TRICARE Reimbursement Manual 6010.61-M, April 1, 2015 Skilled Nursing Facilities (SNFs) Chapter 8 Addendum F (FY 2018) Case-Mix Adjusted Federal Rates For Skilled Nursing Facilities (SNFs) - FY 2018 For Services Received Prior To October 1, 2019 Revision: C-44, December 13, 2019 Figure 8.F.2018-1 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: 82 FR 46166; Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2018. RUX 813.20 575.75 237.45 RUL 795.48 563.20 232.28 RVX 723.81 512.46 211.35 RVL 649.38 459.76 189.62 RHX 655.79 464.30 191.49 RHL 584.90 414.11 170.79 RMX 601.56 425.90 175.66 RML 551.94 390.77 161.17 RLX 528.30 374.04 154.26 RUC 616.50 436.48 180.02 RUB 616.50 436.48 180.02 RUA 515.49 364.97 150.52 RVC 528.88 374.45 154.43 RVB 457.99 324.26 133.73 RVA 456.22 323.00 133.22 RHC 460.85 326.28 134.57 RHB 414.78 293.66 121.12 RHA 365.16 258.53 106.63 RMC 404.86 286.64 118.22 RMB 380.05 269.08 110.97 RMA 312.71 221.40 91.31 RLB 393.63 278.69 114.94 RLA 253.63 179.57 74.06 ES3 742.43 525.64 216.79 ES2 581.17 411.47 169.70 ES1 519.15 367.56 151.59 HE2 501.43 355.01 146.42 HE1 416.37 294.79 121.58 HD2 469.53 332.43 137.10 HD1 391.56 277.22 114.34 HC2 442.95 313.61 129.34 HC1 370.29 262.17 108.12 HB2 437.63 309.84 127.79 HB1 366.75 259.66 107.09 LE2 455.35 322.39 132.96 LE1 380.92 269.69 111.23 LD2 437.63 309.84 127.79 LD1 366.75 259.66 107.09 LC2 384.47 272.20 112.27 LC1 324.22 229.55 94.67 LB2 364.97 258.40 106.57 LB1 310.04 219.51 90.53 CE2 405.73 287.26 118.47 CE1 373.84 264.68 109.16 CD2 384.47 272.20 112.27 CD1 352.57 249.62 102.95 CC2 336.62 238.33 98.29 CC1 311.81 220.76 91.05 CB2 311.81 220.76 91.05 CB1 288.77 204.45 84.32 CA2 263.96 186.88 77.08 CA1 246.24 174.34 71.90 BB2 279.91 198.18 81.73 BB1 267.51 189.40 78.11 BA2 232.07 164.31 67.76 BA1 221.43 156.77 64.66 PE2 373.84 264.68 109.16 PE1 356.11 252.13 103.98 PD2 352.57 249.62 102.95 PD1 334.85 237.07 97.78 PC2 302.95 214.49 88.46 PC1 288.77 204.45 84.32 PB2 256.88 181.87 75.01 PB1 246.24 174.34 71.90 PA2 212.57 150.50 62.07 PA1 203.71 144.23 59.48 Figure 8.F.2018-2 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: 82 FR 46168; Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2018. RUX 831.94 589.01 242.93 RUL 815.02 577.03 237.99 RVX 730.98 517.53 213.45 RVL 659.88 467.20 192.68 RHX 654.63 463.48 191.15 RHL 586.91 415.53 171.38 RMX 594.92 421.20 173.72 RML 547.52 387.64 159.88 RLX 517.81 366.61 151.20 RUC 644.03 455.97 188.06 RUB 644.03 455.97 188.06 RUA 547.54 387.66 159.88 RVC 544.76 385.69 159.07 RVB 477.04 337.74 139.30 RVA 475.35 336.55 138.80 RHC 468.41 331.63 136.78 RHB 424.40 300.48 123.92 RHA 376.99 266.91 110.08 RMC 407.00 288.16 118.84 RMB 383.30 271.38 111.92 RMA 318.97 225.83 93.14 RLB 389.15 275.52 113.63 RLA 255.41 180.83 74.58 ES3 716.95 507.60 209.35 ES2 562.89 398.53 164.36 ES1 503.64 356.58 147.06 HE2 486.71 344.59 142.12 HE1 405.45 287.06 118.39 HD2 456.24 323.02 133.22 HD1 381.75 270.28 111.47 HC2 430.85 305.04 125.81 HC1 361.44 255.90 105.54 HB2 425.77 301.45 124.32 HB1 358.05 253.50 104.55 LE2 442.70 313.43 129.27 LE1 371.60 263.09 108.51 LD2 425.77 301.45 124.32 LD1 358.05 253.50 104.55 LC2 374.98 265.49 109.49 LC1 317.42 224.73 92.69 LB2 356.36 252.30 104.06 LB1 303.88 215.15 88.73 CE2 395.30 279.87 115.43 CE1 364.83 258.30 106.53 CD2 374.98 265.49 109.49 CD1 344.51 243.91 100.60 CC2 329.27 233.12 96.15 CC1 305.57 216.34 89.23 CB2 305.57 216.34 89.23 CB1 283.57 200.77 82.80 CA2 259.87 183.99 75.88 CA1 242.94 172.00 70.94 BB2 275.10 194.77 80.33 BB1 263.25 186.38 76.87 BA2 229.39 162.41 66.98 BA1 219.24 155.22 64.02 PE2 364.83 258.30 106.53 PE1 347.90 246.31 101.59 PD2 344.51 243.91 100.60 PD1 327.58 231.93 95.65 PC2 297.11 210.35 86.76 PC1 283.57 200.77 82.80 PB2 253.09 179.19 73.90 PB1 242.94 172.00 70.94 PA2 210.77 149.23 61.54 PA1 202.31 143.24 59.07 Figure 8.F.2018-3 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: 82 FR 46164; Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2018. RUX 2.67 1.87 473.15 249.61 . . . . . . . . . . 90.44 813.20 RUL 2.57 1.87 455.43 249.61 . . . . . . . . . . 90.44 795.48 RVX 2.61 1.28 462.52 170.85 . . . . . . . . . . 90.44 723.81 RVL 2.19 1.28 388.09 170.85 . . . . . . . . . . 90.44 649.38 RHX 2.55 0.85 451.89 113.46 . . . . . . . . . . 90.44 655.79 RHL 2.15 0.85 381.00 113.46 . . . . . . . . . . 90.44 584.90 RMX 2.47 0.55 437.71 73.41 . . . . . . . . . . 90.44 601.56 RML 2.19 0.55 388.09 73.41 . . . . . . . . . . 90.44 551.94 RLX 2.26 0.28 400.49 37.37 . . . . . . . . . . 90.44 528.30 RUC 1.56 1.87 276.45 249.61 . . . . . . . . . . 90.44 616.50 RUB 1.56 1.87 276.45 249.61 . . . . . . . . . . 90.44 616.50 RUA 0.99 1.87 175.44 249.61 . . . . . . . . . . 90.44 515.49 RVC 1.51 1.28 267.59 170.85 . . . . . . . . . . 90.44 528.88 RVB 1.11 1.28 196.70 170.85 . . . . . . . . . . 90.44 457.99 RVA 1.10 1.28 194.93 170.85 . . . . . . . . . . 90.44 456.22 RHC 1.45 0.85 256.95 113.46 . . . . . . . . . . 90.44 460.85 RHB 1.19 0.85 210.88 113.46 . . . . . . . . . . 90.44 414.78 RHA 0.91 0.85 161.26 113.46 . . . . . . . . . . 90.44 365.16 RMC 1.36 0.55 241.01 73.41 . . . . . . . . . . 90.44 404.86 RMB 1.22 0.55 216.20 73.41 . . . . . . . . . . 90.44 380.05 RMA 0.84 0.55 148.86 73.41 . . . . . . . . . . 90.44 312.71 RLB 1.50 0.28 265.82 37.37 . . . . . . . . . . 90.44 393.63 RLA 0.71 0.28 125.82 37.37 . . . . . . . . . . 90.44 253.63 ES3 3.58 . . . . . . . 634.41 . . . . . . . . . . 17.58 90.44 742.43 ES2 2.67 . . . . . . . 473.15 . . . . . . . . . . 17.58 90.44 581.17 ES1 2.32 . . . . . . . 411.13 . . . . . . . . . . 17.58 90.44 519.15 HE2 2.22 . . . . . . . 393.41 . . . . . . . . . . 17.58 90.44 501.43 HE1 1.74 . . . . . . . 308.35 . . . . . . . . . . 17.58 90.44 416.37 HD2 2.04 . . . . . . . 361.51 . . . . . . . . . . 17.58 90.44 469.53 HD1 1.60 . . . . . . . 283.54 . . . . . . . . . . 17.58 90.44 391.56 HC2 1.89 . . . . . . . 334.93 . . . . . . . . . . 17.58 90.44 442.95 HC1 1.48 . . . . . . . 262.27 . . . . . . . . . . 17.58 90.44 370.29 HB2 1.86 . . . . . . . 329.61 . . . . . . . . . . 17.58 90.44 437.63 HB1 1.46 . . . . . . . 258.73 . . . . . . . . . . 17.58 90.44 366.75 LE2 1.96 . . . . . . . 347.33 . . . . . . . . . . 17.58 90.44 455.35 LE1 1.54 . . . . . . . 272.90 . . . . . . . . . . 17.58 90.44 380.92 LD2 1.86 . . . . . . . 329.61 . . . . . . . . . . 17.58 90.44 437.63 LD1 1.46 . . . . . . . 258.73 . . . . . . . . . . 17.58 90.44 366.75 LC2 1.56 . . . . . . . 276.45 . . . . . . . . . . 17.58 90.44 384.47 LC1 1.22 . . . . . . . 216.20 . . . . . . . . . . 17.58 90.44 324.22 LB2 1.45 . . . . . . . 256.95 . . . . . . . . . . 17.58 90.44 364.97 LB1 1.14 . . . . . . . 202.02 . . . . . . . . . . 17.58 90.44 310.04 CE2 1.68 . . . . . . . 297.71 . . . . . . . . . . 17.58 90.44 405.73 CE1 1.50 . . . . . . . 265.82 . . . . . . . . . . 17.58 90.44 373.84 CD2 1.56 . . . . . . . 276.45 . . . . . . . . . . 17.58 90.44 384.47 CD1 1.38 . . . . . . . 244.55 . . . . . . . . . . 17.58 90.44 352.57 CC2 1.29 . . . . . . . 228.60 . . . . . . . . . . 17.58 90.44 336.62 CC1 1.15 . . . . . . . 203.79 . . . . . . . . . . 17.58 90.44 311.81 CB2 1.15 . . . . . . . 203.79 . . . . . . . . . . 17.58 90.44 311.81 CB1 1.02 . . . . . . . 180.75 . . . . . . . . . . 17.58 90.44 288.77 CA2 0.88 . . . . . . . 155.94 . . . . . . . . . . 17.58 90.44 263.96 CA1 0.78 . . . . . . . 138.22 . . . . . . . . . . 17.58 90.44 246.24 BB2 0.97 . . . . . . . 171.89 . . . . . . . . . . 17.58 90.44 279.91 BB1 0.90 . . . . . . . 159.49 . . . . . . . . . . 17.58 90.44 267.51 BA2 0.70 . . . . . . . 124.05 . . . . . . . . . . 17.58 90.44 232.07 BA1 0.64 . . . . . . . 113.41 . . . . . . . . . . 17.58 90.44 221.43 PE2 1.50 . . . . . . . 265.82 . . . . . . . . . . 17.58 90.44 373.84 PE1 1.40 . . . . . . . 248.09 . . . . . . . . . . 17.58 90.44 356.11 PD2 1.38 . . . . . . . 244.55 . . . . . . . . . . 17.58 90.44 352.57 PD1 1.28 . . . . . . . 226.83 . . . . . . . . . . 17.58 90.44 334.85 PC2 1.10 . . . . . . . 194.93 . . . . . . . . . . 17.58 90.44 302.95 PC1 1.02 . . . . . . . 180.75 . . . . . . . . . . 17.58 90.44 288.77 PB2 0.84 . . . . . . . 148.86 . . . . . . . . . . 17.58 90.44 256.88 PB1 0.78 . . . . . . . 138.22 . . . . . . . . . . 17.58 90.44 246.24 PA2 0.59 . . . . . . . 104.55 . . . . . . . . . . 17.58 90.44 212.57 PA1 0.54 . . . . . . . 95.69 . . . . . . . . . . 17.58 90.44 203.71 Figure 8.F.2018-4 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: 82 FR 46165; Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2018. RUX 2.67 1.87 452.00 287.83 . . . . . . . . . . 92.11 831.94 RUL 2.57 1.87 435.08 287.83 . . . . . . . . . . 92.11 815.02 RVX 2.61 1.28 441.85 197.02 . . . . . . . . . . 92.11 730.98 RVL 2.19 1.28 370.75 197.02 . . . . . . . . . . 92.11 659.88 RHX 2.55 0.85 431.69 130.83 . . . . . . . . . . 92.11 654.63 RHL 2.15 0.85 363.97 130.83 . . . . . . . . . . 92.11 586.91 RMX 2.47 0.55 418.15 84.66 . . . . . . . . . . 92.11 594.92 RML 2.19 0.55 370.75 84.66 . . . . . . . . . . 92.11 547.52 RLX 2.26 0.28 382.60 43.10 . . . . . . . . . . 92.11 517.81 RUC 1.56 1.87 264.09 287.83 . . . . . . . . . . 92.11 644.03 RUB 1.56 1.87 264.09 287.83 . . . . . . . . . . 92.11 644.03 RUA 0.99 1.87 167.60 287.83 . . . . . . . . . . 92.11 547.54 RVC 1.51 1.28 255.63 197.02 . . . . . . . . . . 92.11 544.76 RVB 1.11 1.28 187.91 197.02 . . . . . . . . . . 92.11 477.04 RVA 1.10 1.28 186.22 197.02 . . . . . . . . . . 92.11 475.35 RHC 1.45 0.85 245.47 130.83 . . . . . . . . . . 92.11 468.41 RHB 1.19 0.85 201.46 130.83 . . . . . . . . . . 92.11 424.40 RHA 0.91 0.85 154.05 130.83 . . . . . . . . . . 92.11 376.99 RMC 1.36 0.55 230.23 84.66 . . . . . . . . . . 92.11 407.00 RMB 1.22 0.55 206.53 84.66 . . . . . . . . . . 92.11 383.30 RMA 0.84 0.55 142.20 84.66 . . . . . . . . . . 92.11 318.97 RLB 1.50 0.28 253.94 43.10 . . . . . . . . . . 92.11 389.15 RLA 0.71 0.28 120.20 43.10 . . . . . . . . . . 92.11 255.41 ES3 3.58 . . . . . . . 606.06 . . . . . . . . . . 18.78 92.11 716.95 ES2 2.67 . . . . . . . 452.00 . . . . . . . . . . 18.78 92.11 562.89 ES1 2.32 . . . . . . . 392.75 . . . . . . . . . . 18.78 92.11 503.64 HE2 2.22 . . . . . . . 375.82 . . . . . . . . . . 18.78 92.11 486.71 HE1 1.74 . . . . . . . 294.56 . . . . . . . . . . 18.78 92.11 405.45 HD2 2.04 . . . . . . . 345.35 . . . . . . . . . . 18.78 92.11 456.24 HD1 1.60 . . . . . . . 270.86 . . . . . . . . . . 18.78 92.11 381.75 HC2 1.89 . . . . . . . 319.96 . . . . . . . . . . 18.78 92.11 430.85 HC1 1.48 . . . . . . . 250.55 . . . . . . . . . . 18.78 92.11 361.44 HB2 1.86 . . . . . . . 314.88 . . . . . . . . . . 18.78 92.11 425.77 HB1 1.46 . . . . . . . 247.16 . . . . . . . . . . 18.78 92.11 358.05 LE2 1.96 . . . . . . . 331.81 . . . . . . . . . . 18.78 92.11 442.70 LE1 1.54 . . . . . . . 260.71 . . . . . . . . . . 18.78 92.11 371.60 LD2 1.86 . . . . . . . 314.88 . . . . . . . . . . 18.78 92.11 425.77 LD1 1.46 . . . . . . . 247.16 . . . . . . . . . . 18.78 92.11 358.05 LC2 1.56 . . . . . . . 264.09 . . . . . . . . . . 18.78 92.11 374.98 LC1 1.22 . . . . . . . 206.53 . . . . . . . . . . 18.78 92.11 317.42 LB2 1.45 . . . . . . . 245.47 . . . . . . . . . . 18.78 92.11 356.36 LB1 1.14 . . . . . . . 192.99 . . . . . . . . . . 18.78 92.11 303.88 CE2 1.68 . . . . . . . 284.41 . . . . . . . . . . 18.78 92.11 395.30 CE1 1.50 . . . . . . . 253.94 . . . . . . . . . . 18.78 92.11 364.83 CD2 1.56 . . . . . . . 264.09 . . . . . . . . . . 18.78 92.11 374.98 CD1 1.38 . . . . . . . 233.62 . . . . . . . . . . 18.78 92.11 344.51 CC2 1.29 . . . . . . . 218.38 . . . . . . . . . . 18.78 92.11 329.27 CC1 1.15 . . . . . . . 194.68 . . . . . . . . . . 18.78 92.11 305.57 CB2 1.15 . . . . . . . 194.68 . . . . . . . . . . 18.78 92.11 305.57 CB1 1.02 . . . . . . . 172.68 . . . . . . . . . . 18.78 92.11 283.57 CA2 0.88 . . . . . . . 148.98 . . . . . . . . . . 18.78 92.11 259.87 CA1 0.78 . . . . . . . 132.05 . . . . . . . . . . 18.78 92.11 242.94 BB2 0.97 . . . . . . . 164.21 . . . . . . . . . . 18.78 92.11 275.10 BB1 0.90 . . . . . . . 152.36 . . . . . . . . . . 18.78 92.11 263.25 BA2 0.70 . . . . . . . 118.50 . . . . . . . . . . 18.78 92.11 229.39 BA1 0.64 . . . . . . . 108.35 . . . . . . . . . . 18.78 92.11 219.24 PE2 1.50 . . . . . . . 253.94 . . . . . . . . . . 18.78 92.11 364.83 PE1 1.40 . . . . . . . 237.01 . . . . . . . . . . 18.78 92.11 347.90 PD2 1.38 . . . . . . . 233.62 . . . . . . . . . . 18.78 92.11 344.51 PD1 1.28 . . . . . . . 216.69 . . . . . . . . . . 18.78 92.11 327.58 PC2 1.10 . . . . . . . 186.22 . . . . . . . . . . 18.78 92.11 297.11 PC1 1.02 . . . . . . . 172.68 . . . . . . . . . . 18.78 92.11 283.57 PB2 0.84 . . . . . . . 142.20 . . . . . . . . . . 18.78 92.11 253.09 PB1 0.78 . . . . . . . 132.05 . . . . . . . . . . 18.78 92.11 242.94 PA2 0.59 . . . . . . . 99.88 . . . . . . . . . . 18.78 92.11 210.77 PA1 0.54 . . . . . . . 91.42 . . . . . . . . . . 18.78 92.11 202.31 - END -