Attachment 4 Medicaid Pricing Schedule Information and State Schedules.pdf

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Attached to
VISN 23 36C26320R0126 0008 Updated Fargo and Central Iowa Needed Counties List, Medicaid-based Open & Continuous Solicitation, Closing Date 04 March 2023
Solicitation number
36C26320R01260003
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Attachment 4f South Dakota Medicaid Pricing Schedule.pdf PDF
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Attachment 4: Medicaid Schedules

Instructions:

1. Find the schedule that corresponds with the state your nursing home is in:

4a: Illinois Medicaid Pricing Schedule 4b: Iowa Medicaid Pricing Schedule 4c: Minnesota Medicaid Pricing Schedule 4d: Nebraska Medicaid Pricing Schedule 4e: North Dakota Medicaid Pricing Schedule 4f: South Dakota Medicaid Pricing Schedule

2. If you know your nursing home’s current Medicaid base rates, use those rates to fill in the base rates section of your state’s Medicaid Pricing Schedule

a. If you do not know the Medicaid base rates, contact your state’s department of health to request the current Medicaid base rates for your home. The VA is not responsible for providing you this information. However, you may email Diana.Rosier@va.gov with questions.

3. Fill the base rates into your State’s Medicaid Pricing Schedule.

4. Next, determine your proposed Medicaid add-on percentage and add to the Schedule

5. Lastly, multiply the base rates by your proposed add-on percentage to arrive at your proposed rates.

mailto:Diana.Rosier@va.gov

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