WEST VIRGINIA MEDICAID PROGRAM
STATE PLAN AMENDMENT 17-003
ELIMINATION OF UPPER PAYMENT LIMIT (UPL) PROGRAM
Pursuant to 42 U.S.C. §1396a(a)(13)(1997) and 42 C.F.R. §447.205, the Department of Health and Human Resources (“Department”), Bureau for Medical Services (“BMS”) provides notice of the filing of a state plan amendment (SPA), identified as SPA 17-003, elimination of upper payment limit (UPL) program. The SPA eliminates a program paying supplemental payments up to the amount of Medicare rates to hospital participating in the prospective payment system (PPS). The money will still be paid to the hospitals, but through capitation payments made to the managed care organizations, which manage 80% of the total Medicaid population in West Virginia now. This payment methodology is also known as a “direct payment program.”
This SPA will be effective on October 1, 2017. The expected fiscal impact for fiscal year 2018 is $0. The expected fiscal impact for fiscal year 2019 is $0.
The SPA can be found by clicking on the link below or will be available for public inspection in each county office of the Department of Health and Human Resources during normal business hours, 8:30 a.m. to 4:30 p.m., beginning Friday, September 29, 2017 through Monday, October 30, 2017.
Written comments may be sent to the West Virginia Department of Health and Human Resources, Bureau for Medical Services, 350 Capitol Street, Suite 251, Charleston, WV 25301-3706, or by email at SPAComments@wv.gov
. Any written comments received will be available for review at the above address during normal business hours, 8:30 a.m. to 4:30 p.m., beginning Friday, September 29, 2017 through Monday, October 30, 2017. Comments will also be posted for review on the BMS website.