TRICARE Reimbursement Manual 6010.61-M, April 1, 2015 Skilled Nursing Facilities (SNFs) Chapter 8 Addendum D (FY 2017) Case-Mix Adjusted Federal Rates For Skilled Nursing Facilities (SNFs) - FY 2017 Revision: C-2, May 17, 2017 Figure 8.D.2017-1 Case-Mix Adjusted Federal Rates For Urban SNFs By Labor And Non-Labor Component (RUG-66 Rates) RUG-IV Category Total rate Labor Portion Non-Labor Portion Source: 81 FR 51981; Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2017. RUX 804.36 553.40 250.96 RUL 786.83 541.34 245.49 RVX 715.94 492.57 223.37 RVL 642.32 441.92 200.40 RHX 648.65 446.27 202.38 RHL 578.54 398.04 180.50 RMX 595.02 409.37 185.65 RML 545.94 375.61 170.33 RLX 522.56 359.52 163.04 RUC 609.80 419.54 190.26 RUB 609.80 419.54 190.26 RUA 509.89 350.80 159.09 RVC 523.13 359.91 163.22 RVB 453.02 311.68 141.34 RVA 451.27 310.47 140.80 RHC 455.85 313.62 142.23 RHB 410.27 282.27 128.00 RHA 361.19 248.50 112.69 RMC 400.46 275.52 124.94 RMB 375.92 258.63 117.29 RMA 309.32 212.81 96.51 RLB 389.35 267.87 121.48 RLA 250.88 172.61 78.27 ES3 734.35 505.23 229.12 ES2 574.85 395.50 179.35 ES1 513.50 353.29 160.21 HE2 495.97 341.23 154.74 HE1 411.84 283.35 128.49 HD2 464.42 319.52 144.90 HD1 387.30 266.46 120.84 HC2 438.13 301.43 136.70 HC1 366.26 251.99 114.27 HB2 432.87 297.81 135.06 HB1 362.76 249.58 113.18 LE2 450.40 309.88 140.52 LE1 376.78 259.22 117.56 LD2 432.87 297.81 135.06 LD1 362.76 249.58 113.18 LC2 380.29 261.64 118.65 LC1 320.69 220.63 100.06 LB2 361.01 248.37 112.64 LB1 306.67 210.99 95.68 CE2 401.32 276.11 125.21 CE1 369.77 254.40 115.37 CD2 380.29 261.64 118.65 CD1 348.74 239.93 108.81 CC2 332.96 229.08 103.88 CC1 308.42 212.19 96.23 CB2 308.42 212.19 96.23 CB1 285.64 196.52 89.12 CA2 261.10 179.64 81.46 CA1 243.57 167.58 75.99 BB2 276.87 190.49 86.38 BB1 264.60 182.04 82.56 BA2 229.55 157.93 71.62 BA1 219.03 150.69 68.34 PE2 369.77 254.40 115.37 PE1 352.24 242.34 109.90 PD2 348.74 239.93 108.81 PD1 331.21 227.87 103.34 PC2 299.66 206.17 93.49 PC1 285.64 196.52 89.12 PB2 254.09 174.81 79.28 PB1 243.57 167.58 75.99 PA2 210.27 144.67 65.60 PA1 201.50 138.63 62.87 Figure 8.D.2017-2 Case-Mix Adjusted Federal Rates For Rural SNFs By Labor And Non-Labor Component (RUG-66 Rates) RUG-IV Category Total rate Labor Portion Non-Labor Portion Source: 81 FR 51982; Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2017. RUX 822.89 566.15 256.74 RUL 806.15 554.63 251.52 RVX 723.02 497.44 225.58 RVL 652.70 449.06 203.64 RHX 647.51 445.49 202.02 RHL 580.53 399.40 181.13 RMX 588.44 404.85 183.59 RML 541.56 372.59 168.97 RLX 512.18 352.38 159.80 RUC 637.02 438.27 198.75 RUB 637.02 438.27 198.75 RUA 541.58 372.61 168.97 RVC 538.83 370.72 168.11 RVB 471.85 324.63 147.22 RVA 470.18 323.48 146.70 RHC 463.31 318.76 144.55 RHB 419.78 288.81 130.97 RHA 372.89 256.55 116.34 RMC 402.57 276.97 125.60 RMB 379.13 260.84 118.29 RMA 315.50 217.06 98.44 RLB 384.92 264.82 120.10 RLA 252.63 173.81 78.82 ES3 709.16 487.90 221.26 ES2 556.78 383.06 173.72 ES1 498.17 342.74 155.43 HE2 481.43 331.22 150.21 HE1 401.05 275.92 125.13 HD2 451.29 310.49 140.80 HD1 377.61 259.80 117.81 HC2 426.17 293.20 132.97 HC1 357.52 245.97 111.55 HB2 421.15 289.75 131.40 HB1 354.17 243.67 110.50 LE2 437.89 301.27 136.62 LE1 367.56 252.88 114.68 LD2 421.15 289.75 131.40 LD1 354.17 243.67 110.50 LC2 370.91 255.19 115.72 LC1 313.98 216.02 97.96 LB2 352.49 242.51 109.98 LB1 300.58 206.80 93.78 CE2 391.01 269.01 122.00 CE1 360.87 248.28 112.59 CD2 370.91 255.19 115.72 CD1 340.77 234.45 106.32 CC2 325.70 224.08 101.62 CC1 302.26 207.95 94.31 CB2 302.26 207.95 94.31 CB1 280.49 192.98 87.51 CA2 257.05 176.85 80.20 CA1 240.30 165.33 74.97 BB2 272.12 187.22 84.90 BB1 260.40 179.16 81.24 BA2 226.91 156.11 70.80 BA1 216.86 149.20 67.66 PE2 360.87 248.28 112.59 PE1 344.12 236.75 107.37 PD2 340.77 234.45 106.32 PD1 324.03 222.93 101.10 PC2 293.89 202.20 91.69 PC1 280.49 192.98 87.51 PB2 250.35 172.24 78.11 PB1 240.30 165.33 74.97 PA2 208.49 143.44 65.05 PA1 200.11 137.68 62.43 Figure 8.D.2017-3 Case-Mix Adjusted Federal Rates And Associated Indexes - Urban (RUG-66 Rates) RUG-iv Category Nursing Index Therapy Index Nursing Component Therapy Component Non-Case Mix Therapy Component Non-Case Mix Component Total Rate Source: 81 FR 51976; Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2017. RUX 2.67 1.87 468.00 246.90 . . . . . . . . . . 89.46 804.36 RUL 2.57 1.87 450.47 246.90 . . . . . . . . . . 89.46 786.83 RVX 2.61 1.28 457.48 169.00 . . . . . . . . . . 89.46 715.94 RVL 2.19 1.28 383.86 169.00 . . . . . . . . . . 89.46 642.32 RHX 2.55 0.85 446.96 112.23 . . . . . . . . . . 89.46 648.65 RHL 2.15 0.85 376.85 112.23 . . . . . . . . . . 89.46 578.54 RMX 2.47 0.55 432.94 72.62 . . . . . . . . . . 89.46 595.02 RML 2.19 0.55 383.86 72.62 . . . . . . . . . . 89.46 545.94 RLX 2.26 0.28 396.13 36.97 . . . . . . . . . . 89.46 522.56 RUC 1.56 1.87 273.44 246.90 . . . . . . . . . . 89.46 609.80 RUB 1.56 1.87 273.44 246.90 . . . . . . . . . . 89.46 609.80 RUA 0.99 1.87 173.53 246.90 . . . . . . . . . . 89.46 509.89 RVC 1.51 1.28 264.67 169.00 . . . . . . . . . . 89.46 523.13 RVB 1.11 1.28 194.56 169.00 . . . . . . . . . . 89.46 453.02 RVA 1.10 1.28 192.81 169.00 . . . . . . . . . . 89.46 451.27 RHC 1.45 0.85 254.16 112.23 . . . . . . . . . . 89.46 455.85 RHB 1.19 0.85 208.58 112.23 . . . . . . . . . . 89.46 410.27 RHA 0.91 0.85 159.50 112.23 . . . . . . . . . . 89.46 361.19 RMC 1.36 0.55 238.38 72.62 . . . . . . . . . . 89.46 400.46 RMB 1.22 0.55 213.84 72.62 . . . . . . . . . . 89.46 375.92 RMA 0.84 0.55 147.24 72.62 . . . . . . . . . . 89.46 309.32 RLB 1.50 0.28 262.92 36.97 . . . . . . . . . . 89.46 389.35 RLA 0.71 0.28 124.45 36.97 . . . . . . . . . . 89.46 250.88 ES3 3.58 . . . . . . . 627.50 . . . . . . . . . . 17.39 89.46 734.35 ES2 2.67 . . . . . . . 468.00 . . . . . . . . . . 17.39 89.46 574.85 ES1 2.32 . . . . . . . 406.65 . . . . . . . . . . 17.39 89.46 513.50 HE2 2.22 . . . . . . . 389.12 . . . . . . . . . . 17.39 89.46 495.97 HE1 1.74 . . . . . . . 304.99 . . . . . . . . . . 17.39 89.46 411.84 HD2 2.04 . . . . . . . 357.57 . . . . . . . . . . 17.39 89.46 464.42 HD1 1.60 . . . . . . . 280.45 . . . . . . . . . . 17.39 89.46 387.30 HC2 1.89 . . . . . . . 331.28 . . . . . . . . . . 17.39 89.46 438.13 HC1 1.48 . . . . . . . 259.41 . . . . . . . . . . 17.39 89.46 366.26 HB2 1.86 . . . . . . . 326.02 . . . . . . . . . . 17.39 89.46 432.87 HB1 1.46 . . . . . . . 255.91 . . . . . . . . . . 17.39 89.46 362.76 LE2 1.96 . . . . . . . 343.55 . . . . . . . . . . 17.39 89.46 450.40 LE1 1.54 . . . . . . . 269.93 . . . . . . . . . . 17.39 89.46 376.78 LD2 1.86 . . . . . . . 326.02 . . . . . . . . . . 17.39 89.46 432.87 LD1 1.46 . . . . . . . 255.91 . . . . . . . . . . 17.39 89.46 362.76 LC2 1.56 . . . . . . . 273.44 . . . . . . . . . . 17.39 89.46 380.29 LC1 1.22 . . . . . . . 213.84 . . . . . . . . . . 17.39 89.46 320.69 LB2 1.45 . . . . . . . 254.16 . . . . . . . . . . 17.39 89.46 361.01 LB1 1.14 . . . . . . . 199.82 . . . . . . . . . . 17.39 89.46 306.67 CE2 1.68 . . . . . . . 294.47 . . . . . . . . . . 17.39 89.46 401.32 CE1 1.50 . . . . . . . 262.92 . . . . . . . . . . 17.39 89.46 369.77 CD2 1.56 . . . . . . . 273.44 . . . . . . . . . . 17.39 89.46 380.29 CD1 1.38 . . . . . . . 241.89 . . . . . . . . . . 17.39 89.46 348.74 CC2 1.29 . . . . . . . 226.11 . . . . . . . . . . 17.39 89.46 332.96 CC1 1.15 . . . . . . . 201.57 . . . . . . . . . . 17.39 89.46 308.42 CB2 1.15 . . . . . . . 201.57 . . . . . . . . . . 17.39 89.46 308.42 CB1 1.02 . . . . . . . 178.79 . . . . . . . . . . 17.39 89.46 285.64 CA2 0.88 . . . . . . . 154.25 . . . . . . . . . . 17.39 89.46 261.10 CA1 0.78 . . . . . . . 136.72 . . . . . . . . . . 17.39 89.46 243.57 BB2 0.97 . . . . . . . 170.02 . . . . . . . . . . 17.39 89.46 276.87 BB1 0.90 . . . . . . . 157.75 . . . . . . . . . . 17.39 89.46 264.60 BA2 0.70 . . . . . . . 122.70 . . . . . . . . . . 17.39 89.46 229.55 BA1 0.64 . . . . . . . 112.18 . . . . . . . . . . 17.39 89.46 219.03 PE2 1.50 . . . . . . . 262.92 . . . . . . . . . . 17.39 89.46 369.77 PE1 1.40 . . . . . . . 245.39 . . . . . . . . . . 17.39 89.46 352.24 PD2 1.38 . . . . . . . 241.89 . . . . . . . . . . 17.39 89.46 348.74 PD1 1.28 . . . . . . . 224.36 . . . . . . . . . . 17.39 89.46 331.21 PC2 1.10 . . . . . . . 192.81 . . . . . . . . . . 17.39 89.46 299.66 PC1 1.02 . . . . . . . 178.79 . . . . . . . . . . 17.39 89.46 285.64 PB2 0.84 . . . . . . . 147.24 . . . . . . . . . . 17.39 89.46 254.09 PB1 0.78 . . . . . . . 136.72 . . . . . . . . . . 17.39 89.46 243.57 PA2 0.59 . . . . . . . 103.42 . . . . . . . . . . 17.39 89.46 210.27 PA1 0.54 . . . . . . . 94.65 . . . . . . . . . . 17.39 89.46 201.50 Figure 8.D.2017-4 Case-Mix Adjusted Federal Rates And Associated Indexes - Rural (RUG-66 Rates) RUG-iv Category Nursing Index Therapy Index Nursing Component Therapy Component Non-Case Mix Therapy Component Non-Case Mix Component Total Rate Source: 81 FR 51977; Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2017. RUX 2.67 1.87 447.09 284.69 . . . . . . . . . . 91.11 822.89 RUL 2.57 1.87 430.35 284.69 . . . . . . . . . . 91.11 806.15 RVX 2.61 1.28 437.04 194.87 . . . . . . . . . . 91.11 723.02 RVL 2.19 1.28 366.72 194.87 . . . . . . . . . . 91.11 652.70 RHX 2.55 0.85 427.00 129.40 . . . . . . . . . . 91.11 647.51 RHL 2.15 0.85 360.02 129.40 . . . . . . . . . . 91.11 580.53 RMX 2.47 0.55 413.60 83.73 . . . . . . . . . . 91.11 588.44 RML 2.19 0.55 366.72 83.73 . . . . . . . . . . 91.11 541.56 RLX 2.26 0.28 378.44 42.63 . . . . . . . . . . 91.11 512.18 RUC 1.56 1.87 261.22 284.69 . . . . . . . . . . 91.11 637.02 RUB 1.56 1.87 261.22 284.69 . . . . . . . . . . 91.11 637.02 RUA 0.99 1.87 165.78 284.69 . . . . . . . . . . 91.11 541.58 RVC 1.51 1.28 252.85 194.87 . . . . . . . . . . 91.11 538.83 RVB 1.11 1.28 185.87 194.87 . . . . . . . . . . 91.11 471.85 RVA 1.10 1.28 184.20 194.87 . . . . . . . . . . 91.11 470.18 RHC 1.45 0.85 242.80 129.40 . . . . . . . . . . 91.11 463.31 RHB 1.19 0.85 199.27 129.40 . . . . . . . . . . 91.11 419.78 RHA 0.91 0.85 152.38 129.40 . . . . . . . . . . 91.11 372.89 RMC 1.36 0.55 227.73 83.73 . . . . . . . . . . 91.11 402.57 RMB 1.22 0.55 204.29 83.73 . . . . . . . . . . 91.11 379.13 RMA 0.84 0.55 140.66 83.73 . . . . . . . . . . 91.11 315.50 RLB 1.50 0.28 251.18 42.63 . . . . . . . . . . 91.11 384.92 RLA 0.71 0.28 118.89 42.63 . . . . . . . . . . 91.11 252.63 ES3 3.58 . . . . . . . 599.47 . . . . . . . . . . 18.58 91.11 709.16 ES2 2.67 . . . . . . . 447.09 . . . . . . . . . . 18.58 91.11 556.78 ES1 2.32 . . . . . . . 388.48 . . . . . . . . . . 18.58 91.11 498.17 HE2 2.22 . . . . . . . 371.74 . . . . . . . . . . 18.58 91.11 481.43 HE1 1.74 . . . . . . . 291.36 . . . . . . . . . . 18.58 91.11 401.05 HD2 2.04 . . . . . . . 341.60 . . . . . . . . . . 18.58 91.11 451.29 HD1 1.60 . . . . . . . 267.92 . . . . . . . . . . 18.58 91.11 377.61 HC2 1.89 . . . . . . . 316.48 . . . . . . . . . . 18.58 91.11 426.17 HC1 1.48 . . . . . . . 247.83 . . . . . . . . . . 18.58 91.11 357.52 HB2 1.86 . . . . . . . 311.46 . . . . . . . . . . 18.58 91.11 421.15 HB1 1.46 . . . . . . . 244.48 . . . . . . . . . . 18.58 91.11 354.17 LE2 1.96 . . . . . . . 328.20 . . . . . . . . . . 18.58 91.11 437.89 LE1 1.54 . . . . . . . 257.87 . . . . . . . . . . 18.58 91.11 367.56 LD2 1.86 . . . . . . . 311.46 . . . . . . . . . . 18.58 91.11 421.15 LD1 1.46 . . . . . . . 244.48 . . . . . . . . . . 18.58 91.11 354.17 LC2 1.56 . . . . . . . 261.22 . . . . . . . . . . 18.58 91.11 370.91 LC1 1.22 . . . . . . . 204.29 . . . . . . . . . . 18.58 91.11 313.98 LB2 1.45 . . . . . . . 242.80 . . . . . . . . . . 18.58 91.11 352.49 LB1 1.14 . . . . . . . 190.89 . . . . . . . . . . 18.58 91.11 300.58 CE2 1.68 . . . . . . . 281.32 . . . . . . . . . . 18.58 91.11 391.01 CE1 1.50 . . . . . . . 251.18 . . . . . . . . . . 18.58 91.11 360.87 CD2 1.56 . . . . . . . 261.22 . . . . . . . . . . 18.58 91.11 370.91 CD1 1.38 . . . . . . . 231.08 . . . . . . . . . . 18.58 91.11 340.77 CC2 1.29 . . . . . . . 216.01 . . . . . . . . . . 18.58 91.11 325.70 CC1 1.15 . . . . . . . 192.57 . . . . . . . . . . 18.58 91.11 302.26 CB2 1.15 . . . . . . . 192.57 . . . . . . . . . . 18.58 91.11 302.26 CB1 1.02 . . . . . . . 170.80 . . . . . . . . . . 18.58 91.11 280.49 CA2 0.88 . . . . . . . 147.36 . . . . . . . . . . 18.58 91.11 257.05 CA1 0.78 . . . . . . . 130.61 . . . . . . . . . . 18.58 91.11 240.30 BB2 0.97 . . . . . . . 162.43 . . . . . . . . . . 18.58 91.11 272.12 BB1 0.90 . . . . . . . 150.71 . . . . . . . . . . 18.58 91.11 260.40 BA2 0.70 . . . . . . . 117.22 . . . . . . . . . . 18.58 91.11 226.91 BA1 0.64 . . . . . . . 107.17 . . . . . . . . . . 18.58 91.11 216.86 PE2 1.50 . . . . . . . 251.18 . . . . . . . . . . 18.58 91.11 360.87 PE1 1.40 . . . . . . . 234.43 . . . . . . . . . . 18.58 91.11 344.12 PD2 1.38 . . . . . . . 231.08 . . . . . . . . . . 18.58 91.11 340.77 PD1 1.28 . . . . . . . 214.34 . . . . . . . . . . 18.58 91.11 324.03 PC2 1.10 . . . . . . . 184.20 . . . . . . . . . . 18.58 91.11 293.89 PC1 1.02 . . . . . . . 170.80 . . . . . . . . . . 18.58 91.11 280.49 PB2 0.84 . . . . . . . 140.66 . . . . . . . . . . 18.58 91.11 250.35 PB1 0.78 . . . . . . . 130.61 . . . . . . . . . . 18.58 91.11 240.30 PA2 0.59 . . . . . . . 98.80 . . . . . . . . . . 18.58 91.11 208.49 PA1 0.54 . . . . . . . 90.42 . . . . . . . . . . 18.58 91.11 200.11 - END -