Nursing Home Care Criteria

Anyone seeking admission to a medicaid certified nursing facility in Minnesota must receive a pre-admission screening to determine the need for a nursing facility level of care.

The Minnesota State Legislature amended the nursing home facility level of care criteria recently. The new changes take effect January 1, 2015.

The person must meet one of the following nursing home care criteria:

1. The person requires formal clinical monitoring at least once a day;
2. The person needs the assistance of another person or a 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 a 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 decision making 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 assessment. The person is considered to be at risk if the person currently lives alone or will live alone upon discharge or be homeless without the person’s current housing, and also meets one of the following criteria:
8. The person has experienced a fall resulting in a fracture;
9. The person has been determined to be at risk of maltreatment or neglect, including self neglect; or
10. The person has a sensory impairment that substantially impacts functional ability and maintenance of a community residence.

In no case shall medical assistance payments for long term care services occur prior to the date of the determination of nursing facility level of care. On the other hand, the assessment must have occurred no more than 90 calendar days before the effective date of medical assistance eligibility for payment of long term care services.

It is possible for a person to appeal a nursing facility level of care determination.