Nursing facility level of care modification for purposes of certain home and community-based waiver services
SF 4728 revises Minnesota’s nursing facility level-of-care rules as they apply to certain Medicaid long-term care and home- and community-based waiver programs. The bill updates the statutory definition and assessment framework used to determine whether a person meets nursing facility level of care, and it ties those determinations to newer case-mix systems used in nursing facilities, including the Patient Driven Payment Model (PDPM) and the Resource Utilization Group (RUG) system during the transition period. The bill also updates the criteria for when a person qualifies for nursing facility level of care for medical assistance payment purposes, including criteria related to activities of daily living, supervision needs, cognitive/behavioral needs, prior nursing facility stays, and certain risk factors such as falls, maltreatment risk, or sensory impairment.
A major substantive change is the creation of a separate level-of-care standard for the brain injury waiver and the community access for disability inclusion (CADI) waiver. For those waivers, the bill narrows eligibility to a more specific set of nursing facility level-of-care criteria, excluding some of the broader criteria that continue to apply to other long-term care programs. The bill also directs the Department of Human Services to review prior assessments and provide notice if a person loses waiver eligibility because they meet the general nursing facility level-of-care standard but not the new waiver-specific standard. Existing participants who are affected would receive at least 90 days before termination of waiver services after reassessment.
The bill’s impact on state law is to amend Minnesota Statutes sections 144.0724 and 256B.0911, changing how nursing facility level of care is determined for Medicaid-funded nursing facility services, elderly waiver services, CADI, brain injury waiver services, and alternative care. It also adds a new subdivision specifically governing level-of-care determinations for the brain injury and CADI waivers, and it requires certified assessors to make those determinations. Most of the operational changes are scheduled to take effect January 1, 2027, or upon federal approval, whichever is later, while some administrative directions take effect the day after final enactment.
Because there are no recorded committee transcripts or votes in the provided materials, the overall sentiment cannot be measured from debate or roll call history. Based on the bill text alone, the measure appears to be a technical but consequential eligibility and assessment reform aimed at aligning state waiver rules with updated nursing facility assessment standards and clarifying transition procedures for affected recipients. The main likely point of contention is the narrowing of eligibility for the brain injury and CADI waivers, which could reduce access for some current or prospective participants even as it standardizes criteria and creates clearer notice and appeal protections.
The bill amends Minnesota’s long-term care eligibility statutes by redefining nursing facility level-of-care criteria and by separating the eligibility standard for the brain injury and CADI waivers from the broader standard used for other nursing facility and waiver programs. It affects the Department of Human Services, counties, tribes, managed care organizations, certified assessors, and Medicaid recipients seeking nursing facility, elderly waiver, CADI, brain injury waiver, or alternative care services. The bill also creates transition and notice requirements for people who may lose waiver eligibility under the new standard.
No committee discussion or vote history was provided, so there is no recorded legislative sentiment to summarize from debate or roll call. From the text, the bill appears policy-driven and administrative in tone, with an emphasis on updating assessment rules and creating transition protections. The likely support comes from those favoring clearer, more consistent eligibility standards, while concern would likely come from advocates for waiver recipients who may be newly excluded.
The most notable point of contention is the bill’s narrower nursing facility level-of-care test for the brain injury and CADI waivers, which could make some people ineligible for those home- and community-based services even if they still meet the broader nursing facility standard. Disability advocates, waiver participants, and service providers may be concerned about reduced access or service disruption, while the Department of Human Services and supporters may view the change as a needed alignment of waiver eligibility with more specific functional criteria. The bill addresses this by requiring reassessment, notice of action, appeal information, and a 90-day transition period for affected existing participants.