Minnesota Administrative Rules

9505.0420 LONG-TERM CARE FACILITY SERVICES.

Subpart 1.

Covered service.

Services provided to a recipient in a long-term care facility are eligible for medical assistance payment subject to the provisions in subparts 2, 3, and 4, and in parts 9505.2250 to 9505.2380, 9549.0010 to 9549.0080, and 9553.0010 to 9553.0080.

Subp. 2.

Payment limitation; skilled nursing care facility.

The medical assistance program shall pay the cost of care of a recipient who resides in a skilled nursing facility when the recipient requires:

A.

daily care ordered by the recipient's attending physician on a 24 hour basis; and one of the following:

B.

nursing care as defined in Minnesota Statutes, section 144A.01, subdivision 6, that can be safely performed only by or under the direction of a registered nurse in compliance with parts 4655.0090 to 4655.9342; or

C.

rehabilitative and therapeutic services as in part 9500.1070, subpart 13.

Subp. 3.

Payment limitation; intermediate care facility, levels I and II.

The medical assistance program shall pay the cost of care of a recipient who resides in a facility certified as an intermediate care facility, level I or II by the Department of Health when the recipient requires:

A.

daily care ordered by the recipient's attending physician to be provided in compliance with parts 4655.0090 to 4655.9342;

B.

ongoing care and services because of physical or mental limitations that can be appropriately cared for only in an intermediate care facility.

Subp. 4.

Payment limitation; intermediate care facility, developmentally disabled.

The medical assistance program shall pay the cost of care of a recipient who resides in a facility certified as an intermediate care facility for developmentally disabled persons licensed under Minnesota Statutes, sections 144.50 to 144.56, or chapter 144A and licensed for program services under parts 9525.0210 to 9525.0430 when the recipient:

A.

meets the admission criteria specified in Code of Federal Regulations, title 42, section 442.418;

B.

requires care under the management of a qualified developmental disability professional; and

C.

requires active treatment as defined in Code of Federal Regulations, title 42, section 435.1010.

Subp. 5.

Exemptions from the federal utilization control requirements.

A skilled nursing facility, an intermediate care facility, or intermediate care facility for developmentally disabled persons that is operated, listed, and certified as a Christian Science sanatorium by the First Church of Christ, Scientist, of Boston, Massachusetts, is not subject to the federal regulations for utilization control in order to receive medical assistance payments for the cost of recipient care.

Statutory Authority:

MS s 256B.04

History:

12 SR 624; L 2005 c 56 s 2; L 2013 c 59 art 3 s 21

Published Electronically:

August 1, 2013