<b data-path-to-node=”11,0,0″ data-index-in-node=”0″>Severity/Auity-Based Tiering: Does your state utilize a tiered reimbursement structure for specific service categories (e.g., private duty nursing, behavioral health, long-term services and supports, or specialized outpatient care) where payment rates scale based on the patient’s clinical complexity, functional limitations, or intensive care needs? If so, what assessment tools or modifiers determine these tiers?

<b data-path-to-node=”11,1,0″ data-index-in-node=”0″>Age-Based Tiering: Do your fee schedules differentiate reimbursement rates for identical procedure codes based strictly on the beneficiary’s age (e.g., enhanced pediatric rates vs. standard adult rates, or specialized geriatric care tiers)?

<b data-path-to-node=”11,2,0″ data-index-in-node=”0″>Managed Care Alignment: If your state utilizes a Managed Care Organization (MCO) model, does the state mandate these specific tiered reimbursement structures within MCO provider contracts, or are they restricted to Fee-for-Service (FFS) populations?

<b data-path-to-node=”11,3,0″ data-index-in-node=”0″>Supporting Documentation: Please provide links to or copies of your state’s current provider billing manuals, fee schedules, or administrative rules that outline these specific tiered frameworks.