S02 IOWA PRICING SCHEDULE - FINAL.pdf
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- 36C26320R0126
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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:
IOWA RUGS III CLINS
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