S02 MINNESOTA PRICING SCHEDULE - FINAL.pdf

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Attached to
Q402--VISN 23 CNH Open and Continuous Medicaid Solicitation- Period of Performance: 05 March 2021 to 04 March 2023.
Solicitation number
36C26320R0126
Issued by

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Other files

File Type Posted
Attachment 4d Nebraska Medicaid Pricing Schedule.pdf PDF
Attachment 4e North Dakota Medicaid Pricing Schedule.pdf PDF
Amended Medicaid Solicitation 36C26320R0126 A0002.pdf PDF
Attachment 4b Iowa Medicaid Pricing Schedule.pdf PDF
Attachment 4c Minnesota Medicaid Pricing Schedule.pdf PDF
Attachment 4f South Dakota Medicaid Pricing Schedule.pdf PDF
Attachment 1 Quality Assurance Surveillance Plan (QASP).pdf PDF
Attachment 4 Medicaid Pricing Schedule Information and State Schedules.pdf PDF
Attachment 3 RUGs IV and III Description.pdf PDF
Attachment 4a Illinois Medicaid Pricing Schedule.pdf PDF
Attachment 2 Wage Determination E 98 1973 0126 Rev 64 12 Dec 2020.pdf PDF
Attachment 6 South Dakota Pricing Schedule Final.pdf PDF
Attachment 10 RUGs IV Levels of Care.pdf PDF
4 May Amended Medicaid Solicitation 202136C26320R0126 0001.pdf PDF
Attachment 7 Illinois Pricing Schedule Final.pdf PDF
Attachment 5 North Dakota Pricing Schedule Final.pdf PDF
Attachment 4 Iowa Pricing Schedule Final.pdf PDF
Attachment 2 WAGE DETERMINATION E 98 DECEMBER 21 2020 19730126 Rev No 64.pdf PDF
Attachment 9 CNH SOP RUGs III Descriptions.pdf PDF
Attachment 1 QASP Medicaid Final.pdf PDF
36C26320R0126 0001_1.docx DOCX document
Attachment 8 Minnesota Pricing Schedule Final.pdf PDF
Attachment 3 Nebraska Pricing Schedule Final.pdf PDF
S02 NEBRASKA PRICING SCHEDULE - FINAL.pdf PDF
RUGs IV Levels of Care.pdf PDF
S02 NORTH DAKOTA PRICING SCHEDULE - FINAL.pdf PDF
CNH SOP RUGS III DESCRIPTIONS.pdf PDF
S02 SOUTH DAKOTA PRICING SCHEDULE - FINAL.pdf PDF
36C26320R0126_2.docx DOCX document
QASP - MEDICAID - FINAL.pdf PDF
S02 IOWA PRICING SCHEDULE - FINAL.pdf PDF
P07 WAGE DETERMINATION E98 DECEMBER 21 2020 1973 0126 Rev No 64.pdf PDF
S02 ILLINOIS PRICING SCHEDULE - FINAL.pdf PDF
S02 36C26320R0126 - MEDICAID.pdf PDF
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MINNESOTA

Medicaid Price Schedule

Classification (Medicaid RUG IV Rates) Group Medicaid Case Mix Rate (Base)

All Inclusive VA Per Diem Rate (Base + Add-on)

Rehabilitation RAE

Rehabilitation RAD

Rehabilitation RAC

Rehabilitation RAB

Rehabilitation RAA

Extensive Services Level 3 ES3

Extensive Services Level 2 ES2

Extensive Services Level 1 ES1

Special Care HIGH with Depression HE2

Special Care High with NO Depression HE1

Special Care HIGH with Depression HD2

Special Care High with NO Depression HD1

Special Care HIGH with Depression HC2

Special Care High with NO Depression HC1

Special Care HIGH with Depression HB2

Special Care High with NO Depression HB1

Special Care LOW with Depression LE2

Special Care LOW with NO Depression LE1

Special Care LOW with Depression LD2

Special Care LOW with NO Depression LD1

Special Care LOW with Depression LC2

Special Care LOW with NO Depression LC1

Special Care LOW with Depression LB2

Special Care LOW with NO Depression LB1

Clinically Complex with Depression CE2

Clinically Complex with NO Depression CE1

Clinically Complex with Depression CD2

Clinically Complex with NO Depression CD1

Clinically Complex with Depression CC2

Clinically Complex with NO Depression CC1

Clinically Complex with Depression CB2

Clinically Complex with NO Depression CB1

Clinically Complex with Depression CA2

Clinically Complex with NO Depression CA1

Behavior/Cognition with Restorative Nursing

BB2

Behavior/Cognition with NO Restorative Nursing

BB1

Behavior/Cognition with Restorative Nursing

BA2

Behavior/Cognition with NO Restorative Nursing

BA1

Reduced Function with Restorative Nursing

PE2

Reduced Function with NO Restorative Nursing

PE1

Reduced Function with Restorative Nursing

PD2

Reduced Function with NO Restorative Nursing

PD1

Reduced Function with Restorative Nursing

PC2

Reduced Function with NO Restorative Nursing

PC1

Reduced Function with Restorative Nursing

PB2

Reduced Function with NO Restorative Nursing

PB1

Reduced Function with Restorative Nursing

PA2

Reduced Function with NO Restorative Nursing

PA1

NOT

Classified

AAA

Rate Weight of 1

All Inclusive VA Per Diem Rates include the following: Drugs, Supplies, Oxygen, X-Ray, Laboratory, Physicians visits, Respiratory Therapies, and Rental Equipment

END OF SECTION

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