Attachment 4d Nebraska Medicaid Pricing Schedule.pdf

PDF 121 KB Posted Feb 17, 2022

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: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 23

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Levels of Care Medicaid Rates Total Add on

Total Per Diem

PA1/101

PA2/102

PB1/103

PB2/104

RBH/105

PC1/110

PC2/111

PD1/112

PD2/113

PE1/114

PE2/115

BA1/120

BA2/121

BB1/122

BB2/123

IA1/130

IA2/131

IB1/132

IB2/133

CA1/140

CA2/141

CB1/142

CB2/143

CC1/144

CC2/145

SSA/150

SSB/151

SSC/152

RAA/160

RAB/161

RAC/162

RAD/163

SE1/170

SE2/171

SE3/172

STS/180

NEBRASKA PRICE SCHEDULE

Attachment 4d- Nebraska Medicaid Pricing Schedule

Sheet1

File details come from the government source that posted it. Updated Feb 17, 2022.