Attachment 6 Sample Medicare RUGs IV Pricing Schedule.pdf
PDF 144 KB Posted
- Attached to
- Open and Continuous Community Nursing Home RFQ
- Solicitation number
- 36C25725Q0034
About this file
This is a sample pricing schedule template for Medicare RUGs IV (Resource Utilization Groups) categories used in a Department of Veterans Affairs solicitation for community nursing home services. The template contains 66 line items organized into major categories including Extensive Services, Special Rehabilitation (Ultra High, Very High, High, Medium, and Low), Special Care (High and Low), Clinically Complex, Behavior Symptoms, and Physical Function Reduced. Each category is further broken down by Activities of Daily Living (ADL) score ranges.
The template includes columns for Medicare Base Rate, Percentage Discount, and Medicare Per Diem Rate, though no actual rates or discounts are filled in. The document is marked as Attachment 9, effective July 22, 2022, Revision 01, and is associated with an open and continuous community nursing home RFQ (36C25725Q0034) for Veterans Integrated Service Network 17. This is a pricing template that bidders would use to submit their proposed rates for various levels of nursing home care.
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Text version
Attachment 9: Sample RUGs IV Pricing Schedule for Medicare
LINE
ITEM RUGS IV CATEGORY DESCRIPTION
Medicare Base Rate
Percentage Discount
Medicare Per Diem
Rate 1 RUX – Extensive Services criteria + RU Criteria – ADL 16-18 2 RUL – Extensive Services criteria + RU Criteria – ADL 7-15 3 RVX – Extensive Services criteria + RV Criteria – ADL 16-18 4 RVL - Extensive Services criteria + RV Criteria – ADL 7-15 5 RHX - Extensive Services criteria + Rehab High Criteria – ADL 13-18 6 RHL- Extensive Services criteria + Rehab High Criteria – ADL 7-12 7 RMX - Extensive Services criteria + RM Criteria – ADL 15-18 8 RML - Extensive Services criteria + RM Criteria – ADL 7-15 9 RLX - Extensive Services criteria + RL Criteria – ADL 7-18
10 RUC – Special Rehab Ultra High – ADL 16-18 11 RUB – Special Rehab Ultra High – ADL 9-15 12 RUA – Special Rehab Ultra High – ADL 1-8 13 RVC Special Rehab Very High – ADL 16-18 14 RVB – Special Rehab Very High – ADL 9-15 15 RVA – Special Rehab Very High – ADL 1-8 16 RHC – Special Rehab High – ADL 13-18 17 RHB – Special Rehab High – ADL 8-12 18 RHA – Special Rehab High – ADL 1-7 19 RMC – Special Rehab Medium – ADL 15-18 20 RMB – Special Rehab Medium – ADL 8-14 21 RMA – Special Rehab Medium – ADL 4-7 22 RLB Special Rehab Low – ADL 14-18 23 RLA – Special Rehab Low – ADL 1-13 24 ES3 – Extensive Services – ADL 2-16 25 ES2 – Extensive Services – ADL 2-16 26 ES1 – Extensive Services – ADL 2-16 27 HE2 – Special Care High – ADL 15-16 28 HE1 – Special Care High – ADL 15-16 29 HD2 – Special Care High – ADL 11-14 30 HD1 – Special Care High – ADL 11-14 31 HC2 – Special Care High – ADL 6-10 32 HC1 – Special Care High – ADL 6-10 33 HB2 – Special Care High – ADL 2-5 34 HB1 – Special Care High – ADL 2-5 35 LE2 – Special Care Low - ADL 15-16 36 LE1 – Special Care Low – ADL 15-16 37 LD2 – Special Care Low – ADL 11-14 38 LD1 – Special Care Low – ADL 11-14 39 LC2 – Special Care Low – ADL 6-10 40 LC1 – Special Care Low – ADL 6-10 41 LB2 – Special Care Low – ADL 2-5 42 LB1 – Special Care Low – ADL 2-5 43 CE2 – Clinically Complex – ADL 15-16 44 CE1 – Clinically Complex – ADL 15-16 45 CD2 – Clinically Complex – ADL 11-14
Medicare RUGS IV Pricing Schedule
Effective Date: 07/22/2022 Revision: 01 Page 1 of 2
Attachment 9: Sample RUGs IV Pricing Schedule for Medicare
LINE
ITEM RUGS IV CATEGORY DESCRIPTION
Medicare Base Rate
Percentage Discount
Medicare Per Diem
Rate
Medicare RUGS IV Pricing Schedule
46 CD1 – Clinically Complex – ADL 11-14 47 CC2 – Clinically Complex – ADL 6-10 48 CC1 – Clinically Complex – ADL 6-10 49 CB2 – Clinically Complex – ADL 2-5 50 CB1 – Clinically Complex – ADL 2-5 51 CA2 – Clinically Complex – ADL 0-1 52 CA1 – Clinically Complex – ADL 0-1 53 BB2 – Behavior Symptoms – ADL 2-5 54 BB1 – Behavior Symptoms – ADL 2-5 55 BA2 – Behavior Symptoms – ADL 0-1 56 BA1 – Behavior Symptoms – ADL 0-1 57 PE2 – Physical Function Reduced – ADL 15-16 58 PE1 – Physical Function Reduced – ADL 15-16 59 PD2 – Physical Function Reduced – ADL 11-14 60 PD1 – Physical Function Reduced – ADL 11-14 61 PC2 – Physical Function Reduced – ADL 6-10 62 PC1 – Physical Function Reduced – ADL 6-10 63 PB2 – Physical Function Reduced – ADL 2-5 64 PB1 – Physical Function Reduced – ADL 2-5 65 PA2 – Physical Function Reduced – ADL 0-1 66 PA1 – Physical Function Reduced – ADL 0-1
Effective Date: 07/22/2022 Revision: 01 Page 2 of 2
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