6-2017

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Resource Utilization Group (RUG) Individual Plan of Care (IPC) Cost Limits

RUG Criteria IPC Cost Limit
SE3 Extensive Services 3 / ADL > 6 $42,174
SE2 Extensive Services 2 / ADL > 6 $35,985
SE1 Extensive Services 1 / ADL > 6 $31,403
RAD Rehabilitation All Levels / ADL 17-18 $35,505
RAC Rehabilitation All Levels / ADL 14-16 $31,500
RAB Rehabilitation All Levels / ADL 10-13 $29,656
RAA Rehabilitation All Levels / ADL 4-9 $26,223
SSC Special Care / ADL 17-18 $30,697
SSB Special Care / ADL 15-16 $29,085
SSA Special Care / ADL 4-14 $29,023
CC2 Clinically Complex with Depression / ADL 17-18 $25,291
CC1 Clinically Complex / ADL 17-18 $24,019
CB2 Clinically Complex with Depression / ADL 12-16 $23,298
CB1 Clinically Complex / ADL 12-16 $22,300
CA2 Clinically Complex with Depression / ADL 4-11 $21,230
CA1 Clinically Complex / ADL 4-11 $20,029
IB2 Cog. Impairment with Nursing Rehab / ADL 6-10 $21,261
IB1 Cog. Impairment / ADL 6-10 $19,902
IA2 Cog. Impairment with Nursing Rehab / ADL 4-5 $18,277
IA1 Cog. Impairment / ADL 4-5 $17,396
BB2 Behavior Problem with Nursing Rehab / ADL 6-10 $20,898
BB1 Behavior Problem / ADL 6-10 $19,026
BA2 Behavior Problem with Nursing Rehab / ADL 4-5 $17,956
BA1 Behavior Problem / ADL 4-5 $16,361
PE2 Physical Function with Nursing Rehab / ADL 16-18 $22,413
PE1 Physical Function / ADL 16-18 $21,254
PD2 Physical Function with Nursing Rehab / ADL 11-15 $21,537
PD1 Physical Function / ADL 11-15 $20,336
PC2 Physical Function with Nursing Rehab / ADL 9-10 $19,829
PC1 Physical Function / ADL 9-10 $19,062
PB2 Physical Function with Nursing Rehab / ADL 6-8 $18,589
PB1 Physical Function / ADL 6-8 $17,746
PA2 Physical Function with Nursing Rehab / ADL 4-5 $16,715
PA1 Physical Function / ADL 4-5 $15,837

 

Shared Appendix 25

This appendix appears in the following handbooks:

STAR Kids Handbook (SKH): Appendix VIII
STAR Kids Program Support Unit Operational Procedures Handbook (SKOPH): Appendix VIII