S02 NORTH DAKOTA 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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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
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Attachment 3 Nebraska Pricing Schedule Final.pdf PDF
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CNH SOP RUGS III DESCRIPTIONS.pdf PDF
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36C26320R0126_2.docx DOCX document
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NORTH DAKOTA

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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