Rate Setting

The Rate Setting Unit is responsible for determining adequate methods of reimbursement for departmental services provided by designated agencies. The goal is to develop rates for services that will be cost effective and affordable as well as meeting the service delivery system's needs. To achieve this goal Rate Setting staff work with Department program staff to develop and implement financial policies and procedures with regard to rate methodologies to be used to reimburse services. A partial list of other functions Rate Setting performs is:

  • Participation in policy development
  • Prepare reports for legislature
  • Analyze the impact of proposed price changes on providers, state budget, and Medicaid program
  • Assists in standardizing rates for similar services
  • Recommends new methods of reimbursement
  • Works as a resource for other agencies establishing new rates for services
  • Responsible for responding to inquiries from providers, agencies and legislatures on pricing of medical services provided by the Department to members of the Medicaid program

Service Areas of Responsibilty


MBM Policy Section Fee Schedule Rate Setter
S2 AdultFamilyCare.pdf

S3 AmbulatoryCare.pdf

Sect. 4: Ambulatory Surgical Center Svcs. 

Repealed Eff. 8/30/2012

S5 R08012010.pdf
S7 Dialysis Services.pdf
Sect. 9: Indian Health Services S9 Indian Health Svcs.pdf
S12 R09012010.pdf
S13 TargCaseMgmt.pdf

S14 R09012010.pdf

S14 CRNA Pricing.pdf

S15 Chiropractic Svcs.pdf
S17 ComSuppSvcs.pdf
S19 R09012010.pdf
S21 HomeComBen.pdf
S22 R09012010.pdf
S23 R09282010.pdf

Sect. 24:Day Hab Svcs. for Persons with

Mental Retardation     Repealed Eff. 4/1/2010

S25 Dental Svcs.pdf
S26 R09012010.pdf

Sect. 27: Early Intervention

Repealed Eff. 9/1/2010

S28 RehabCSSChild.pdf
S29 Support Svcs Adults.pdf
S30 FamilyPlanning.pdf

S31 FQHC.pdf

S31 FQHCProvider.pdf

Sect. 32 Waiver Services S32 WaiverSvcs.pdf
S35 Hearing Aids and Svcs.pdf
S40 Home Health Svcs.pdf

Sect. 41: Day Treatment Services

Repealed Eff. 7/1/2010

Sect. 43 Hospice Services S43 Hospice.pdf
S45 HospitalSvcs.pdf

S50 ICFMRSvcs.pdf

S50 FacilitySpecific.pdf

S55 Laboratory Svcs.pdf
S60 Med Supp and DME.pdf

Sect. 62: Genetic Testing & Clin. Genetic Svc.

Repealed Eff. 10/1/09


S65 BehavHealth.pdf

S67 NursFacSvcs.pdf
S68 Occupational Therapy Svcs.pdf
S75 RO9012010.pdf
S85 Physical Therapy Svcs.pdf

S90 Anesthesiology.pdf

S90 Drug Fee Schedule.pdf

S90 ACAPCP.pdf

S95 Podiatry.pdf
S96 R01092011.pdf
S97 R09012011.pdf
Sect. 97: Appendix B S97 BR011152010.pdf
Sect. 97: Appendix C S97C Appendix C.pdf
Sect. 97: Appendix D S97D 07012013.pdf
Sect. 97: Appendix E S97E R07012013.pdf

Sharon Stanley

S97F Appendix F.pdf
S101 Medical Imaging Svcs.pdf
Sect. 102: Rehabilitative Services S102R04012010.pdf
Sect. 103: Rural Health Clinic Services

S103 RHC.pdf

S103 RHCProvider.pdf

Sect. 104: School Based Rehab. Svcs.

Repealed Eff. 9/1/2010

Sect. 109: Speech and Hearing Services S109 Speech and Hearing Svcs.pdf

Sect. 150: STD Screening Svcs.

Repealed Eff. 8/30/2012