Attachment 4a Illinois Medicaid Pricing Schedule.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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Illinois Nursing Homes Please List Your Medicaid Price/Cost Schedule Reimbursement Rate Box (D3) MEDICAID RATE RUG 48 Category

CLIN

Medicaid Base Rates

Percentage Add-On

Medicaid Per Diem Rates

0001 VA Basic Care Rate 0001A VA Reduced Phy Functioning PA1, PA2, PB1, PB2, PC1

PC2, PD1, PD2, PE1, PE2

0001B VA Cognitive Performance BA1, BA2

0001C VA Behavior Symptoms BB1, BB2

0002 VA Clinically Complex CA1, CA2, CB1, CB2, CC1

CC2, CD1, CD2, CE1, CE2

0003 VA Special Care Low LB1, LB2, LC1, LC2, LD1

LD2, LE1, LE2

0004 VA Special Care High HB1, HB2, HC1, HC2,HD1

HD2, HE1, HE2

0005 VA Extensive Service ES1, ES2, ES3

0006 VA Light Rehabilitation RAA, RAB

0007 VA Heavy Rehabilitation RAC, RAD, RAE

0008 VA Specialized Care N/A 0008A Dementia/Alzheimer's Unit 0008B Young Adult Program 0008C HIV/AIDS Unit 0008D Clinitron Dependent

Calculations utilized are based upon Illinois Department of Public Health Medicare Reimbursement Rates, effective Date:

Attachment 4a: Illinois Medicaid Pricing Schedule

ILLINOIS 48 Grouper CLINS

File details come from the government source that posted it. Updated .