VA263-17-R-1094-0003006.docx

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VA263-17-R-1094 0003 VA263-17-R-1094 North Dakota Pricing Schedule - Medicaid Amended.docx

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NORTH DAKOTA

Medicaid Price Schedule 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
DDF

Gero-Psych Unit - Special Care Unit (if applicable)

GP1

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