Attachment 5 Medicare Pricing Schedule Final.pdf
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- Solicitation number
- 36C26320R0125
About this file
This solicitation is for community nursing home services under Indefinite Delivery Indefinite Quantity contracts to be awarded by the Department of Veterans Affairs, Veterans Health Administration, Network Contracting Office 23. Nursing homes in North Dakota, South Dakota, Minnesota, Wisconsin, Iowa, Illinois, and Nebraska are invited to submit proposals on a rolling basis from March 5, 2021 through March 4, 2022 to provide services under the RUGS IV case mix reimbursement methodology as outlined in the attached pricing schedule. Awards will be made on an as-needed basis to responsible sources licensed by their respective states and qualified under Medicare. Placements will be made based on facility availability and veteran/family preferences across the counties listed in the solicitation instructions.
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Medicare RUGS IV Pricing Schedule
LINE
ITEM
RUGS IV CATEGORY
DESCRIPTION
Medicare Base Rate
Percentage Discount
Medicare Per Diem Rate
1 RUX – Extensive Services criteria + RU Criteria – ADL 16-18
2 RUL – Extensive Services criteria + RU Criteria – ADL 7-15
3 RVX – Extensive Services criteria + RV Criteria – ADL 16-18
4 RVL - Extensive Services criteria + RV Criteria – ADL 7-15
5 RHX - Extensive Services criteria + Rehab High Criteria – ADL 13-
6 RHL- Extensive Services criteria + Rehab High Criteria – ADL 7-12
7 RMX - Extensive Services criteria + RM Criteria – ADL 15-18
8 RML - Extensive Services criteria + RM Criteria – ADL 7-15
9 RLX - Extensive Services criteria + RL Criteria – ADL 7-18
10 RUC – Special Rehab Ultra High –
ADL 16-18
11 RUB – Special Rehab Ultra High –
ADL 9-15
12 RUA – Special Rehab Ultra High –
ADL 1-8
13 RVC Special Rehab Very High –
ADL 16-18
14 RVB – Special Rehab Very High –
ADL 9-15
15 RVA – Special Rehab Very High –
ADL 1-8
16 RHC – Special Rehab High – ADL 13-18
17 RHB – Special Rehab High – ADL 8-12
18 RHA – Special Rehab High – ADL 1-7
19 RMC – Special Rehab Medium –
ADL 15-18
20 RMB – Special Rehab Medium –
ADL 8-14
21 RMA – Special Rehab Medium –
ADL 4-7
22 RLB Special Rehab Low – ADL 14-
23 RLA – Special Rehab Low – ADL 1-13
24 ES3 – Extensive Services – ADL 2-
25 ES2 – Extensive Services – ADL 2-
26 ES1 – Extensive Services – ADL 2-
27 HE2 – Special Care High – ADL 15-16
28 HE1 – Special Care High – ADL
29 HD2 – Special Care High – ADL 11-14
30 HD1 – Special Care High – ADL
31 HC2 – Special Care High – ADL 6-
32 HC1 – Special Care High – ADL 6-
33 HB2 – Special Care High – ADL 2-
34 HB1 – Special Care High – ADL 2-
35 LE2 – Special Care Low - ADL 15-
36 LE1 – Special Care Low – ADL 15-
37 LD2 – Special Care Low – ADL 11-
38 LD1 – Special Care Low – ADL 11-
39 LC2 – Special Care Low – ADL 6-
40 LC1 – Special Care Low – ADL 6-
41 LB2 – Special Care Low – ADL 2-5
42 LB1 – Special Care Low – ADL 2-5
43 CE2 – Clinically Complex – ADL
44 CE1 – Clinically Complex – ADL
45 CD2 – Clinically Complex – ADL
46 CD1 – Clinically Complex – ADL
47 CC2 – Clinically Complex – ADL 6-
48 CC1 – Clinically Complex – ADL 6-
49 CB2 – Clinically Complex – ADL 2-
50 CB1 – Clinically Complex – ADL 2-
51 CA2 – Clinically Complex – ADL 0-1
52 CA1 – Clinically Complex – ADL
53 BB2 – Behavior Symptoms – ADL 2-5
54 BB1 – Behavior Symptoms – ADL 2-5
55 BA2 – Behavior Symptoms – ADL
56 BA1 – Behavior Symptoms – ADL
57 PE2 – Physical Function Reduced
– ADL 15-16
58 PE1 – Physical Function Reduced
– ADL 15-16
59 PD2 – Physical Function Reduced
– ADL 11-14
60 PD1 – Physical Function Reduced
– ADL 11-14
61 PC2 – Physical Function Reduced
– ADL 6-10
62 PC1 – Physical Function Reduced
– ADL 6-10
63 PB2 – Physical Function Reduced
– ADL 2-5
64 PB1 – Physical Function Reduced
– ADL 2-5
65 PA2 – Physical Function Reduced
– ADL 0-1
66 PA1 – Physical Function Reduced
– ADL 0-1
| MEDICARE PRICING SCHEDULE - 1 |
| QASP - MEDICAID - FINAL |
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