Specifications include, but are not limited to: Evaluate Alaska’s prospective payment system for establishing nursing home rates and determine whether the system can be modified to include a component (add-on, enhancement, etc) reflecting patient acuity. • Identify the process for setting nursing home rates in at least three other states that consider acuity as a component of the rate plus have nursing facilities in rural areas. To the extent possible, the states should have characteristics similar to Alaska including low percent of Medicare patients in nursing facilities and high percent of Medicaid, very low volume facilities (under 15 beds) with high fixed costs and low variable costs. Evaluate Alaska’s prospective payment system for establishing nursing home rates and determine whether the system can be modified to include a component (add-on, enhancement, etc) reflecting patient acuity. • Identify the process for setting nursing home rates in at least three other states that consider acuity as a component of the rate plus have nursing facilities in rural areas. To the extent possible, the states should have characteristics similar to Alaska including low percent of Medicare patients in nursing facilities and high percent of Medicaid, very low volume facilities (under 15 beds) with high fixed costs and low variable costs.