SF 4728
Introduction - 94th Legislature (2025 - 2026)
Posted on 03/24/2026 10:57 a.m.
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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 deleted text begin a resident's or prospective resident'sdeleted text end new text begin an individual'snew text end need for
nursing facility level of care as established in subdivision 11 new text begin or 11a new text end 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.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2027, or upon federal approval,
whichever is later.
new text end
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 servicesnew text begin specified in subdivision 2, paragraph (g), clauses (1), (2), and
(4)new text end , 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 deleted text begin decision
makingdeleted text end new text begin decision-makingnew text end , 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 deleted text begin and section 256B.49deleted text end 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.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2027, or upon federal approval,
whichever is later.
new text end
Sec. 3.
Minnesota Statutes 2024, section 144.0724, is amended by adding a subdivision
to read:
new text begin Subd. 11a. new text end
new text begin
Determination of nursing facility level of care for the brain injury and
community access for disability inclusion waivers.
new text end
new text begin
(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:
new text end
new text begin
(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;
new text end
new text begin
(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
new text end
new text begin
(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.
new text end
new text begin
(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.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
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.new text begin This paragraph expires upon the effective date
of paragraph (c).
new text end
new text begin
(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.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 5. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; NOTICE
OF WAIVER ELIGIBILITY CHANGES.
new text end
new text begin
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:
new text end
new text begin
(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;
new text end
new text begin
(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
new text end
new text begin
(3) information about appeal rights and the alternative benefits options for which the
person may be eligible.
new text end
Sec. 6. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES;
IMPLEMENTATION OF NEW NURSING FACILITY LEVEL OF CARE CRITERIA.
new text end
new text begin
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.
new text end