Private Upper Payment Limit Program (UPL)

In 2006, The Texas Health and Human Services Commissions received approval from the Centers for Medicare and Medicaid Services to amend its Medicaid state plan to authorize a Medicaid supplemental payment program for private hospitals subject to the limitations of the Medicare UPL.

The supplemental UPL payments are available on a regional basis throughout the state for privately owned hospitals that have a collaborative agreement (an indigent care affiliation agreement) with a hospital district or other state or local governmental entity.

The program offers an opportunity to bring additional federal funds by cooperative agreements between the private facilities and area governmental entities willing to commit the state share of supplemental UPL payments in return for services benefiting the community.

DHCG provides turnkey operation in the initial establishment and ongoing administration of the program.