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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) |
| 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
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