Nursing facility level of care modified for purposes of home and community-based waiver services.

A bill for an act

relating to human services; modifying the nursing facility level of care for purposes

of certain home and community-based waiver services; amending Minnesota

Statutes 2024, sections 144.0724, by adding a subdivision; 256B.0911, subdivision

26; Minnesota Statutes 2025 Supplement, section 144.0724, subdivisions 2, 11.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2025 Supplement, section 144.0724, subdivision 2, is

amended to read:

Subd. 2.

Definitions.

For purposes of this section, the following terms have the meanings

given.

(a) "Assessment reference date" or "ARD" means the specific end point for look-back

periods in the MDS assessment process. This look-back period is also called the observation

or assessment period.

(b) "Case mix index" means the weighting factors assigned to the case mix reimbursement

classifications determined by an assessment.

(c) "Index maximization" means classifying a resident who could be assigned to more

than one category, to the category with the highest case mix index.

(d) "Minimum Data Set" or "MDS" means a core set of screening, clinical assessment,

and functional status elements, that include common definitions and coding categories

specified by the Centers for Medicare and Medicaid Services and designated by the

Department of Health.

(e) "Representative" means a person who is the resident's guardian or conservator, the

person authorized to pay the nursing home expenses of the resident, a representative of the

Office of Ombudsman for Long-Term Care whose assistance has been requested, or any

other individual designated by the resident.

(f) "Activities of daily living" or "ADL" includes personal hygiene, dressing, bathing,

transferring, bed mobility, locomotion, eating, and toileting.

(g) "Nursing facility level of care determination" means the assessment process that

results in a determination of
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a resident's or prospective resident's
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an individual's
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need for

nursing facility level of care as established in subdivision 11
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or 11a
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for purposes of medical

assistance payment of long-term care services for:

(1) nursing facility services under chapter 256R;

(2) elderly waiver services under chapter 256S;

(3) CADI and BI waiver services under section
256B.49
; and

(4) state payment of alternative care services under section
256B.0913
.

(h) "Patient Driven Payment Model" or "PDPM" means the case mix reimbursement

classification system for residents in nursing facilities based on the resident's condition,

diagnosis, and the care the resident received at the time of the MDS assessment with an

ARD on or after October 1, 2025.

(i) "Resource utilization group" or "RUG" means the case mix reimbursement

classification system for residents in nursing facilities according to the resident's clinical

and functional status as reflected in data supplied by the facility's MDS with an ARD on or

before September 30, 2025.

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EFFECTIVE DATE.

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This section is effective January 1, 2027, or upon federal approval,

whichever is later.

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Sec. 2.

Minnesota Statutes 2025 Supplement, section 144.0724, subdivision 11, is amended

to read:

Subd. 11.

Nursing facility level of care.

(a) For purposes of medical assistance payment

of long-term care services
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specified in subdivision 2, paragraph (g), clauses (1), (2), and

(4)
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, a recipient must be determined, using assessments defined in subdivision 4, to meet

one of the following nursing facility level of care criteria:

(1) the person requires formal clinical monitoring at least once per day;

(2) the person needs the assistance of another person or constant supervision to begin

and complete at least four of the following activities of living: bathing, bed mobility, dressing,

eating, grooming, toileting, transferring, and walking;

(3) the person needs the assistance of another person or constant supervision to begin

and complete toileting, transferring, or positioning and the assistance cannot be scheduled;

(4) the person has significant difficulty with memory, using information, daily
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decision

making
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decision-making
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, or behavioral needs that require intervention;

(5) the person has had a qualifying nursing facility stay of at least 90 days;

(6) the person meets the nursing facility level of care criteria determined 90 days after

admission or on the first quarterly assessment after admission, whichever is later; or

(7) the person is determined to be at risk for nursing facility admission or readmission

through a face-to-face long-term care consultation assessment as specified in section

256B.0911, subdivision 17 to 21, 23, 24, 27, or 28, by a county, Tribe, or managed care

organization under contract with the Department of Human Services. The person is

considered at risk under this clause if the person currently lives alone or will live alone or

be homeless without the person's current housing and also meets one of the following criteria:

(i) the person has experienced a fall resulting in a fracture;

(ii) the person has been determined to be at risk of maltreatment or neglect, including

self-neglect; or

(iii) the person has a sensory impairment that substantially impacts functional ability

and maintenance of a community residence.

(b) The assessment used to establish medical assistance payment for nursing facility

services must be the most recent assessment performed under subdivision 4, paragraph (b),

that occurred no more than 90 calendar days before the effective date of medical assistance

eligibility for payment of long-term care services. In no case shall medical assistance payment

for long-term care services occur prior to the date of the determination of nursing facility

level of care.

(c) The assessment used to establish medical assistance payment for long-term care

services provided under chapter 256S
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and section
256B.49
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and alternative care payment

for services provided under section
256B.0913
must be the most recent face-to-face

assessment performed under section
256B.0911, subdivision 17 to 21, 23, 24, 27, or 28
,

that occurred no more than one calendar year before the effective date of medical assistance

eligibility for payment of long-term care services.

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EFFECTIVE DATE.

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This section is effective January 1, 2027, or upon federal approval,

whichever is later.

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Sec. 3.

Minnesota Statutes 2024, section 144.0724, is amended by adding a subdivision

to read:

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Subd. 11a.

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Determination of nursing facility level of care for the brain injury and

community access for disability inclusion waivers.

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(a) Effective January 1, 2027, or upon

federal approval, whichever is later, a person must be determined to meet one of the following

nursing facility level of care criteria to be eligible for the brain injury and community access

for disability inclusion waivers under section 256B.49:

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(1) the person needs the assistance of another person or constant supervision to begin

and complete at least four of the following activities of daily living: bathing, bed mobility,

dressing, eating, grooming, toileting, transferring, or walking;

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(2) the person needs the assistance of another person or constant supervision to begin

and complete toileting, transferring, or positioning and the assistance cannot be scheduled;

or

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(3) the person has significant difficulty with memory, using information, daily

decision-making, or behavioral needs that require the person to be constantly supervised or

require interventions that cannot be scheduled.

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(b) Nursing facility level of care determinations for purposes of initial and ongoing

access to the brain injury and community access for disability inclusion waiver programs

must be conducted by a certified assessor under section 256B.0911.

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EFFECTIVE DATE.

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This section is effective the day following final enactment.

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Sec. 4.

Minnesota Statutes 2024, section 256B.0911, subdivision 26, is amended to read:

Subd. 26.

Determination of institutional level of care.

(a) The determination of need

for hospital and intermediate care facility levels of care must be made according to criteria

developed by the commissioner, and in section
256B.092
, using forms developed by the

commissioner.

(b) The determination of need for nursing facility level of care must be made based on

criteria in section
144.0724, subdivision 11
.
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This paragraph expires upon the effective date

of paragraph (c).
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(c) Effective January 1, 2027, or upon federal approval, whichever is later, the

determination of need for nursing facility level of care must be made based on criteria in

section 144.0724, subdivision 11, except for determinations of need for nursing facility

level of care for purposes of the brain injury and community access for disability inclusion

waivers under section 256B.49. Determinations of need for nursing facility level of care

for the purposes of the brain injury and community access for disability inclusion waivers

must be made based on criteria in section 144.0724, subdivision 11a.

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EFFECTIVE DATE.

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This section is effective the day following final enactment.

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Sec. 5.
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DIRECTION TO COMMISSIONER OF HUMAN SERVICES; NOTICE

OF WAIVER ELIGIBILITY CHANGES.
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If a person who was previously eligible for either the brain injury waiver or the

community access for disability inclusion waiver is found ineligible for waiver services

under Minnesota Statutes, section 256B.0911, subdivision 26, paragraph (c), because of a

determination that the person does not meet the criteria in Minnesota Statutes, section

144.0724, subdivision 11a, the commissioner must review the person's latest assessment

under Minnesota Statutes, section 256B.0911, to determine if the person meets any of the

nursing facility level of care criteria under Minnesota Statutes, section 144.0724, subdivision

11. If the commissioner determines after the review that the person does meet the nursing

facility level of care criteria under Minnesota Statutes, section 144.0724, subdivision 11,

the commissioner must provide a notice of action that includes:

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(1) an explanation that the person's waiver services are being terminated because the

person meets a nursing facility level of care under Minnesota Statutes, section 144.0724,

subdivision 11, but not under Minnesota Statutes, section 144.0724, subdivision 11a;

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(2) a statement specifying which criterion the person met under Minnesota Statutes,

section 144.0724, subdivision 11, and that the cited criterion is no longer a basis of eligibility

for the brain injury waiver or community access for disability inclusion waiver; and

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(3) information about appeal rights and the alternative benefits options for which the

person may be eligible.

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Sec. 6.
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DIRECTION TO COMMISSIONER OF HUMAN SERVICES;

IMPLEMENTATION OF NEW NURSING FACILITY LEVEL OF CARE CRITERIA.
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For existing brain injury and community access for disability inclusion waiver

participants, the effective date of the termination of waiver services based on Minnesota

Statutes, section 256B.0911, subdivision 26, paragraph (c), must be at least 90 days after

the date of the reassessment that results in a determination that the individual no longer

meets the level of care criteria.

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