9-2025
Resource Utilization Group (RUG) Individual Plan of Care (IPC) Cost Limits
Assessment submitted on or before Aug. 31, 2025
| 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 |
Patient Driven Payment Model Long Term Care (PDPM LTC) Level Annual MDCP Cost Limits
Assessment submitted on or after Sept. 1, 2025
| PDPM Group | PDPM Group Base Rate | Weighted Liability Insurance | Total Daily Rate | Annual MDCP Cost Limit (50%) |
|---|---|---|---|---|
| B1X | $192.91 | $1.67 | $194.58 | $35,510 |
| B1Y | $205.07 | $1.67 | $206.74 | $37,729 |
| B2X | $185.86 | $1.67 | $187.53 | $34,224 |
| B2Y | $198.02 | $1.67 | $199.69 | $36,443 |
| B3X | $182.85 | $1.67 | $184.52 | $33,674 |
| B3Y | $195.01 | $1.67 | $196.68 | $35,893 |
| C1X | $211.47 | $1.67 | $213.14 | $38,899 |
| C1Y | $223.63 | $1.67 | $225.30 | $41,118 |
| C2X | $204.42 | $1.67 | $206.09 | $37,612 |
| C2Y | $216.58 | $1.67 | $218.25 | $39,831 |
| C3X | $201.41 | $1.67 | $203.08 | $37,063 |
| C3Y | $213.57 | $1.67 | $215.24 | $39,282 |
| E1X | $405.33 | $1.67 | $407.00 | $74,278 |
| E1Y | $417.49 | $1.67 | $419.16 | $76,497 |
| E2X | $364.07 | $1.67 | $365.74 | $66,748 |
| E2Y | $376.23 | $1.67 | $377.90 | $68,967 |
| E3X | $333.50 | $1.67 | $335.17 | $61,169 |
| E3Y | $345.66 | $1.67 | $347.33 | $63,388 |
| H1X | $244.34 | $1.67 | $246.01 | $44,897 |
| H1Y | $256.50 | $1.67 | $258.17 | $47,116 |
| H2X | $237.29 | $1.67 | $238.96 | $43,610 |
| H2Y | $249.45 | $1.67 | $251.12 | $45,830 |
| H3X | $234.28 | $1.67 | $235.95 | $43,061 |
| H3Y | $246.44 | $1.67 | $248.11 | $45,280 |
| L1X | $218.90 | $1.67 | $220.57 | $40,253 |
| L1Y | $231.06 | $1.67 | $232.73 | $42,473 |
| L2X | $211.85 | $1.67 | $213.52 | $38,967 |
| L2Y | $224.01 | $1.67 | $225.68 | $41,186 |
| L3X | $208.84 | $1.67 | $210.51 | $38,417 |
| L3Y | $221.00 | $1.67 | $222.67 | $40,637 |
| P1X | $174.30 | $1.67 | $175.97 | $32,115 |
| P1Y | $186.46 | $1.67 | $188.13 | $34,334 |
| P2X | $167.25 | $1.67 | $168.92 | $30,828 |
| P2Y | $179.41 | $1.67 | $181.08 | $33,047 |
| P3X | $164.24 | $1.67 | $165.91 | $30,279 |
| P3Y | $176.40 | $1.67 | $178.07 | $32,498 |