Attachment 4c Minnesota Medicaid Pricing Schedule.pdf
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MINNESOTA
Medicaid Price Schedule
Classification (Medicaid RUG IV Rates) Group Medicaid Case Mix Rate (Base)
All Inclusive VA Per Diem Rate (Base + Add-on)
Rehabilitation RAE
Rehabilitation RAD
Rehabilitation RAC
Rehabilitation RAB
Rehabilitation RAA
Extensive Services Level 3 ES3
Extensive Services Level 2 ES2
Extensive Services Level 1 ES1
Special Care HIGH with Depression HE2
Special Care High with NO Depression HE1
Special Care HIGH with Depression HD2
Special Care High with NO Depression HD1
Special Care HIGH with Depression HC2
Special Care High with NO Depression HC1
Special Care HIGH with Depression HB2
Special Care High with NO Depression HB1
Special Care LOW with Depression LE2
Special Care LOW with NO Depression LE1
Special Care LOW with Depression LD2
Special Care LOW with NO Depression LD1
Special Care LOW with Depression LC2
Special Care LOW with NO Depression LC1
Special Care LOW with Depression LB2
Special Care LOW with NO Depression LB1
Clinically Complex with Depression CE2
Clinically Complex with NO Depression CE1
Clinically Complex with Depression CD2
Clinically Complex with NO Depression CD1
Clinically Complex with Depression CC2
Clinically Complex with NO Depression CC1
Clinically Complex with Depression CB2
Clinically Complex with NO Depression CB1
Clinically Complex with Depression CA2
Clinically Complex with NO Depression CA1
Behavior/Cognition with Restorative Nursing
BB2
Behavior/Cognition with NO Restorative Nursing
BB1
Attachment 4c: Minnesota Medicaid Pricing Schedule
Behavior/Cognition with Restorative Nursing
BA2
Behavior/Cognition with NO Restorative Nursing
BA1
Reduced Function with Restorative Nursing
PE2
Reduced Function with NO Restorative Nursing
PE1
Reduced Function with Restorative Nursing
PD2
Reduced Function with NO Restorative Nursing
PD1
Reduced Function with Restorative Nursing
PC2
Reduced Function with NO Restorative Nursing
PC1
Reduced Function with Restorative Nursing
PB2
Reduced Function with NO Restorative Nursing
PB1
Reduced Function with Restorative Nursing
PA2
Reduced Function with NO Restorative Nursing
PA1
NOT
Classified
AAA
Rate Weight of 1
All Inclusive VA Per Diem Rates include the following: Drugs, Supplies, Oxygen, X-Ray, Laboratory, Physicians visits, Respiratory Therapies, and Rental Equipment
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