Modification of Nursing Facility Level of Care (NF LOC) criteria

NF LOC and ECS to be implemented January 1, 2015

The Department of Human Services will implement the revised Nursing Facility Level of Care (NF LOC) criteria and the Essential Community Supports (ECS) program January 1, 2015. These revised criteria are found in MN Statutes 144.0724, Subd. 11.

NF LOC criteria

In 2009, the Minnesota Legislature passed legislation that changes nursing facility level of care (NF LOC) criteria for public payment of long-term care. This change affects the most independent people who would receive publicly-funded nursing facility services or publicly-funded long-term care services in the community through programs such as Elderly Waiver (EW), Alternative Care (AC), and Community Alternatives for Disabled Individuals (CADI). The legislation also provides an alternative for some individuals 65 years or older whose eligibility for Medical Assistance or Alternative Care is affected.

Why was the NF LOC criteria modified?

This change is important to:

  • • Provide more consistent access to services
  • • Address Minnesota’s aging demographics and manage growth in public spending for long term care
  • • Support service sustainability
  • • Improve the ability of lead agencies to assess individuals, monitor programs, evaluate outcomes and assess the impact of public spending.
  • What services and programs are affected?

    The NF LOC criteria apply to:

  • • Medical Assistance (MA) payment for nursing home services
  • • Public payment for home and community-based service programs that provide alternatives to nursing home services. These programs include the state-funded Alternative Care (AC) program for people age 65 and older, and the MA-funded Elderly Waiver (EW), Community Alternatives for Disabled Individuals (CADI), and Brain Injury – NF (BI-NF) programs.
  • What are the NF LOC criteria?

    To meet the criteria, an individual must be assessed for at least one of the following:

    1. A high ADL need:

  • • Need for assistance in four or more ADLS; or
  • • Need for assistance that cannot be scheduled in toileting, transferring, or positioning;
    OR
  • 2. An ongoing clinical need

  • • Need for clinical monitoring at least once a day
    OR
  • 3. A cognitive impairment or behavioral needs as indicated by significant difficulty with:

  • • Memory; or
  • • Using information; or
  • • Daily decision-making; or
  • • Behavior needs that require at least occasional intervention
    OR
  • 4. At institutional risk

  • • A qualifying NF admission of at least 90 days; or
  • • The person lives alone, or would live alone or be homeless without their housing type AND at least one of the following risk factors is also present, as determined by a face-to-face Long Term Care Consultation assessment as specified in MN Statute, section 256B.0911, subdivisions 3a, 3b or 4d:
  • 1) The person has experienced a fall resulting in a fracture, or
    2) The person has been determined to be at risk of maltreatment or neglect, including self-neglect, or
    3) The person has a sensory impairment that substantially impacts functional ability and maintenance of a community residence

    When will this change be implemented?

    The Department of Human Services will implement the revised Nursing Facility Level of Care (NF LOC) criteria and the Essential Community Supports (ECS) program January 1, 2015. These revised criteria are found in MN Statutes 144.0724, Subd. 11.

    What is the Essential Community Supports program?

    The Essential Community Supports (ECS) program provides alternatives for people 65 years or older whose eligibility for Medical Assistance or Alternative Care is affected by the change in NF LOC.

    ECS also provides alternative services for people who were on a waiver program as of January 1, 2015 and subsequently lose eligibility for MA payment of waiver services due to not meeting the NF LOC criteria at their next assessment on or after January 1, 2015.

    External Stakeholder Workgroup

    DHS has convened an External Stakeholder Workgroup to provide input on specific aspects of the implementation of the new NF LOC criteria and the ECS program. Selected members were chosen by solicitation through the HCBS Partners Panel.

    Workgroup members / Workgroup Role

    Communications Plan

    Communications plan - July 2013 (PDF)

    More Resources

    Bulletins
    Bulletin 14-25-10
    - NF LOC Criteria Changing January 1, 2015 - Nursing Facilities & Residents
    Bulletin 14-25-09
    - NF LOC Criteria Changing January 1, 2015 - Update and Legislative Changes

    Meeting Information:

    Workgroup meetings

    First Workgroup meeting - December 16, 2009
    Second Workgroup meeting - February 19, 2010

    Third Workgroup meeting - June 11, 2010

    External Stakeholders Workgroup Meeting - November 7, 2011

    Questions & Answers

    Q & A's document - July 2013 (PDF)

    Next meeting:

    December 8, 2014 - DHS Lafayette Building, 9:00 a.m. - 12:00 p.m.

    E-mail any questions or comments to dhs.nfloc@state.mn.us

    NF LOC Training Schedule

    Nursing Facility Level of Care training has been set up. Currently on the schedule you will find videoconferences, external trainings, and links to archived sessions.


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