate Share Hospital Payments.
• By federal rule, UPL payments allow states to make up the difference between a reasonable estimate of what Medicare would pay and Medicaid payments (in aggregate within a type and class of provider).
• However, it can be challenging to untangle financing arrangements that have evolved over many years.
• Healthcare providers (e.g., hospitals, doctors, nursing facilities, etc.) receive payments for the services they provide to persons with Medicaid.

Uncompensated Care payments to hospitals are authorized under Section 1115 demonstrations. UC payments originated as a way for Texas to continue to expand managed care in Medicaid programs and continue making supplemental payments to hospitals. States negotiate the parameters of their uncompensated care pools with the Centers for Medicare and Medicaid Services (CMS). Texas UC payments may be used to reduce the actual uncompensated cost of medical services provided to uninsured individuals who meet a provider’s charity care policy. The medical services must meet the definition of “medical assistance” defined in federal law. The distribution between payments for services and supplemental payment expenditures varies by the type of provider.

Why GAO Did This Study

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For example, states may provide https://turbo-tax.org/supplemental-payments/ to providers to support quality initiatives, graduate medical education (GME), and certain types of facilities (e.g., rural or safety-net providers), among other reasons. States make supplemental payments through FFS, managed care, and waivers, but the mechanism for making these payments differs according to the service delivery system. States also have used Delivery System Reform Incentive Payment (DSRIP) waivers to maintain supplemental payments after conversion to a managed care delivery model. While DSRIP waivers can help a state redeploy supplemental payments to support its delivery system reform objectives, not all states are in a position to secure such a waiver. In addition, a DSRIP waiver is not a permanent solution to redeployment, because these waivers are intended to be time-limited.19 Exhibit 4 lists the 10 states that have redirected supplemental payments through Section 1115 waivers to support delivery system transformation or uncompensated care pools, or both.

Priorities for Reform

In determining whether and how much money to allocate to UPL payments, states start by calculating the difference between the UPL for services provided by a class of institutions and the aggregate amount Medicaid paid for those services under FFS. States then target the amount of the difference—or some portion of it—to a subgroup of institutions, allocating it among eligible institutions based on state-defined criteria that sometimes, but not always, include Medicaid days, visits, or discharges. There are no provider-specific limits and, therefore, individual providers may receive more than their reported Medicaid costs as long as the aggregate payments to all providers in their class do not exceed the aggregate UPL. (However, payments for inpatient hospital services may not exceed a provider’s customary charges to the general public for services.) As of 2013, states are required to submit annual UPL calculations to CMS and demonstrate that Medicaid payments do not exceed the UPL. In their current form, supplemental payments—in particular, UPL payments—are not compatible with emerging payment reforms.

Relationship to other supplemental payments – GME payments are considered Medicaid payments for the purposes of calculating Medicaid shortfall for DSH and UPL purposes. Base Payments are made for specific services (e.g., surgery, x-rays, diagnostic tests) provided to persons with Medicaid. These payments can be made through a fee-for-service (FFS) method or through a managed care service delivery system. Supplemental Payments are payments above and beyond standard Medicaid Payments made to Home and Community Based Services (HCBS) providers that deliver physical and behavioral health services in the home or community. The Supplemental Payment program is part of the Home and Community Services Spending Plan and Narrative. Supplemental wages paid on top of regular wages introduce a different calculation bracket.