36C24418Q0061-006.docx
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- 36C24418Q0061
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36C24418Q0061 Attachment 5- Medicare pricing Table Instructions.docx
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Attachment 5- Medicare Pricing Table Instructions
MEDICARE PRICING TABLE
Medicare Resource Utilization Group (RUG) rates have 66 Levels of Care, the Department of Veteran Affairs anticipates determining rates based on 8 blended categories’ comprised of the following: Note to Offerors…..the below will be completed for final contract. Offeror should complete Pricing Attachment to solicitation and submit with offer. Use FY17 Medicare rates.
| CLINs |
| RESOURCE UTILIZATION GROUP (RUGs) IV (66 Levels of Care) grouped into 8 blended categories. |
Source: Federal Register RUGS IV Pricing Schedule
| Medicare Rate and Wage Adjustment average for grouping |
| Percentage Add-On or Discount (offeror can use different discount or add-on for each line item) |
| Adjusted Medicare |
Per Diem Rate
| 0001 |
| Rehab Plus Extensive Services |
inclusive of: RUX, RUL, RVX, RVL, RHX, RHL, RMX, RML,RLX
| 0002 |
| Rehab |
inclusive of: RUC, RUB, RUA, RVC, RVB, RVA, RHC, RHB, RHA, RMC, RMB, RMA, RLB, RLA
| 0003 |
| Extensive Services |
inclusive of: ES3, ES2, ES1 $604.68 From example below -15% Determined by Offeror $513.89 Rate to invoice VA
| 0004 |
| Special Care High |
inclusive of: HE2, HE1, HD2, HD1, HC2, HC1, HB2, HB1
| 0005 |
| Special Care Low |
inclusive of: LE2, LE1, LD2, LD1, LC2, LC1, LB2, LB1
| 0006 |
| Clinically Complex |
inclusive of: CE2, CE1, CD2, CD1, CC2, CC1, CB2, CB1, CA2, CA1
| 0007 |
| Impaired Cognition & Behavior Problems |
inclusive of: BB2, BB1, BA2, BA1
| 0008 |
| Reduced Physical Function |
inclusive of: PE2, PE1, PD2, PD1, PC2, PC1, PB2, PB1, PA2, PA1
Example below for York County. Wage Adjustment will need to be revised based on County, ie, Lancaster, Lebanon, York, Perry, Dauphin, etc…..
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