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Office of Program Policy Analysis and Government Accountability

Uncertainty Exists Regarding Florida's Proposed Physician Upper Payment Limit Program, Report No. 03-15, February 2003
 
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  • Federal Medicaid regulations allow states flexibility to disburse supplemental payments to cover the difference between standard Medicaid fees and the usual and customary charges for certain providers.  These supplemental payments are often referred to as upper payment limit programs.
  • In November 2002, the Agency for Health Care Administration submitted a Medicaid plan amendment to the federal government to allow payments for physician services provided through public teaching hospitals and certain other facilities.  The agency estimates this program will generate approximately $62 million in supplemental federal funds through this arrangement in Fiscal Year 2002-03.
  • Florida’s plan amendment is currently under review by the federal Centers for Medicare and Medicaid Services.  However, uncertainty exists as to when, and at what level funding will be approved by the federal government.
  • This report includes policy options for legislative consideration.  The Legislative Budget Commission may need to re-address these issues if federal approval is not received before the end of the 2003 Legislative Session.


    Copies of this report in print or alternate accessible format may be obtained by telephone (850/488-0021), by FAX (850/487-9213), in person, or by mail (OPPAGA Report Production, Claude Pepper Building, Room 312, 111 W. Madison St., Tallahassee, FL 32399-1475).
    e-mail address: oppaga@oppaga.fl.gov


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