Attachment 4b Iowa 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
Issued by

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Price/Cost Schedule Reimbursement Rate box (D3) MEDICAID RATE RUGS III 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 Behavior Problems BA1, BA2, BB1, BB2

0001C VA Impaired Cognition IA1, IA2, IB1, IB2

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

CC2

0003 VA Special Care SSA, SSB, SSC

0004 VA Extensive Service SE1, SE2, SE3

0005 VA Light Rehabilitation RAA, RAB

0006 VA Heavy Rehabilitation RAC, RAD

0007 VA Rehabilitation + N/A Extensive Services

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 Iowa Department of Human Services Medicaid Reimbursement Rates, effective Date:

Attachment 4b- Iowa Medicaid Pricing Schedule

IOWA RUGS III CLINS

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