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Bill Summary · HF 4690

Summary of HF 4690 (2025-2026) – Minnesota

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

Jurisdiction: Minnesota House of Representatives

Session: 2025-2026

Author(s): Rep. Schomacker; Co-sponsors Rep. Ripper Repinski, Rep. Joe Schomacker

Introduced: March 25, 2026
Committee: Human Services Finance and Policy

Effective Date: Generally January 1, 2027 or upon federal approval, whichever is later (with several provisions specifying this timing)

1) Purpose and Intent

  • The bill modifies how nursing facility level of care (NF LOC) determinations are used for eligibility and payment purposes in several home- and community-based waivers and long-term care programs.
  • Specifically, it introduces new criteria and alignment between NF LOC determinations and eligibility for brain injury (BI) waiver and Community Access for Disability Inclusion (CADI) waivers (both under section 256B.49), and it redefines how these LOC determinations interact with state and federal payment systems.

2) Key Provisions and Changes

A. Definitions and Framework (Sec. 1)

  • Updates definitions related to the assessment process for NF LOC, including:
    • Assessment Reference Date (ARD)
    • Casemix Index, Index Maximization
    • Minimum Data Set (MDS)
    • Representative
    • Activities of Daily Living (ADLs)
    • Nursing Facility Level of Care determination
    • Patient Driven Payment Model (PDPM)
    • Resource Utilization Group (RUG)
  • Sets the context for when and how NF LOC is determined for various long-term care and waiver services.

B. Nursing Facility Level of Care Criteria (Sec. 2)

  • Amends Minnesota Statutes to specify NF LOC criteria for medical assistance payments for long-term care services (including nursing facility services under chapter 256R, elderly waiver, CADI/BI waivers, and state payments for alternative care).
  • The effective LOC criteria (subdivision 11) include seven conditions, such as:
    • Daily formal clinical monitoring needs
    • Need for assistance or constant supervision to begin and complete at least four ADLs (bathing, bed mobility, dressing, eating, grooming, toileting, transferring, walking)
    • Need for assistance to begin and complete toileting, transferring, or positioning with unscheduled assistance
    • Significant memory/decision-making/behavioral needs requiring intervention
    • Prior qualifying NF stay of at least 90 days
    • Reassessment timing criteria (90 days after admission or first quarterly assessment)
    • At-risk status based on certain assessments (e.g., living alone, risk factors like falls, maltreatment risk, sensory impairment)
  • Clarifies that the used assessment must be the most recent under subdivision 4, with timing rules relative to eligibility dates.

C. Brain Injury and CADI/BI Waiver Eligibility (Sec. 3)

  • Adds Subd. 11a establishing NF LOC criteria specific to BI and CADI/Community Access for Disability Inclusion (CADI) waivers.
  • Effective January 1, 2027 (or later with federal approval).
  • Criteria include ADL dependence with assistance or constant supervision, or significant cognitive/behavioral impairment requiring supervision or non-schedulable interventions.
  • Assessments must be conducted by a certified assessor under section 256B.0911.

D. Determination of LOC for BI and CADI/Community Inclusion Waivers (Sec. 4)

  • Amends 256B.0911, Subd. 26:
    • As of 2027 (or later with federal approval), LOC determinations for BI and CADI/CI waivers will be based on the LOC criteria in 144.0724, subdivision 11, except for determinations for BI/CADI waivers which use subdivision 11a criteria.
  • Effective date aligns with other LOC changes.

E. Waiver Eligibility Changes and Notices (Sec. 5)

  • If a BI or CADI/CI waiver recipient becomes ineligible due to LOC criteria (under 144.0724, 11a), DHS must review the person’s latest assessment to determine if they meet LOC criteria under 11.
  • If LOC criteria are met under 11 but not 11a, the department must issue a notice of action explaining waiver termination and provide information about appeal rights and alternative benefits.

F. Implementation Timeline (Sec. 6)

  • Directs DHS to implement new NF LOC criteria for BI and CADI/CI waivers.
  • For existing BI and BI-CADI participants, waiver termination based on new criteria must wait at least 90 days after reassessment that results in a LOC determination.

3) Who or What Is Affected

  • Recipients of:
    • Nursing facility-level care determinations for medical assistance
    • BI waiver and CADI/Community Access for Disability Inclusion waiver eligibility and ongoing access
    • Elderly waiver and BI/CADI-related long-term care services (as linked through NF LOC and PDPM/RUG frameworks)
  • Agencies:
    • Minnesota Department of Human Services (DHS)
    • Certified assessors (under 256B.0911) who conduct LOC determinations
  • Care providers and facilities reimbursed under new PDPM/RUG-based frameworks

4) Procedural and Timeline Highlights

  • Effective dates generally January 1, 2027, or upon federal approval, whichever is later.
  • Some provisions are effective immediately for organizational changes, while others wait for federal alignment.
  • Implementation requires reassessment processes and potential notices of action if eligibility changes, with a 90-day window for implementing changes after reassessment.

5) Practical Implications

  • Aligns NF LOC criteria with current and upcoming waiver eligibility rules, potentially changing who qualifies for BI and CADI/CI waivers.
  • Emphasizes standardized, certified assessments for certain waiver determinations.
  • Creates a structured pathway for transition between waiver eligibility and NF LOC-based eligibility, with explicit notice and appeal rights for affected individuals.

Compiled from official sources — confirm details with the bill’s official record.

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